The teenage years bring many changes. As you move through junior high and high school, you may find new friends, challenging classes, different sports or clubs, and more social events. You are doing more things away from your family. You're starting to face new challenges in handling your diabetes.
You may start seeing your health-care team on your own, without your parents. You'll take charge of talking about diabetes and other personal matters with your doctor. You will also decide whether to tell new friends and new teachers that you have diabetes.
As you try to talk about your diabetes with other people, two qualities will help you: self-esteem and assertiveness. Having self-esteem means valuing yourself and feeling confident. Being assertive means being clear and direct about what you want.
Talking to the Health-Care Team
Jan visited the doctor last week for her 3-month check-up. She'd begun field hockey after school and her doctor advised her to eat a bigger snack to avoid low blood glucose during practice.
Jan nodded. But inside, she knew she couldn't eat more. She wanted to lose weight. She remembered telling the doctor about her goal last visit. He had forgotten. Jan was annoyed. But she didn't speak up. Instead, she walked out of the doctor's office and kept her snack as small as always. And she kept getting low blood glucose.
If Jan been more assertive she would have said, "I really want to lose weight. It's important to me." Her doctor might have found a way to help her add more activities after school, stay with her weight loss program, and still keep her diabetes under control. This would have made her feel a lot better and would have improved her relationship with her health-care providers.
Your Health-Care Team Needs You
Whether you like it or not, your health-care team relies on you. They need you to supply information that no one else has. Without your honest answers, your doctor will have a tough time figuring out the best way for you to manage your diabetes.
If you try to hide mistakes or problems by fiddling with your blood glucose numbers or by simply being silent, you are working against your doctor and your own best health care.
Self-Esteem
Sometimes it's hard to keep your self-esteem high when you are having trouble managing your diabetes. You want your doctor to see you at your best. You may feel embarrassed, or worry that the doctor will think you haven't followed his or her advice. You may get tired of telling other people about your personal problems. You may be afraid that your questions are stupid.
But most doctors know how tough it is to manage diabetes day after day. They won't blame you for problems, because when you bring problems out into the open, you let your health-care team know you want help.
Tell yourself that there is no such thing as a stupid question. Your questions show your doctor that you want to find the best way to manage your diabetes. You may come up with an idea that never occurred to the doctor, because only you know your lifestyle.
Together, you may be able to find some answers. Doctors know that the more you agree with a treatment, the more likely you are to stick with it. Remember, you are an equal member of your health-care team.
Assertiveness
Maybe you feel confident inside, but you find it tough to be direct and open with your health-care team. Try learning to communicate better. Doctors should be aware of your needs, but don't expect them to read your mind. They may be too busy or hurried to pick up on silent messages of anger or annoyance, so speak up.
First, be specific. It's not enough to make a casual comment like, "I'm going on the road with the football team this weekend." Ask what you want to know. "I'm going on the road with the football team this weekend. How should I handle the hectic eating schedule?"
Second, prepare for your visit. Before your appointment, look over your blood glucose test records. If you find patterns, make a note. Bring your blood glucose records to your appointment. You can talk about them with your doctor. (If you find serious problems, call your doctor to get back on track as soon as possible.)
Write down your questions and have them handy during the visit. It's easy to get flustered and forget what you wanted to discuss. Writing down your doctor's answers can also help.
If you don't understand, ask your doctor to explain again. If you forget something important, make a follow-up phone call. Despite your best efforts, you might get confused or think of one more question. A diabetes educator in your doctor's office may be able to help.
Is This Confidential?
Some questions are hard to ask. You may have questions about birth control, pregnancy, or alcohol and drugs. If you feel embarrassed, you might start by saying, "Doctor, this is hard to talk about, but...."
Some teens keep questions to themselves because they worry about privacy. If you want to know whether your conversation will stay just between the doctor and you, ask your doctor's views on confidentiality. Many states honour confidentiality between a doctor and a minor (a person under the age of 18 still living at home) if the minor is mature enough to understand the treatment the doctor may suggest.
All states allow health-care professionals to give some kinds of medical care without parents' permission. This may include testing or treatment for sexually transmitted diseases and information on birth control.
If privacy is important to you, tell your doctor you'd rather not talk about certain parts of your life unless you are certain the discussion will stay confidential.
If your doctor can't promise confidentiality, ask if he or she can give you the name of another doctor who will.
When It Doesn't Work
It's important to be at ease with your doctor so you can have an open, honest relationship. Sometimes, no matter how hard you and your doctor try, you just don't click. Your personalities may not mesh, or you may want to see a doctor of your own sex. You might want to switch from a pediatrician to a doctor who treats adults.
If you are not pleased with your doctor, talk to your parents. You may be able to find another diabetes specialist who will better suit your needs. If you have a specific problem, your insurance may pay for a second opinion.
Whatever you do, don't just stop seeing the doctor or go on being unhappy without taking action. Building a good relationship with your health-care team is well worth the effort. Your health depends on it.
"I Have D..."
Dealing with your health-care team on your own is a big step. So is deciding who should know that you have diabetes. When you make new friends, the choice to tell or not to tell is yours. Think about the pros and cons of telling people.
Secrets.
Telling your friends that you have diabetes frees you from the burden of carrying a secret. You can stop hiding your blood glucose testing supplies. You can tell people why you may turn down birthday cake or midnight snacks.
It's tough to keep a secret from your friends. You are always on guard against letting anything slip. And if close friends find out you haven't been open, they may find it hard to trust you again.
Sharing.
Telling something personal about yourself is a gift. It says, "I like you. I trust you. You are important to me." There's a closeness that comes from talking about something serious and personal.
You may find your friends looking at you with new respect. They will see you handling a difficult situation every day of your life, one they may think they couldn't handle at all.
And because diabetes affects millions of people, telling others means you're likely to run into someone else who either has diabetes or has a relative who does.
On your part, you can tell a lot about someone by how they react to your news. Some will ignore it and others will seem more curious than you like. But you'll also find friends of both sexes who will continue to see you as a whole person -- a person who happens to have diabetes.
Safety.
If you tell your friends, you can teach them how to help you if you ever have a serious insulin reaction. They can learn to offer you some juice if you get confused, and even to administer a shot of glucagon if you pass out.
Strange looks.
There could be a down side to revealing your diabetes. Some people will ignore your news and others will seem more curious than you'd like. Most friends will support you, but some will see you as different. You can take steps to reassure people that they can't "catch" diabetes. But if they keep freezing you out, it can hurt. It's hard to think clearly when you're hurting. But later on, you might admit that the friendship wasn't what you needed, anyway. If you can admit that, try to think about the fact that your friend's response doesn't reflect on you. Instead, it shows your friend's immaturity.
Who To Tell
You may choose to tell everyone you get to know. That way, any friend you're with will be able to tell you to take a piece of candy because you're not sounding clear or get help for you if you need it.
You don't have to worry about keeping secrets. But you may want to tell only a select few -- your closest friends and perhaps a certain teacher.
It might seem as if teachers are the last people to open up to about your personal life. You only see them a few hours a day and know them only a few years at most.
But there are good reasons to tell your teachers about your diabetes. They can give you advance permission to snack during class, sip an orange juice, put your head down, or leave the room for a few minutes.
If you've explained the symptoms to a teacher, you'll have someone in authority watching out for you. Your teacher may notice if you seem shaky or confused.
If you are into sports, you can see why the coach or gym teachers should know. You won't have to explain running off the field suddenly -- even in the middle of a game -- for a snack or juice. You can feel free to test during a game or adjust your insulin and snack schedule. Your coach could even work with you and your doctor to improve your diabetes management.
Whether you tell any teacher or not, you need to have your medical history on file with the school, either with the nurse or in the general student files. That way, if anything happens during school hours, your record will explain what's wrong, what doctor to call, and who else to notify.
Telling
If you decide to tell others, be prepared to answer their questions. Reassure them that they can't get diabetes from you. Let them know the symptoms of a reaction and what to do if they spot them.
Tell them that you keep your diabetes under control with insulin, frequent testing, exercise, and diet. Emergencies are not likely to happen. And, if they ask, tell them that you're not on some weird diet. The way you eat is good for everyone.
Your friends, teachers, and health-care team will probably be impressed with you for having the confidence to talk about your diabetes. You will be showing those two all-important qualities: self-esteem and assertiveness. You show them that you feel good about yourself, even with diabetes.
Friends and Self-Esteem
When we value ourselves, people around us tend to think well of us, too. When you tell others about your diabetes, they will take their cues from you. If you're matter of fact, they will be too. If you make diabetes seem like something embarrassing that should be hidden, they will most likely see it that way too. A few things can help you keep your self-esteem high:
* Staying with a good plan of diabetes control. Remember to take your insulin, eat healthy foods, and exercise regularly. Good self-care shows you value yourself.
* Giving yourself a compliment -- or even a gift -- when you do these things.
* Remembering something you do well, whether it's a sport, an art, a hobby, or schoolwork.
Of course, everyone gets a little down sometimes. Maybe your blood glucose levels are too high for a couple of days. Having supportive family and friends can help cheer you up. This is another reason to let friends know about your condition -- they will be able to help you through difficult times.
Getting What You Want
Being assertive will also help you deal with diabetes and social situations. Learning to assert yourself can help you move from feeling trapped to feeling in control of friendships and diabetes.
Here's an example. Mary asked a boy from her English class out to see a movie. That was pretty assertive. But she was embarrassed to tell him that pizza at 10 p.m. didn't fit in with her meal plan. In fact, she wasn't ready to tell him about having diabetes at all.
So she ignored the problem. She went out and had pizza and a diet drink. When she got home, she tested her blood glucose. It was sky high. The date was great, but now she felt guilty. Why should she have to choose between doing what's right for her health and fitting in?
Now, imagine a more assertive Mary. Same problem: that 10 p.m. pizza doesn't fit with her meal plan. Is there a way to be assertive without spoiling everything?
What does Mary want? She needs to keep her blood glucose under good control because she wants to feel her best. She also wants to have a good time on this date and not be different. She wants this guy to like her. She doesn't want to seem weird.
She has two choices. She can be open about her diabetes. She can tell him that she can't eat pizza at 10 p.m. and explain why. She can let him know she still wants to hang out with him, but she'll just be drinking a diet soda.
She can also be open with her health-care team or a parent. She figures she'll be facing this problem again and again. It might be a good idea to see if there is a way to work a late night snack into her diabetes care plan. She doesn't feel ready to open up about her diabetes to this guy yet. She talks with her dietician. They work out a way for her to eat a small slice of pizza as her evening snack.
Either way, Mary's assertiveness helped her get what she wanted: a good date and good diabetes control.
Becoming an Adult
As you grow older, you will learn new skills for handling your diabetes at home, at school, with friends, and at the doctor's office. The learning will be a lifelong process. Again and again, you will call on your assertiveness and self-esteem. They will help you with your diabetes care and with the many other important parts of your life.
Basic Skills
Most people have to learn how to assert themselves. If you're interested, here are some basic skills:
Learn to Say No
* Expect people to accept "no" for an answer.
* Repeat it, if you need to.
* If someone won't accept "no," you can suggest alternatives. But it's not your job to come up with other options, just because you're saying "no"
* You can explain why you're saying "no" Keep it short and don't apologize. You have a good reason for refusing.
Value Yourself
* Show you value yourself by making diabetes care important.
* Know that your health needs are as important as any needs of the other person.
Watch Your Language
Practice saying what you need in an assertive way. Here are some examples:
Passive: "I have to. . ."
Assertive: "I want to. . ." or "I'm going to. ."
Passive: "I can't" or "I don't have time to"
Assertive: "I'd rather not" or "I don't want to"
Passive: "I hope you'll" or "I don't suppose you'd"
Assertive: "I'd like you to"
Keep It Courteous
Courtesy means that you will treat others' needs with the respect that you want from them. You can be courteous and firm at the same time.
You may start seeing your health-care team on your own, without your parents. You'll take charge of talking about diabetes and other personal matters with your doctor. You will also decide whether to tell new friends and new teachers that you have diabetes.
As you try to talk about your diabetes with other people, two qualities will help you: self-esteem and assertiveness. Having self-esteem means valuing yourself and feeling confident. Being assertive means being clear and direct about what you want.
Talking to the Health-Care Team
Jan visited the doctor last week for her 3-month check-up. She'd begun field hockey after school and her doctor advised her to eat a bigger snack to avoid low blood glucose during practice.
Jan nodded. But inside, she knew she couldn't eat more. She wanted to lose weight. She remembered telling the doctor about her goal last visit. He had forgotten. Jan was annoyed. But she didn't speak up. Instead, she walked out of the doctor's office and kept her snack as small as always. And she kept getting low blood glucose.
If Jan been more assertive she would have said, "I really want to lose weight. It's important to me." Her doctor might have found a way to help her add more activities after school, stay with her weight loss program, and still keep her diabetes under control. This would have made her feel a lot better and would have improved her relationship with her health-care providers.
Your Health-Care Team Needs You
Whether you like it or not, your health-care team relies on you. They need you to supply information that no one else has. Without your honest answers, your doctor will have a tough time figuring out the best way for you to manage your diabetes.
If you try to hide mistakes or problems by fiddling with your blood glucose numbers or by simply being silent, you are working against your doctor and your own best health care.
Self-Esteem
Sometimes it's hard to keep your self-esteem high when you are having trouble managing your diabetes. You want your doctor to see you at your best. You may feel embarrassed, or worry that the doctor will think you haven't followed his or her advice. You may get tired of telling other people about your personal problems. You may be afraid that your questions are stupid.
But most doctors know how tough it is to manage diabetes day after day. They won't blame you for problems, because when you bring problems out into the open, you let your health-care team know you want help.
Tell yourself that there is no such thing as a stupid question. Your questions show your doctor that you want to find the best way to manage your diabetes. You may come up with an idea that never occurred to the doctor, because only you know your lifestyle.
Together, you may be able to find some answers. Doctors know that the more you agree with a treatment, the more likely you are to stick with it. Remember, you are an equal member of your health-care team.
Assertiveness
Maybe you feel confident inside, but you find it tough to be direct and open with your health-care team. Try learning to communicate better. Doctors should be aware of your needs, but don't expect them to read your mind. They may be too busy or hurried to pick up on silent messages of anger or annoyance, so speak up.
First, be specific. It's not enough to make a casual comment like, "I'm going on the road with the football team this weekend." Ask what you want to know. "I'm going on the road with the football team this weekend. How should I handle the hectic eating schedule?"
Second, prepare for your visit. Before your appointment, look over your blood glucose test records. If you find patterns, make a note. Bring your blood glucose records to your appointment. You can talk about them with your doctor. (If you find serious problems, call your doctor to get back on track as soon as possible.)
Write down your questions and have them handy during the visit. It's easy to get flustered and forget what you wanted to discuss. Writing down your doctor's answers can also help.
If you don't understand, ask your doctor to explain again. If you forget something important, make a follow-up phone call. Despite your best efforts, you might get confused or think of one more question. A diabetes educator in your doctor's office may be able to help.
Is This Confidential?
Some questions are hard to ask. You may have questions about birth control, pregnancy, or alcohol and drugs. If you feel embarrassed, you might start by saying, "Doctor, this is hard to talk about, but...."
Some teens keep questions to themselves because they worry about privacy. If you want to know whether your conversation will stay just between the doctor and you, ask your doctor's views on confidentiality. Many states honour confidentiality between a doctor and a minor (a person under the age of 18 still living at home) if the minor is mature enough to understand the treatment the doctor may suggest.
All states allow health-care professionals to give some kinds of medical care without parents' permission. This may include testing or treatment for sexually transmitted diseases and information on birth control.
If privacy is important to you, tell your doctor you'd rather not talk about certain parts of your life unless you are certain the discussion will stay confidential.
If your doctor can't promise confidentiality, ask if he or she can give you the name of another doctor who will.
When It Doesn't Work
It's important to be at ease with your doctor so you can have an open, honest relationship. Sometimes, no matter how hard you and your doctor try, you just don't click. Your personalities may not mesh, or you may want to see a doctor of your own sex. You might want to switch from a pediatrician to a doctor who treats adults.
If you are not pleased with your doctor, talk to your parents. You may be able to find another diabetes specialist who will better suit your needs. If you have a specific problem, your insurance may pay for a second opinion.
Whatever you do, don't just stop seeing the doctor or go on being unhappy without taking action. Building a good relationship with your health-care team is well worth the effort. Your health depends on it.
"I Have D..."
Dealing with your health-care team on your own is a big step. So is deciding who should know that you have diabetes. When you make new friends, the choice to tell or not to tell is yours. Think about the pros and cons of telling people.
Telling your friends that you have diabetes frees you from the burden of carrying a secret. You can stop hiding your blood glucose testing supplies. You can tell people why you may turn down birthday cake or midnight snacks.
It's tough to keep a secret from your friends. You are always on guard against letting anything slip. And if close friends find out you haven't been open, they may find it hard to trust you again.
Telling something personal about yourself is a gift. It says, "I like you. I trust you. You are important to me." There's a closeness that comes from talking about something serious and personal.
You may find your friends looking at you with new respect. They will see you handling a difficult situation every day of your life, one they may think they couldn't handle at all.
And because diabetes affects millions of people, telling others means you're likely to run into someone else who either has diabetes or has a relative who does.
On your part, you can tell a lot about someone by how they react to your news. Some will ignore it and others will seem more curious than you like. But you'll also find friends of both sexes who will continue to see you as a whole person -- a person who happens to have diabetes.
If you tell your friends, you can teach them how to help you if you ever have a serious insulin reaction. They can learn to offer you some juice if you get confused, and even to administer a shot of glucagon if you pass out.
There could be a down side to revealing your diabetes. Some people will ignore your news and others will seem more curious than you'd like. Most friends will support you, but some will see you as different. You can take steps to reassure people that they can't "catch" diabetes. But if they keep freezing you out, it can hurt. It's hard to think clearly when you're hurting. But later on, you might admit that the friendship wasn't what you needed, anyway. If you can admit that, try to think about the fact that your friend's response doesn't reflect on you. Instead, it shows your friend's immaturity.
Who To Tell
You may choose to tell everyone you get to know. That way, any friend you're with will be able to tell you to take a piece of candy because you're not sounding clear or get help for you if you need it.
You don't have to worry about keeping secrets. But you may want to tell only a select few -- your closest friends and perhaps a certain teacher.
It might seem as if teachers are the last people to open up to about your personal life. You only see them a few hours a day and know them only a few years at most.
But there are good reasons to tell your teachers about your diabetes. They can give you advance permission to snack during class, sip an orange juice, put your head down, or leave the room for a few minutes.
If you've explained the symptoms to a teacher, you'll have someone in authority watching out for you. Your teacher may notice if you seem shaky or confused.
If you are into sports, you can see why the coach or gym teachers should know. You won't have to explain running off the field suddenly -- even in the middle of a game -- for a snack or juice. You can feel free to test during a game or adjust your insulin and snack schedule. Your coach could even work with you and your doctor to improve your diabetes management.
Whether you tell any teacher or not, you need to have your medical history on file with the school, either with the nurse or in the general student files. That way, if anything happens during school hours, your record will explain what's wrong, what doctor to call, and who else to notify.
Telling
If you decide to tell others, be prepared to answer their questions. Reassure them that they can't get diabetes from you. Let them know the symptoms of a reaction and what to do if they spot them.
Tell them that you keep your diabetes under control with insulin, frequent testing, exercise, and diet. Emergencies are not likely to happen. And, if they ask, tell them that you're not on some weird diet. The way you eat is good for everyone.
Your friends, teachers, and health-care team will probably be impressed with you for having the confidence to talk about your diabetes. You will be showing those two all-important qualities: self-esteem and assertiveness. You show them that you feel good about yourself, even with diabetes.
Friends and Self-Esteem
When we value ourselves, people around us tend to think well of us, too. When you tell others about your diabetes, they will take their cues from you. If you're matter of fact, they will be too. If you make diabetes seem like something embarrassing that should be hidden, they will most likely see it that way too. A few things can help you keep your self-esteem high:
* Staying with a good plan of diabetes control. Remember to take your insulin, eat healthy foods, and exercise regularly. Good self-care shows you value yourself.
* Giving yourself a compliment -- or even a gift -- when you do these things.
* Remembering something you do well, whether it's a sport, an art, a hobby, or schoolwork.
Of course, everyone gets a little down sometimes. Maybe your blood glucose levels are too high for a couple of days. Having supportive family and friends can help cheer you up. This is another reason to let friends know about your condition -- they will be able to help you through difficult times.
Getting What You Want
Being assertive will also help you deal with diabetes and social situations. Learning to assert yourself can help you move from feeling trapped to feeling in control of friendships and diabetes.
Here's an example. Mary asked a boy from her English class out to see a movie. That was pretty assertive. But she was embarrassed to tell him that pizza at 10 p.m. didn't fit in with her meal plan. In fact, she wasn't ready to tell him about having diabetes at all.
So she ignored the problem. She went out and had pizza and a diet drink. When she got home, she tested her blood glucose. It was sky high. The date was great, but now she felt guilty. Why should she have to choose between doing what's right for her health and fitting in?
Now, imagine a more assertive Mary. Same problem: that 10 p.m. pizza doesn't fit with her meal plan. Is there a way to be assertive without spoiling everything?
What does Mary want? She needs to keep her blood glucose under good control because she wants to feel her best. She also wants to have a good time on this date and not be different. She wants this guy to like her. She doesn't want to seem weird.
She has two choices. She can be open about her diabetes. She can tell him that she can't eat pizza at 10 p.m. and explain why. She can let him know she still wants to hang out with him, but she'll just be drinking a diet soda.
She can also be open with her health-care team or a parent. She figures she'll be facing this problem again and again. It might be a good idea to see if there is a way to work a late night snack into her diabetes care plan. She doesn't feel ready to open up about her diabetes to this guy yet. She talks with her dietician. They work out a way for her to eat a small slice of pizza as her evening snack.
Either way, Mary's assertiveness helped her get what she wanted: a good date and good diabetes control.
Becoming an Adult
As you grow older, you will learn new skills for handling your diabetes at home, at school, with friends, and at the doctor's office. The learning will be a lifelong process. Again and again, you will call on your assertiveness and self-esteem. They will help you with your diabetes care and with the many other important parts of your life.
Basic Skills
Most people have to learn how to assert themselves. If you're interested, here are some basic skills:
Learn to Say No
* Expect people to accept "no" for an answer.
* Repeat it, if you need to.
* If someone won't accept "no," you can suggest alternatives. But it's not your job to come up with other options, just because you're saying "no"
* You can explain why you're saying "no" Keep it short and don't apologize. You have a good reason for refusing.
Value Yourself
* Show you value yourself by making diabetes care important.
* Know that your health needs are as important as any needs of the other person.
Watch Your Language
Practice saying what you need in an assertive way. Here are some examples:
Passive: "I have to. . ."
Assertive: "I want to. . ." or "I'm going to. ."
Passive: "I can't" or "I don't have time to"
Assertive: "I'd rather not" or "I don't want to"
Passive: "I hope you'll" or "I don't suppose you'd"
Assertive: "I'd like you to"
Keep It Courteous
Courtesy means that you will treat others' needs with the respect that you want from them. You can be courteous and firm at the same time.
