A perspective on the brittle teenage diabetic

The brittle teenage diabetic presents a difficult problem well known to clinicians. It is the authors' contention that its major component is psychological and not biological, and that much of this poor control can be avoided by proper developmental planning from the onset of disease. Failure to modify transactional health care models appropriate for the child to that appropriate for the adolescent accounts for much of this difficulty. Anticipatory long-range planning is outlined to aid the physician in allowing the youth to isolate and insulate his diabetes from becoming either a focus for control contests and power struggles or a maladaptive, manipulative regressive behavior. The reasonable goal is to prevent any further hospitalizations for ketoacidosis or hypoglycemia beyond the first admission for diagnosis and initial stabilization. Five illustrative cases augment this discussion.