RICK EGLINTON/TORONTO STAR

Jacqueline Burger and son Nicholas Reed, 16, vehemently disagree about the way he manages his Type 1 diabetes.

At loggerheads over his diabetes

Put Jacqueline Burger and her 16-year-old son Nicholas Reed in the same room and an argument about his diabetes regimen will follow.

Reed has contended with Type 1 diabetes since he was 8 years old. But as he has taken on responsibility for his own care, his blood sugar levels have climbed, Burger says. His most recent A1C test (glycated hemoglobin or HbA1c), which measures average blood glucose control for the past several months, stands at more than 11. It should be six to eight.

Burger, a financial planner and divorced mom of two teenagers, says her attempts to get her son to test his sugar levels when he should and to take appropriate precautions, such as wearing his MedicAlert necklace, have so strained their relationship, Reed moved in with his father last year.

Perched on the edge of a couch in the living room of her Davisville home, Burger expresses deep fear for her son's future health.

"I worry that he won't have a full life and I can't seem to convey that," she says.

Reed sits on a couch directly opposite his mother. His hands move constantly, one leg dances rhythmically. As Burger talks, the teen's slender 6-foot-1-inch frame conveys suppressed defiance.

Burger says her son should take four glucose readings a day, but he never tests at lunchtime.

Reed says he doesn't need the midday test every day. He insists he's familiar enough with his body to know when it's necessary.

"I don't like testing around my friends," he says. He says he takes readings before breakfast, before dinner and at bedtime when he gives himself insulin injections. "I am careful," he says. "Diabetes is part of me but it's not who I am."

An exasperated Burger reminds him how often he "forgets" pre-dinner tests. She reminds him how he would have eaten all those extra carbohydrates at Thanksgiving dinner without taking the appropriate amount of insulin beforehand.

"I just wanted to stay with the guests and eat," Reed replies. "I thought I'd test and take my insulin after the meal."

Reed, a Grade 11 student in auto mechanics at Danforth Collegiate with a part-time job in a fast-food restaurant, says he simply wants to live life to the fullest – and that doesn't include thinking about diabetes every waking moment. He says he's willing to risk his future health if he can live his way right now.

When the discussion turns to Reed's absolute refusal to wear his MedicAlert necklace, Burger's temperature soars. She worries he could appear drunk or drugged due to a sudden drop in blood sugar and not get the treatment he needs.

"I really don't want to wear the necklace. It bothers me," Reed states. "How about a tattoo?"

But he grins, knowing full well the negative reaction he'll get.

His mother also scolds him for refusing to keep a bottle of juice in his school bag for emergency lows.

"I'm not going to pass out on the street," Reed assures her. "I don't see that ever happening. I do feel (lows) coming on and then I'll go to the store to buy a juice if I need it."

She reminds him that he passed out in Grade 8 and had to be revived by paramedics.

But he dismisses that episode by noting he'd had a cold, which makes blood sugar levels see-saw so quickly that he didn't feel it coming.

"This is not unusual teenage interaction," Burger says. "The difference here is that he transfers this to diabetes management. When this boy is angry about something, he gets back at me by not wearing his MedicAlert necklace, not testing often enough."

Reed concedes that he has sometimes used his condition to annoy his mother but insists that, on the whole, the choices he makes have little to do with her. "Mostly, I just want to do my own thing," he says.

Elizabeth Dettmer, a psychologist in the adolescent medicine division of Toronto's Hospital for Sick Children, says parents' fear and frustration over their child's health may cause them to push too hard.

"The less pushy, the better it works," she suggests. "A parent has to be willing to compromise and give it time."

For example, Dettmer says Burger and Reed could talk to his doctor about whether lunchtime testing is really necessary. She also suggests Reed get a wallet-size card as a medical alert (available through www.sickkids.on.ca/myhealthpassport).

Dettmer says sticking to a diabetic's regimen can be difficult and that even model patients go through periods when they don't adhere to their programs.

She urges parents to focus on positive reinforcement by rewarding children when they do things correctly; to give them some choices in their treatment and to use non-verbal reminders about what they have to do, such as putting a picture of a syringe on the fridge.

"But when they really dig in their heels, (parents) might need outside help," Dettmer says.