How to encourage autonomy and independence?

My 13 year old stepdaughter has had T1D for over 5 years now and we are past the tumult that comes with the initial diagnosis. Of course we have bad days when extreme highs and lows force us to slow down, but for the most part, she is doing exceptionally well. She is on a pump and her A1C is relatively good.

However, her dad and I are having concerns that we are not encouraging her to be independent enough with maintaining her levels. Unless she is feeling low or high, she very rarely checks without us prompting her. She always asks us how many carbs are in her food instead of looking herself, she always asks before doing a correction (even though the answer is virtually always yes, unless there is something very off, which she typically knows ahead of time), almost always needs to be prompted to do a change-out. She was still a little kid when she was diagnosed, so everyone took on the responsibility of handling this stuff for her, but now she’s only got a few more years until she’s out of the house and on her own, and we’re becoming nervous that she won’t be prepared to succeed without us over her shoulder. It’s not that we don’t want to help, but I do want to see her taking steps to manage her disease without being told how so we know she will be able to do it when she’s out of the house.

(For logistic’s sake, it’s worth nothing we have her in our home full time, so anything we implement can be maintained 24/7.) Now that the new school year is starting, we’d like to start taking steps to put more responsibility in her hands (new year, new responsibilities type thing). One thing we are thinking of is having her set an alarm every night around 8:30 to check her levels and leave time to correct before bedtime, which is something we typically take the reins on. Are there any other ideas for steps we can take, now and in the future, to empower her to confidently and accurately manage her T1D without us?

Hi @Melanie,

First off, congratulations to your stepdaughter [and probably also to you and her father] for relatively good A1c reports. Then, I very strongly encouraging her to take on more and more responsibility so that she doesn’t constantly need you to make HER decisions. Although I’m not in the medical profession, I do try to encourage those I informally coach to allow their kids to gradually assume responsibility as they become aware of their condition and T1D management; I base my suggestions on my own 60 years “learning experience” managing diabetes. If she has siblings she could involve them by her “teaching” them and in turn she will learn her own management; from age 4 our granddaughter began checking my blood and wanted to poke my finger more often than I’d formerly do, and by age six was giving me injections. My management improved!

My pump has various alarms including a “Check BG” - if hers has that, set it to beep a certain number of hours after her latest bolus. I also set my “auto off” at six hours so if I don’t touch the pump within that time it will beep and vibrate; yes, 4 AM us six hours after my 10 PM evening BG check and snack.

She should be aware enough now to calculate her own corrections but a while let her ask you for confirmation- recently I’ve been asking my wife, we’ve been married more than a half century, when I’m high in care I’ve overlooked a reason so that I don’t over-correct and go low. The three of you could make a game of carb-counting must do the research to be “judge”.

Keep in mind that she is at the age for wild unexplained BG swings so don’t chastise her overly and remember that result of a BG check [notice I refrain from saying “test”] is a reference point for HER to make any necessary change or adjustment. Positive encouragement, and remind her that soon she will be in high school and wanting to do everything the other kids are doing and go places with her friends; there isn’t a thing that she can’t do [because of diabetes] and she can live a full life.

Mom & Dad, enjoy your daughter, let her “fly free” while you remain silently n the background and she will sour and bring life to you.

My son is 16 and was diagnosed at 6. Same story with us. He did his own shots at 6 but after getting on pump we did most the maintenance. Getting on a CGM has been so amazing. Only have to prick finger twice a day to calibrate the CGM.
So you always have a real time BG Number A1C is so much better and it tells you when headed up or down Still have to remind him to change site. But he finally does it himself
I think at 13 you still have a few years and when it’s time for her to drive they have to show the Dr they are responsible to get permission for license
Such a hard transition time in their lives I think you have to just be supportive and encouraging
Good luck!!