ColumnsLiving with Type 1 Diabetes

Why Teens with Type 1 Should Consider Psychotherapy

Over coffee, I and a group of other D-mothers started sharing stories of our teens with Type 1. Two of the moms recounted frightening tales of risk-taking behavior and aggression, influenced by high blood glucose levels. Parental efforts to help the teens manage their disease had been completely rebuffed. It was the kind of conversation that strikes fear in the heart of any parent of a pre-teen child with Type 1.

This wasn’t my first time contemplating the toll of uncontrolled diabetes on teens. Almost 20 years ago, I worked as a social worker in a kidney dialysis unit, managing a caseload of people with renal failure. A few patients were fairly young and had blindness and amputations in addition to their renal failure. They had been unable to manage their diabetes in their teen years and into early adulthood.

That was difficult enough to witness, but the difference now is that the spectre of uncontrolled blood sugar levels hits closer to home now that I have a son with Type 1. He was diagnosed at age 5, and we have gradually handed responsibilities of his care over to him. Our son, now 14, manages his diabetes with the use of an insulin pump and a continuous glucose monitor. He has always taken an active role in his care and he’s had a pretty good attitude about it.

When he turned 13, however, it was as though he received a memo that says, “You’re 13 now; question everything.” He started taking shortcuts: bolusing for snacks without checking his blood sugar first, grabbing seconds without adding a bolus, and skipping the step of weighing or measuring food. Overall, these shortcuts are minor and his endocrinologist and certified diabetes educator are very pleased with how he’s doing. Nonetheless, these actions nag at us as parents because we always worry they will lead to something worse.

I feel fortunate that our family has cultivated a resource to use, if needed: psychotherapy. Since studies show that children and adults with diabetes are at a much higher risk of developing depression and anxiety than the average population, I think a psychotherapist can be just as valuable for people with diabetes as a endocrinologist or diabetes educator.

When my son was first diagnosed, he had some mental health struggles. He was clearly pretty angry, and he expressed this in drawings, lack of participation in classroom activities, and with negative interactions with peers.

We connected him with a therapist and he began to see her weekly. It brought great results. With therapy, he could learn that it isn’t scary to share his concerns about diabetes. With skilled support, he learned new ways to cope. As parents, we got coaching alongside him to support him in this process. I also hope that getting our son into therapy as a child will increase the likelihood that he will utilize this important resource when he is out of the house. I see it as an inoculation of sorts.

As I sat with the group of moms, I shared my thoughts both as a mom and as a social worker. I told the other moms about our experience with therapy, and shared the names of some therapists. The moms leaned in at the mention of therapy. A few of us acknowledged that we were in therapy ourselves. The mom of one of the struggling teens said her child has a mental health evaluation coming up the following week. The conversation, where we discussed the option of therapy in the open, left me feeling hopeful.

Diabetes is a difficult disease to manage, and the emotional toll on our kids is real. Having conversations about the value of mental health therapy can help break down barriers and ease suffering.

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Karen Joseph is the mother of three children, including one with Type 1 diabetes, celiac, and a food allergy. A parent, former medical social worker, and travel enthusiast, she combines her passions by writing for her blog There she shares family travel tips and inspiration for embracing health challenges.

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