Thursday, 11 December 2014

Strategies to Motivate Teens to Prevent Diabetes Part1

Unwanted weight gain

Teens who improve their blood glucose control may gain unwanted weight unless the meal plan or activity routine is modified. In addition, they may experience more frequent hypoglycemia that requires additional carbohydrate and adds calories. This is especially problematic for young women who may begin to give less insulin or omit doses altogether. Regular attention to the teen’s pattern of weight gain or loss is important. The teen needs to work with the diabetes team to decide how to adjust insulin  doses or food intake.

Chronic poor control with reported large insulin doses and unexplained weight loss may indicate intentional under-dosing or insulin omission in an attempt to lose weight.

The incidence of eating disorders is no greater in teens with diabetes than those without diabetes. Promotion of healthy eating, regular physical activity, and acceptance of the diversity of body shapes and sizes should be discussed regularly.

Alcohol use

Although many alcoholic drinks contain carbohydrate, alcohol is not converted to glucose. It tends to inhibit gluconeogenesis and interferes with the counter-regulatory response to hypoglycemia. It also impairs judgment. Guidelines to prevent low blood glucose levels with alcohol use include:

         Do not skip meals or snacks when drinking.

         Consume additional carbohydrate if drinking more than the equivalent of two alcoholic beverages.

         Inform someone with you that you have diabetes.

         Do not drive after drinking.

         Do not take extra insulin when drinking.


Teens should be reminded of the dangers of driving when blood glucose levels are low. Guidelines to prevent or treat low blood glucose levels immediately include:
         Keep carbohydrate-containing foods (glucose tablets, juice, hard candy, regular soda) in your car at all times.

         Wear an ID bracelet.

         Test before driving at times when the teen may have a greater risk for hypoglycemia (after exercising, after skipped or delayed meals).


         Young women with diabetes need education about contraception. All commonly used hormonal contraceptives are safe with diabetes and do not influence blood glucose levels.

         The physician should consider early pregnancy in the differential diagnosis of unexplained hypoglycemia.

         Young women with diabetes should be referred to a diabetes program for intensive insulin management as soon as they learn they are pregnant.

Developmental issues

         Adolescence is a time for developing a teen’s sense of identity and increasing autonomy and independence. More free time is spent with friends and social activities are loosely structured, unplanned, and often include food. School and work schedules become more challenging and physical activity may be erratic.

         Despite a normal appearance, teens with type 1 diabetes must alter their lifestyle to follow treatment recommendations and minimize serious hypoglycemia and hyperglycemia. They must monitor blood glucose levels, food intake, and exercise as well as inject insulin several times each day. The physical, emotional, and social demands of self-management are often associated with neglect of self-monitoring, dietary recommendations, and insulin injections during adolescence. Depression and avoidance also may contribute to poor blood glucose control. At a time when teens are seeking independence, parents often have to increase their involvement to make sure daily diabetes care is done.

         An interdisciplinary diabetes team can help support the teen and match treatment plans with his/her motivation, ability, and level of functioning. Behavioral interventions, such as coping- skills training to teach problem-solving skills and communication, have been shown to help improve blood glucose control and quality of life in teens starting intensive insulin regimens.7

         Teens preparing to live away from home (in college dormitories or apartments) may initiate more intensive insulin regimens in order to increase flexibility and allow for less structured routines. Workshops for juniors and seniors in high school can help them make these transitions.

Strategies to motivate teens (especially those in poor control)

         Identify the reason for poor control and negotiate a plan with the teen.

         Decide on one reasonable and measurable action-oriented goal (number of blood glucose tests, recording carbohydrate at a specific meal, adjusting insulin based on blood glucose or carbohydrate intake).

         Identify short-term benefits relevant to the teen– less hypoglycemia, less frequent nocturia, improved physical performance, more flexibility in timing and content of meal, rewards from parents, greater independence.

         Establish a realistic time for accomplishment based on behavior and goal (e.g., average fasting blood glucose level will be 20% lower over the next 2 weeks).

         Provide frequent feedback. See the teen more often.

         Find out how much supervision or support the parents provide. Request more parental involvement.


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