With or without diabetes, all teenagers develop differently.
The teenage years are a time of physical, mental, and emotional growth.
It has long been known that risk-taking behaviors are a big part of adolescent behavior.
They are searching for their place in the world and working at becoming independent.
Part of adolescents’ make-up is that they don’t think bad things will happen to them, and they also have difficulty delaying gratification.
Alcohol consumption, tobacco use, other drug use, unprotected sex, and other risky behaviors are common among teens today.
When it comes to diabetes care, skipping blood glucose monitoring or insulin injections may be a way of testing the limits, or it may reflect a teen’s inability to consider the potential consequences of these actions when he’s preoccupied by something else.
Diabetes management needs a degree of responsibility and behavioural control that is not typical in many adolescents.
The daily demands of the disease have an impact on the personal and public lives of these teens.
It affects important developmental stages including independence, body image, identity, sexuality, responsibility, and self-esteem.
Once teenagers can start to reason and think about their future, they will understand the implications of diabetes and its management.
There are many factors such as peer pressure, parties and other social events, part-time jobs, and a busy life in general that may interfere with the teen’s ability to translate this new awareness into good self-care.
Teens with Diabetes: A Clinician’s Guide
Adolescents with diabetes have trouble making their diabetes a priority in their lives.
It is not that they don’t care about it, but they tend to care more about other things, such as fitting in with their friends, not being noticed for having diabetes, and not being different from their peers.
They usually do not want parents, friends, and teachers to focus on their diabetes, and when there is focus on it they can be easily embarrassed.
For teens whose diabetes is not in control, it can help to obtain HbA1c tests more frequently than every three months (the usual recommendation).
A rising HbA1c can alert parents and teens to the need for action, while a decreasing HbA1c shows that diabetes control is improving and provides motivation to keep up the effort.
Depression is often the reason that a teen quits caring for himself.
A teen who is depressed may or may not have other symptoms of depression such as crying, anger, and changes in appetite or sleep habits, but a teen who quits taking insulin and quits caring for his diabetes is sending a clear message that he needs help.
It may not be diabetes causing his depression, but diabetes care suffers because of it.
Some adolescents, especially girls, omit insulin doses as a way to control their weight.
This is a very dangerous practice that can lead to serious health problems.
Like girls who have eating disorders, however, teens who are omitting insulin are often reluctant to admit it.
Be supportive – not judgmental. How you talk with your teen is as important as what you actually say.
Acknowledge that dealing with diabetes day to day is a hassle but be firm about taking care of the daily testing and injecting tasks.
Be positive to build your teen’s confidence. Use affirming statements whenever possible.
Encourage decision-making skills. Ask your teen how they would handle specific situations. Let them answer and support appropriate answers.
Take time on a regular basis to go over your teen’s diabetes information, review her logbook and make a plan of action with her.
Many teens and parents are not clear on who should do what tasks.
For example, parents may assume that their teen is recording blood glucose results, insulin doses, etc. only to find out at the diabetes visit that no records were kept for the previous months.
It is key to clarify expectations before problems occur.
Avoid placing blame on your teen when you did not know what was actually happening .
Diabetes management is a heavy burden to carry alone.
Teens should be encouraged to develop their own relationships with members of their diabetes team.
A strong relationship between your teen and his/her doctor, diabetes educator, or dietitian is critical, both to the health-care provider’s ability to evaluate and motivate your teen, and to your teen’s ability to communicate with the health-care provider.
Let your teen have private time with the doctor or nurse at each clinic visit.
It’s natural for parents to want to stay informed, discuss issues, and be part of developing the plan for the next phase.
However, teens should be able to expect confidentiality in certain aspects of their health care.
A positive attitude will go a long way to helping your teen manage his/her diabetes.
It is normal for young people with diabetes to feel overwhelmed at times or to feel like no one understands them.
Their diabetes health care team is there to help them.
Their diabetes team might even be able to put the teen in touch with others the same age who have diabetes and who understand just how they are feeling.
Giving teens the tools they need to manage their diabetes can be an important step for them to transition to full independence regarding their diabetes care and feel fully confident once they move out of the family home.
Helping Adolescents Manage Diabetes
The health care professional team, in partnership with the young person with diabetes and parents or other caregivers, needs to develop a personal diabetes management plan and daily schedule.
The plan helps the teen to follow a healthy meal plan, get regular physical activity, check blood glucose levels, take insulin or oral medication as prescribed, and manage hyperglycemia and hypoglycemia.
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Emotional and Behavioral Issues Of Young People With Diabetes
Diabetes: Caring For Your Emotions As Well As Your Health, Second Edition
Diabetes presents unique issues for young people with the disease. Simple things, such as going to a birthday party, playing sports, or staying overnight with friends, need careful planning.
Checking blood glucose, making correct food choices, and taking insulin or oral medication can make teens feel “different” from their classmates.
For any teen with diabetes, learning to cope with the disease is a big task.
Dealing with a chronic illness such as diabetes may cause emotional and behavioral challenges, sometimes leading to depression.
A young person newly diagnosed with diabetes will have a range of reactions and emotions. Common reactions experienced by teens and their parents include shock, denial, anger, sadness, fear and guilt. These feelings usually subside with time and appropriate support.
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Getting a Grip on Diabetes: Quick Tips & Techniques for Kids and Teens
Transition to Independence: Young people with diabetes––depending on their age and level of maturity––will learn to take over much of their own diabtes care.
Most school-age children can recognize symptoms of hypoglycemia and monitor blood glucose levels. They also can participate in nutrition decisions.
They often can give their own insulin injections but may not be able to draw up the dose accurately in a syringe until a developmental age of 11 to 12 years.
Adolescents often have the cognitive skills to perform all diabetes-related tasks and determine insulin doses based on blood glucose levels and food intake.
This is a time, however, when peer acceptance is important, risk-taking behaviors common, and rebellion against authority is part of teens’ search for independence.
Thus, adolescents must be supervised in their diabetes tasks and allowed gradual independence with the understanding that the independence will be continued only if they adhere to the diabetes regimen and succeed in maintaining reasonable diabetic control.
Encourage attendance at diabetes camps. Your teen will meet other young people with diabetes and learn about diabetes care in a fun, safe and relaxed environment.
The family and health care team should also stress to teens the importance of checking blood glucose levels prior to driving a car to avoid hypoglycemia while driving.
Driving a car requires sound judgement and responsibility.
You should be certain your teen is responsible about their diabetes care before you allow him/her to apply for a driver’s license or lend him/her the family car.
Young people with diabetes can hold a driver’s licence or learner’s permit as long as their diabetes is well controlled.
A medical report must be provided before a driver’s licence or learner’s permit can be issued. This report should come from the young person’s family doctor or diabetes specialist.
Young People With Diabetes And Close Relationships
Dating is an entirely new world for teens and often an important one for them.
Some teens with diabetes already secretly harbor the notion that someone might not want them because they have Type 1 diabetes and are “damaged” in some way by it.
Parents of kids with T1D need to be sensitive to the fact that their teen might be feeling sensitive about the subject.
It’s fine to ask your teen if his date knows he has Type 1 diabetes.
If the date does not know, remind your teen that at some point during the evening he is going to have to check his blood sugar or take insulin.
Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction.
For young people with T1D, they need to understand that sexual activity can affect blood-sugar levels, at times causing low levels from exertion or high levels from stress; it differs with each person.
For young people with type 1 diabetes who are sexually active, intercourse should be considered an extra activity that uses energy, requiring a carbohydrate snack afterward.
Hopefully, your teen will realize that these additional factors simply mean he /she has to take sexual activity very seriously and consider waiting before engaging in sex.
We all know the importance of protection from sexually transmitted diseases (STDs) and unwanted pregnancy. Girls can become pregnant, and boys can father a child!
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Pregnancies in teenaged girls are always considered high risk. This means there is a greater chance of things going wrong for both the mother and her baby. But being a pregnant teenager with diabetes adds even greater risk.
Babies who are exposed to high blood glucose levels when they are in their mother’s womb have a greater risk of birth defects, difficult deliveries, and a greater chance of developing diabetes when they grow up.
Teens with diabetes should be given information about sexuality and pregnancy well before they need it.
These discussions should take place with members of the diabetes team and should be confidential.
When the time comes to plan a family, they should be reassured that the health care team will be there to help them and their baby get the best possible start.
Adolescents With Diabetes At School And College
It is important to understand the effect diabetes has on a particular student and how that student’s diabetes is treated.
Diabetes can be a disability and can have substantial impacts on a student’s academic performance and safety at school, but it does not affect all students in the same ways.
Diabetes can affect students in several ways:
First, diabetes must be managed 24 hours a day, 7 days a week.
Diabetes care requires an ongoing treatment regimen.
The treatment regimen affects the student’s daily schedule and, if appropriate provisions are not made, may impact the ability of the student to have equal access to all school-related activities.
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