Someone once said “Only few things are happier than seeing your children have teenage kids!” While the grandparent is enjoying a tit for tat, it is true that managing adolescent children is enough to give you stress, anxiety, and high blood pressure; more so if that child unfortunately has diabetes type 1.
Why are adolescents hard to manage?
Hitherto a piece of cake, managing kids as they get into their teens becomes really hard for parents. That sudden streak of rebellion, wanting their own space, aggression, and not communicating with parents is the hallmark of adolescent behavior.
While it is normal and tolerable in some proportions, it can be exasperating for parents to witness this turn into a fiasco. Losing control of emotions, risk-taking, substance abuse, impulsive behavior, and hot-headed behaviors are some externalizing behaviors that tend to create friction.
Becoming anxious, worrying a lot, being afraid of circumstances, hyper-vigilant, stressed, and having mood disorders and depression are some internalizing behaviors that affect adolescents.
These behaviors are known to stem from the desire to stand out and identify themselves, to fit in and gain peer acceptance, to develop competence and achieve, and to discover their sexuality.
With academic pressures, social and peer pressures, self-image, and hormonal changes, adolescent children (and families) go through a lot of stress and pressure. Adolescence can get even more complicated if the child has to deal with diabetes type 1.
Hurdles in managing diabetes type 1 in adolescence
Diabetes type 1 is generally diagnosed in children in the early years or during their adolescence. Following symptoms of frequent urination, excessive thirst and hunger, and blurry vision, a diagnosis is made. Post diagnosis, other tests like pancreatic islet antibodies, c-peptide, and ketones are made.
After an initial in-patient stay at the hospital with intravenous insulin and other fluids, the patient is discharged with an education of insulin therapy, low blood sugar levels, physical activity, diet, self-monitoring, and the use of substances like alcohol and drugs.
However, managing diabetes treatment can be trying for both the parents and care givers as there can be major adherence issues. In diabetes type 1, it is very important to adhere to the treatment plan provided by the endocrinologist. This is because poor adherence can lead to both short-term and long –term complications.
What with the turmoil of adolescence, there is every chance that adherence to diabetes treatment may take a backseat. This can lead to poor blood glucose control with increased HbA1c, increased fluctuations in blood glucose levels, increased risk of hypoglycemia and diabetic ketoacidosis.
Issues that hinder type 1 diabetes treatment in adolescents
Transition of care from parent to adolescent –
While parents tend to maintain and monitor the condition of their child during childhood, adolescents may fail to take complete care. During the childhood, parents take care of insulin therapy, self-monitoring, and diet. However as the child grows to be an adolescent, he/she may find these activities a burden and may not completely adhere to them.
Peer pressure –
It can get quite embarrassing for adolescents to measure their blood sugar levels, or to go for insulin shot in the presence of their peers. This creates an adherence issue as children spend most of their time at school during this age.
Physical activity –
The physical activity of adolescents and children can get unpredictable. Some days they might not move out of the house, and some days they indulge in heavy physical activity.
Mental health –
It is not uncommon for children with diabetes type 1 to have depression. This can either be due to their inability o tope up with their condition or due to other causes.
Lack of complete knowledge –
Though they learn some basic facts about their diabetes treatment, they do not fully understand the importance of self-monitoring, insulin therapy, and periodical diagnostic tests.
Treatment becomes weary –
Many adolescent children feel the process of self-monitoring and insulin therapy tiresome. Oftentimes, diabetes treatment demands multiple times of self-monitoring of blood glucose levels, and calculating the dosing of insulin. Despite improvements in technology of glucometers and insulin administration, the number of times it has to be done tends to make them weary.
Eating disorders –
It is very common among adolescents to have eating disorders. Binge eating, choosing the wrong kind of diet, and going for prolonged periods of time without eating are common among adolescents when they are unmonitored in school or during playtime. This can lead to unnecessary episodes of hypoglycemia, and sudden spikes in blood sugar levels.
Smoking, alcohol and other substance abuse –
Children at this age tend to experiment with smoking, alcohol, and other narcotic substances. Not only do these substances cause fluctuations in blood sugar levels, they can make the child incapable of noticing key symptoms of low blood sugar levels and diabetic ketoacidosis. Moreover, smoking and substance abuse aggravates and hastens diabetes complications like diabetic retinopathy, diabetic nephropathy, and cardiovascular diseases.
How to manage diabetes type 1 in adolescents
Because of the above mentioned reasons, diabetes treatment adherence becomes difficult in adolescents. However, lack of adherence to diabetes treatment can have disastrous consequences when blood sugar levels fluctuate. Complications of poor adherence to diabetes treatment include:
- Hypoglycemia (low blood sugar levels) – This can lead to hospitalization and a condition called diabetic coma
- Diabetic ketoacidosis – This is a potentially life-threatening condition
- Other autoimmune diseases like autoimmune thyroid disease, and celiac disease
- Dyslipidemia – characterized by high LDL cholesterol and triglyceride levels
- Diabetic retinopathy
- Diabetic nephropathy
- Diabetic neuropathy
There is no denying the fact that management of diabetes type 1 is complex. It involves complex rituals of daily self-care, problem-solving and decision making. It involves continuous education regarding diabetes, and better understanding on insulin dosage including pre-mixed insulin, multiple daily injections, free mixing insulin, and insulin pump therapy.
Apart from these, following a diabetic diet, and getting adequate physical activity without going into hypoglycemia, and getting diabetes tests are quite important in order to reach target blood glucose and HbA1c levels.
Since adherence is the major issue among adolescents with diabetes type 1, there is need for lifestyle and behavioral modifications. It is proven that positive attitudes and willingness towards diabetes treatment has a bearing on the outcomes. More and more adolescents have reached target HbA1c levels when they receive behavioral therapy.
Behavioral interventions begin at the household level and involve the entire family. Though teenagers can be trying at times, it is for the family to stay supportive, accessible, and conflict-free. Added to that, education of diabetes is equally important for the family members apart from the patient.
The family has to work together in daily care of diabetes, solving problems of low blood sugar levels, diet, exercise, self-monitoring, and follow up examination. Family members should know how to inject insulin, insulin injection sites, and how to use a glucometer to measure blood glucose levels.
Endocrinologists, diabetes doctors, diabetes educators and dieticians also have a key role to play in managing diabetes among adolescents. When the entire diabetes care team works in unison with regular interaction beyond the clinic, the child is bound to stay motivated on managing diabetes.
Technological interventions like mobile applications, smartphone glucometers, and latest insulin administering devices help in the patient remaining focused on diabetes care. It has been proven that mobile applications that provide medication reminders, test reminders, and reminders to follow up examinations improve the patient’s outlook towards care.
Added to that smartphone glucometers allow the care team to know the blood sugar levels of the patient real-time. This allows them to give relevant advice that can be implemented.
Finally, it is important for parents of adolescents with diabetes type 1 to try these means so that the child adheres to treatment and has a good quality of life.
If you want to know about special long term care programs for people with diabetes type 1 and our doctor-connected glucometer, please call our toll free number for further assistance: 1800 103 1010