Diabetes in adolescents
diabetes; type 1; juvenile; onset; insulin; dependent; adolescents; adolescence; high; blood; sugar; level; testing; low; hypo; hypos; hyper; glycaemic; hypoglycaemia; sex; pregnancy; contraception; hyperglycaemia; diabetes; mellitus; alcohol; puberty; glucose; insulin; exams; needles; tobacco; smoking; driving; licence; driver; school; management; plan; hypoglycemia; hyperglycemia;
Contents
Alert!
If a person who has diabetes becomes confused, obviously unwell, drowsy or unconscious, that person needs urgent help. She may have very low levels of blood glucose (hypoglycaemia) or very high levels of blood glucose (hyperglycaemia) or ketoacidosis.
This topic looks at the changes that occur for adolescents physically, emotionally and socially and how these changes impact on living with the chronic disease diabetes mellitus type 1.
More detailed information about ketoacidosis, hyperglycaemia and hypogylcaemia can be found in the topic 'Diabetes in childhood'. Information about symptoms, complications and management of diabetes can be found in the topics 'Diabetes in childhood' and 'Diabetes - managing diabetes in childhood'.
Taking responsibility
As children get older they will take more responsibility for their diabetes and by mid adolescence they should be able to manage on their own most of the time.
- Parents need to work out how to allow their young person the freedom and responsibility of being older and more capable.
- Young people who have diabetes need to work out how to be 'in charge' of a health issue that is much more serious than most of their friends need to manage.
Adolescents with diabetes will go through all of the normal changes of puberty (physical, social and emotional). Diabetes will probably not be the main cause of most of the difficulties that they have. If they are having problems, always think of other things too, and don't blame it only on the diabetes. Diabetes may be a health problem they have, but it should not be a cause of illness, anger or depression, social difficulties and not coping.
Diabetes management plan
- All children and young people who have diabetes should have their own diabetes management plan worked out with their doctor and their diabetes team.
- Most of the problems that occur in adolescence are due to 'control' issues; having to have insulin, having to have regular meals, having to control alcohol use, and having to listen to their parents.
Some of the steps in letting go
Seeing their health workers by themselves
- Let adolescents see their health professionals on their own. This will encourage them to take responsibility for their own diabetes management.
- Be encouraging but remain an observer of the process rather than a doer. It is often hard for parents to tread the fine line between being seen as 'not caring' and 'it's my life, I can do what I want'!
Record-keeping
- Adolescents can take responsibility for their own record-keeping.
- It is also important to let young people themselves deal with not having a 'good' record when they see their health professional. Avoid 'I told you so' or similar remarks, which will be seen as put-downs.
Problems with control
- The hormonal changes of puberty, rapid growth and changes in exercise levels will make it harder to keep blood glucose levels under control so make allowance for this for your young person.
- Problems might not be due to carelessness - it really is harder to keep good control of diabetes through puberty.
- Menstrual cycles also affect control. You both need to be fully aware of what may happen well before puberty, so that you can let your daughter manage through what can be difficult times.
High school
- Moving to high school is a big step and sometimes scary. You will need to be especially supportive and understanding of your child's fear of being different.
- The school and the diabetes team will be familiar with this move and problems which can arise, and there will usually be ways to work out how to manage. It would be best to work out what problems there might be before trouble occurs so your child knows what to say and do in advance.
- Discuss your child's diabetes with the school and seek the help of home room teachers or school counsellors if you feel your child is not coping with his diabetes in the school environment.
- In primary school your child had one teacher for almost all activities, but he or she will now have many teachers who will need to know that your child has diabetes and what to do.
- When it comes to exams, provision is made for diabetes but you need to let the school know well ahead of time.
Driving
- The major risk of driving when someone has type 1 diabetes is an unexpected hypoglycaemia leading to loss of control of the car.
- Before starting to drive, it would be best if the young person could test for blood glucose level, or if that is not possible, eat some carbohydrate food.
- On longer drives, regular eating is important, and it may be best to carry food in the car (shops may not be open).
- Diabetes is one of the conditions where you are required to have a certificate of fitness filled in by your doctor. If you are on insulin you will need to get a new certificate every year and if you are on tablets, once every three to five years. There is no difference to the amount of third party insurance you must pay.
Sex and pregnancy
- An unplanned pregnancy can be a major problem for both the mother and the developing baby, and diabetes increases the risks of problems for both of them.
- In almost all cultures young women are at risk of pregnancy, sometimes well before their parents are ready to recognise it.
- Young women with diabetes need good information about contraception and planning for pregnancy well before they start sexual relationships.
- Some contraception methods, such as a condom and diaphragm are safe to use and condoms give protection against many sexually transmitted infections.
- The choice of other contraception may be influenced by a young woman's diabetes. She will probably be more able to discuss her contraception needs with her doctor if you have already encouraged her to see the doctor by herself when she needs to discuss other concerns about her diabetes.
- The emergency contraceptive pill, ECP, ('morning-after pill') can usually be taken, but a doctor needs to check the young woman's health first. Have a look at the topic 'Emergency contraception'.
Risk-taking
- Peer pressure is a strong influence on all young people. Young people with diabetes will take risks like all other young people, but they may have to cope with more serious health problems that can result from some risks.
- Work out, with parents of the other young people who are friends of your son or daughter, what are reasonable ground rules for all young people, not only your child who happens to have diabetes (times to come home, who drives, use of alcohol and tobacco etc). This can save some of the 'why me' fights.
- Alcohol use can be tricky with diabetes. Alcohol can affect blood sugar levels. Young people who are drinking may not monitor food intake or insulin use well. Hypos may not be recognised if others think they are 'just drunk'. Information from the diabetes team or from other parents may be helpful.
- Smoking makes the negative effects of diabetes worse.
- Encourage your child to join a diabetes youth group or go on a diabetes camp where they will meet others in the same situation and 'leaders' who have worked through some of the issues for themselves. Encourage them to become leaders.
- There is a teenage myth that parents need to be aware of, that 'you will lose weight if you stop insulin'. This is true but you will almost certainly get ketoacidosis which is often life threatening.
Some points to remember
- With all young people (and other relationships) keeping good communication is most important. This is especially so if the young person has a health problem. If communication between your young person and yourself is not going well, make sure that some other trusted person, such as a school counsellor or diabetes support worker is watching out for her.
- Make sure that you have time to spend with her, talking about all the things young people enjoy – not just thinking about the health problems.
- Keep informed yourself.
- When young people have a problem it is always useful to listen well before you answer because finding out what is behind it can be very important, eg. "What makes you think that?" "How come?" etc
Further reading
Resources
South Australia
- A support group for teenagers aged 12-18 years is run by the Women's and Children's Hospital - telephone 08 8161 7000. There are social, educational and recreational activities with an emphasis on personal responsibility. (The unofficial motto the teenagers have given the program is 'Or Else'!) The support group also has two camps a year. The camps are supervised by nurses, a doctor and dietitian and there are camp leaders who are older teenagers with diabetes. Activities include abseiling, rock climbing and aquatics.
- Diabetes Australia - South Australia (DA-SA) is an independent, not for profit, charitable organisation providing a range of services and products designed to meet the needs of people with diabetes.
159 Sir Donald Bradman Drive, Hilton SA 5033
- telephone: 08 8234 1977
http://www.diabetessa.com.au
- National Diabetic Services Scheme (NDSS) is funded by the Australian Federal Government and administered in South Australia by DA-SA. It provides an easy, low cost way for people with diabetes to purchase essential diabetic supplies. Lifetime registration is free. You need to fill in a registration form, get it signed by your doctor and return it to DA-SA.
http://www.diabetessa.com.au/aspx/about_the_ndss.aspx
Australia
International
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.