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.
Driving
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).
Pregnancy
•
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.
TO BE CONTINEU
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