I’ve found that a theme song can sometimes help 
Most of the time, I don’t have much trouble putting in the sensors. I don’t really like that I can’t see the needle though, and I don’t have the same amount of control as I do with shots. It can take me a minute to work up the nerve to push the plunger down. I’ve found 80’s ballads to be particularly effective 
Ha!!! I’m trying to imagine the look on Eric’s face is I started belting out some Bon Jovi or something. Ha!
Lolol. Yes, I just turn on the music. I’m not sure I’d be able to stop laughing for long enough to push the plunger!
Ok, so I’ve been thinking about this topic and I may have an unconventional and novel solution. There is a way to incentivize good BG control. There a few basic things that would be required.
Internet access
Dexcom G4 (with share) or G5
A Nightscout site (free and easy to create)
An account with IFTTT (free)
Anyone not familiar with IFTTT, it is essentially a way to create automatic rules for various accounts that are linked together. For example, you can turn down the thermostat when you leave the house. Or blink a light when your favorite sports team scores or when your BG gets to high…hmmm…
So I was thinking, how could I use this tech to incentivze good BG control for a teen? There are 12 built-in events in nightscout (below). Using your own imagination you could create automatic rules to help nudge your teen to better control–in your own way.
For example, how about:
A simple text reminder that his/her BG is getting too high/low.
A rule that de-prioritizes his xbox or ps4 internet speed on your home network, if his/her sugar gets too high.
A rule that rewards him/her with $$$ if he/she adds a treatment into the care portal.
Maybe a rule that deducts $$$ if he/she spends money at Krispy Kream donut store?
How about a rule that plays the Barney “I love you” song every time his/her Dexcom has not uploaded new data in x amount of time…okay, that one might be borer-line torture.
The options are only limited by your imagination. The benefit is that these actions are immediate and are directly associated with their behavior at the time of the incident. Below is the current list of built-in events that Nightscout offers.
ns-event – This event is sent to the maker service for all alarms and notifications. This is good catch all event for general logging.
ns-allclear – This event is sent to the maker service when an alarm has been acknowledged or when the server starts up without triggering any alarms. For example, you could use this event to turn a light to green.
ns-info – Plugins that generate notifications at the info level will cause this event to also be triggered. It will be sent in addition to ns-event.
ns-warning – Alarms at the warning level with cause this event to also be triggered. It will be sent in addition to ns-event.
ns-urgent – Alarms at the urgent level with cause this event to also be triggered. It will be sent in addition to ns-event.
ns-warning-high – Alarms at the warning level with cause this event to also be triggered. It will be sent in addition tons-event and ns-warning.
ns-urgent-high – Alarms at the urgent level with cause this event to also be triggered. It will be sent in addition tons-event and ns-urgent.
ns-warning-low – Alarms at the warning level with cause this event to also be triggered. It will be sent in addition tons-event and ns-warning.
ns-urgent-low – Alarms at the urgent level with cause this event to also be triggered. It will be sent in addition to ns-event and ns-urgent.
ns-info-treatmentnotify – When a treatment is entered into the care portal this event is triggered. It will be sent in addition to ns-event and ns-info.
ns-warning-bwp – When the BWP plugin generates a warning alarm. It will be sent in addition to ns-event and ns-warning.
ns-urgent-bwp – When the BWP plugin generates an urgent alarm. It will be sent in addition to ns-event and ns-urgent.
All of this can be done in theory. I personally haven’t done more than blinking some lights, logging events, and setting off an urgent low siren–but all of the ingredients are there.
Let me know what you guys think and if anyone has tried any. I would be curious as to what configurations you guys can come up with. 
@Bradford, this has got to be the most intriguing proposal that anyone has brought on the topic ever!
I would be happy to pilot it if you decide to work through the systems issues: I would love to work on the system work right now but our temporary move to Europe, and our Android/Nightscout/ Loop projects are sucking all of my time experimental time out.
I am planning on implementing some rules just to see if they work. If all goes well, I will write up a wiki so that anyone can easily follow along and create their own.
Bradford, that is very kind, and I really love the way you have been approaching this problem. Unfortunately, it wouldn’t work with my T1, but I can absolutely believe that there will be people that would benefit from this.
How so?
I’m sure that kind of reinforcement system could work for someone, and I could easily imagine it being useful if self-implemented—I’m a fan of having reward systems for myself. However, something that my parent used to punish me as a teen for not adhering to diabetes treatment would have damaged my relationship with my parents and probably would have resulted in my reacting with the opposite behavior and saying f*** it to all of it. Also, if someone tried to use something like that to control what I purchased to eat, I would have reacted by finding a way around it to buy more junk food in secret. To be honest, I can feel resentment just imagining all of that… and I was generally a fairly well behaved kid, so it’s not like I was some antisocial outlier. Just a teen with an independent streak. I also think that sort of system could fail to build more intrinsic motivation, risking any gains in control falling apart once the teen is outside parental control.
The thing I don’t get reading about some of the more involved management of teens, is how are your kids able to do normal stuff like go to sleepovers, if they rely on their parents to manage their blood sugars overnight? That seems crazy to me, but then I grew up somewhat similarly to @Eric (Team Old School!). Within about month of being diagnosed at age 10, I spent two weeks at a not-diabetes overnight camp, and while the nurse was helping me with things at that point, no one was monitoring anything overnight except me. The following years, I went away to camps for up to a month at a time every summer, only once going to a diabetes-focused camp (and hating it, because in part because suddenly I had adults intervening in my control that I knew how to do better than they did). I think I was about 16 when I started going to endo appointments by myself primarily and reporting back to my parents. And my parents are super involved, paranoid Jewish parents that I’m very close with to this day—it was just really different then I guess. I think of course the kid themselves makes a big difference too, and so it will differ a lot kid by kid. Just seems like it could be setting a kid up for other problems later to either make them too concerned about tight control at the expense of being able to foster independence. I’m not a parent though, so I don’t know if I’d feel differently in that position. I doubt there’s a simple answer to any of it.
I’m glad that my t1 came after I got out of the house… My parents were controlling enough without that. They exerted so much control in the name of being “worried” about me. I was a very good kid and generally followed all the rules and did my darndest to meet their standards until I couldn’t anymore (completely imploded with depression sophomore year at MIT). I think I was self motivated enough that urgent low alarms and bonuses for good a1c’s were all that they needed to do… anything else would have made me turtle because I was so sensitive. Who really knows, I’m just guessing for myself… many of my classmates were less independent.
My son is self-motivated. He pushes back against anyone telling him what to do at this point. He is very independent, strong willed, and smart. A quite potent combination.
He has thought through the ramifications of his diabetes, has taken on an approach that works for him, and among other things, won’t allow anyone but himself to make dosing decision or deliver insulin. My wife and I can wake him up if he is sleeping through alarms, we can gather all the stuff he needs, but no one other than him, inserts sites, refills cartridges, fills syringes, etc.
He will entertain discussions about his diabetes, he will sit down and review his reports with us, he will even allow me to guide some of his discovery regarding studies and treatment regimes. But that is about it.
If we designed a system that rewarded and punished he would figure a way around it. We support, but know we can’t control. The only way a system like yours would work for my son, is if he decided he wanted it and made all of the decisions on what consequences went with each item.
The running joke in our house when I was an adolescent was:
Mom: "Have a nice day, Carolyn!"
Me: “Don’t tell me what to do”
Yea, I agree it depends on personality type. I would expect positive reinforcement rules would work better. Such as being rewarded when bg has improved compared to the previous week, ect…
I’ve been playing around with it and have created a Google sheet calendar that can automatically log instances of lows and highs from the day and input it to the calendar. This could then be used to create a myriad of automatic incentives.
I suppose I was just thinking that immediate feedback (good or bad) would be better than abstract thinking about future consequences. Let’s face it, teenagers aren’t really good at planning for the future because they are always living for today.
I think that a set-up such as this one, focused on positive reinforcement, and with automated rules agreed-upon ahead of time, could work well with a kid like mine: better than when we review things together in person, because sometimes there can be personality clashes.
I think that rules that are agreed-upon are a good method: that’s often what we use at home. But the enforcement is always harder, even for positive reinforcement only. So automatic enforcement could work really well.
Mom: “Have a nice day, Carolyn!”
Me: “Don’t tell me what to do”
LOL, that was me to a tee. Feel pretty bad for my parents now looking back.
I actually think, despite whether or not this is a psychologically valid strategy, you should be commended for coming up with such a creative and well thought out suggestion. I actually kind of thought you were suggesting that the young T1D person could do this themselves and work on the programming aspect of it - could be fun!
Whether or not this would work for an individual, I think it would depend! Could be a fun family project for some, or a wedge for others. Depends. Very creative thinking though!