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 take care of their T1D? Whether it’s not testing blood sugar, not counting carbs, or not giving insulin, not taking care of diabetes 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? Let me introduce you to the 24 hour plan.
I’m not a fan of the phrase “non-compliance. There are many reasons that children don’t pay much attention to their T1D, 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. Maybe your daughter forgets because she has other things on her mind. They could be experiencing burnout and simply not feel like dealing with diabetes. Whatever the reason, the 24 hour plan might be just what they need to 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 diagnosis and was taught to be independent, at about 14 he became neglectful with his diabetes 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 averagely 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 diabetes 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 T1D, 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 diabetes 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 his 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!
How can I see a sample of your plan to see where to even start with my 15 year old daughter? She feels she needs to lie to us about things concerning her blood sugars. And just had a major blow up. I really think its tearing us apart.
Hi Trish, thanks for reaching out. That’s always a difficult situation. T1D can be so stressful for parents and children alike. And it’s upsetting when we see it affecting our relationships.
This was a guest post written by another T1D mom, so I don’t have an exact plan. It will vary from person to person anyway. It depends on what the parent and teen can agree on. I believe the author of this article went with something very simple like lows had to be treated a certain way and the teen had to check bg something quite low like 2 or 4 times per day (this was pre-CGM). Basically, the 24 hour plan method is the absolute bare minimum that you as the parent are ok with. And you have to keep the alternative in mind. If they’re never checking bg and just making up numbers, then even checking when they wake up and before bed is an improvement.
Being a teenager with T1D is a lot to deal with. Your daughter might be burnt out. What some parents will do for that is (after a discussion with the teen) take over as much T1D management as they can and come up with a plan for the rest of the time. For instance, she might need to handle her T1D at school, but a parent might be able to take over during non-school hours or after work.
This is another article that might be helpful for understanding how she might be feeling and how to make sure you’re framing it as something to collaborate on rather than something to fight about. It’s completely developmentally normal for children and teens to lie. It’s actually a good thing that they do this. But it can be really frustrating and even dangerous when it comes to T1D, so we need to make sure that we’re focusing on the important part and not getting hung up on the fact that they’re lying. It’s really important to connect and empathize and work together to find a solution that will work for everyone involved. https://carbcountingmama.ca/10-unfortunate-quirks-every-t1d-teen-has/