Non-compliance. It’s a word we hear a lot in the world of T1D. But what does it mean? How can we teach our children to be compliant when it comes to their care? Whether it’s not testing blood sugar, not counting carbs, or not giving themselves insulin, non-compliance can be dangerous. So what can we as parents do to help guide our children to care for their diabetes without becoming overbearing and nagging?
There are many reasons for non-compliance, especially in the teen years. And most of them are innocent enough. Maybe your son is embarrassed about having to check his blood sugar in front of his friends while they can just chow down. Maybe your daughter forgets because she has other things on her mind. They could be experiencing burn out and simply not feel like dealing with diabetes at the moment. Whatever the reason, the 24 hour plan might help steer them back toward taking control of their diabetes.
The 24 Hour Plan
By: Cami Corley Tepper, T1D Mom
Even though my son had been allowed to eat or do anything since dx and was taught to be independent, at about 14 he became neglectful with his d care. Not defiant, but teen slackness to the point of being considered non-compliant. So our endo, who is also t1, introduced us to what we call the 24 hour plan.
I credit it for getting us through the teen roller coaster and getting us to his now 18 year old independent, confident self with a great A1C. He’s not perfect, don’t get me wrong, but it got us through. It made him feel in control of his life and in charge of my involvement. It helped us not feel like nags or failures.
How the 24 Hour Plan Works
First, our endo sat down with him and they came up with the minimum things he needed to do for diabetes. (I thought they were pretty loose). NOT for perfection, not forever, not for a perfect A1C, but the minimum things to be average healthy. They negotiated and the endo gave pump settings accordingly. Each item that wasn’t ideal, the endo would tell him so he knew what would one day be expected. In other words, he would say instead of the usual testing “x” amount of times – you could test a minimum of “x”, which is not ideal but safe. Then I had to agree to the 24 hour plan.
For 24 hours, I could not mention d unless it was an emergency (not just seeing him make a mistake but a true medical emergency). I could not nag, remind, ask questions, give kind suggestions – NOTHING! Unless he asked me. 24 hours was manageable and also a short enough time to avoid a huge emergency if he wasn’t complying.
At end of 24 hours, we sat down and I could ask anything, go through his meter- whatever. If he met the minimum then we continued for 24 hours and met again. If he did not meet the minimum, I got 24 hours to do as I pleased—nag, ask, go through his meter, talk about d, etc. Then after 24 hours of that, we would start fresh. And this continues. He met with his endo every 2 months during this time.
Here is What Happened
It took one week for him to decide he liked me out of his business. He hated the nagging days. So he continued the minimums until we were meeting once a week. If he violated during that week we went back to 24 hours. He loved the times “off” as he called it. He said he felt like he didn’t have d because he was treating it and moving on without my bringing it up all time.
Next, after a few weeks, he noticed he FELT better. So at his first meeting with the endo, we had a progress report and the endo said, “ok, would you like to feel even better?” He said yes. So they talked about adding a few more things gradually. And same at the next appointments. By doing this slowly with his input, calling it minimums, and not expecting all our perfection, he developed good habits slowly and felt in control.
Now he is 18, rocking a great A1C, compliant and totally in control of his d life unless he asks me. At endo appointments, I get to ask questions, voice concerns etc. I don’t know if this is for everyone or if every endo would be on board but it changed our life and set him up for success. It definitely got us through teen years and kept him healthy for the most part —but most of all it kept him compliant, no burnout, and helped him develop good habits. We don’t need this rule anymore and he’s agreeable to tweak whatever to feel great and have good “control” but he knows there is this option out there and he would be fine.
Do you have any T1D tips for the teen years? Let us know in the comment section. And don’t forget to follow Carb Counting Mama on Facebook!