ADOLESCENTII

Posted on July 27, 2007

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NEW YORK (Reuters Health) – Teenagers with type 1 diabetes may have a tougher time managing their blood sugar on days when they are feeling angry or down, a new study suggests.

The findings, published in the Annals of Behavioral Medicine, suggest that emotions may affect teens’ blood sugar control by making them less confident in their ability to manage their diabetes.

For the study, Katherine T. Fortenberry and colleagues at the University of Utah in Salt Lake City recruited 62 subjects between 11- and 16-years old with type 1 diabetes, an autoummunne disorder that res caused by an abnormal immune system attack on the body’s insulin-producing cells. People with the disease have to take daily insulin injections, closely monitor their blood sugar levels and be careful about their diets to avoid sugar highs and lows.

Teens in the study kept a daily diary for two weeks, detailing their mood and confidence in their ability to manage their diabetes.

In general, Fortenberry’s group found, the teenagers’ blood sugar levels were more likely to be near-normal on days when they were happy or excited.

On days when they were sad or angry, their sugar levels tended to be higher, the researchers report in the Annals of Behavioral Medicine.

The teenagers’ self-confidence in their diabetes control seemed to explain the link, Fortenberry’s team found.

They note that teenagers who stay positive in the face of managing the disease may be more likely to take all the steps they need to keep their blood sugar in check. Helping teenagers to manage their emotions, the researchers write, may have “important implications” for their lifelong diabetes control.

SOURCE: Annals of Behavioral Medicine, online March 3, 2009.

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When Parents give to much control?

http://www.diabetes.org.uk/Guide-to-diabetes/My-life/Kids/

http://www.diabetes.org.uk/Guide-to-diabetes/My-life/Teens/

Selectii dintr-un forum al adolescentilor cu diabet:

When Parents give to much control?

A.:

Okay my usual control freak mum has totally I think gone over board….

She has told me it is my deceision when I choose to tell my teachers and anyone else I feel fit that I am Hypoglycemic.

When is to much control and deceision making waaaaay to much?

Where do your parents draw the line?

B.:

Hey hypo,

Thankfully my parents don’t “draw the line” for me anymore! If you feel uncomfortable telling people about your hypoglycemia then I think you should speak with your mom about it.

But on the other hand, this is a great opportunity for you to show your maturity, which you obviously have a lot of. Later in life you’ll be faced with this same decision again and again, whether or not to tell and who to tell about your condition, us diabetics go through this too. So I say go for it and think about it and decide how to do this, it’s a lot easier than you may think and many teachers are understanding. If not, you can always fall back to your parents something even I wish I could do sometimes!

A.:

I don’t feel ready to tell my teachers.I’d rather they not know just yet. I have told my friends and they know what to do in an emergancy. I’m totally in charge there is no line drawin for me no limit to my control. I make my own docter apointments even which is freaky and weird to me.

Than why do I feel so guilty and afraid that I’m making wrong decesions?

What if I feel comfortable some teachers knowing and others not?Is it possible to tell them in the confidence that they won’t tell? What if my meter gets mistaken for a cell phone and I get in troble? Why am I such a worry wart.

B.:

The only way to ever know if you’re doing something wrong is to try it and be prepared for the consequences. This is true of anything in life. You can research and ask about it but in the end it’s your own personal experiences that tell you how you feel about something.

It’s natural to feel hesitant about an important decision. If you didn’t then that would be a real problem, but don’t let that hold you back or persuade you against what you know you need to do.

Your teachers should know enough to keep what you tell them in confidence, but they have a responsibility to you to keep you safe and that may require them telling someone like the school nurse, I don’t really know as I’m not a teacher. Myself personally, some of my professors know I’m diabetic and some don’t. Some of my friends know and others don’t. Some people feel like they should tell others, some like to keep it a secret. You shouldn’t feel obligated either way. It’s your life and you can and should make the decisions as you see fit.

Whatever you decide I know you’ll have thought it through and made a good decision, just getting over that first hurdle is the toughest.

C.:

When I was in HS I told my teachers and I was glad I did. I just did it matter of factly at the beginning of the year, “Hey, I’m hypoglycemic, so if you see me eating in class, it’s because my blood sugar is low and I have to, ok?” They’re usually cool with that. If they aren’t, you can always bring in a doctor’s note.

A.:

There are people in my immediate family I havn’t told. Telling my teachers is something that scares me. I’m just worried that their going to mistake my meter for a cell phone and demand I give it to them and when I say no I can’t that they’ll have a fit. Mostly I want to know if my mom should draw a line somewhere. I feel she should I don’t know where but to me it feels like I’m doing something wrong and getting away with it. Ive thought really hard about it and I think I’l be okay if I don’t tell certain teachers if I choose. At this age I should be able to manage like an adult even if at times I get confused.

I recently started a diet diary to help my control so I havn’t hypo’d in a long while. I almost did when I went off my diet for one day.

There has only been one situation where I had all the symptoms of a hypo and I didn’t recognise it but the teacher of the class who is T-1 did recognise it along with one of my friends.

He asked me if I had eaten my lunch and I got right confused and couldn’t remember if I had or not. Immediately I got something to eat and I was fine again.

My mom thinks that at this age I should be able to look after myself .

If you where a kid/teen and your mom said “You make all your own rules for this….”

wouldn’t you feel a bit questioning if you’d been following the same set of rules all your life made by one person.

Our school does not have a school nurse so it is up to students anyway to look after everything themselves.

Well I made my deceision. I did tell my teachers and I got a negitive reaction from one but Ive finally learned not everyone is okay with the same things.

My mom did the right thing and I took a chance and did the right thing to and now I’m a whole lot more confident in my deceision making!

Thanks you guys for giving me the courage to do so!

B.:

What was the negative reaction?

A.:

Awww thanks guys!

It wasn’t a negetive reaction presay but I found it kinda negetive.

I told a older female teacher one that is very against ‘cell phones’ and anything that makes any noises just so she wouldn’t confenscate my meter. She kinda got a bit defensive and tense and the two comments that stand out the most are “Your not going to test in class are you?” said rather frantically and I calmly explained “Only if I feel low” and next she like “You didn’t have that thing last year.”

it clearly freaked her out a bit but I think she’ll get used to it my new meter and new Dx after awhile. I mean I must have tested in her class now over 5 times.

I had a awesome reaction though from my english teacher he’s a t-1 and the other day he invited us into his class room and he tryed to guess my BGL levels and he tryed to geuss his own. LOL he wasn’t very good at geussing. I’m kinda glad I did tell them so if I do get into troble even if they freak out they still know whats going on.

A mother:

Well done you. I���m sure it took a lot of courage and it will benefit other diabetics that follow you through the school.

My daughter and I have been ���training��� her teachers for 2 years (she���s now 9). On her first day of the new term her new teacher told her she couldn���t test in class and before we could even complain the head teacher was on the phone apologising to us and saying that of course my daughter could test whenever and wherever she wanted!

David:

For how many people have diabetes, it’s truly amazing how little people know. I assume that the “don’t test in class response” is a result of ignorance. Once someone knows what a low/high blood sugar experience looks like and how difficult it can be, he or she couldn’t possibly feel that someone shouldn’t test. If not, you’re a pretty rotten person deep down!

A.:

Quote:

My daughter and I have been ���training��� her teachers for 2 years (she���s now 9). On her first day of the new term her new teacher told her she couldn���t test in class and before we could even complain the head teacher was on the phone apologising to us and saying that of course my daughter could test whenever and wherever she wanted!

I as a parent would have been slightly angery still! I would have made it a big deal but I’m a teenager and I’m intitled to mood swings and bad deceision makings at times.

I’m only 16 right now and in grade 11. Surpriseingly everythings gone as smooth as it can be.

Quote:

For how many people have diabetes, it’s truly amazing how little people know. I assume that the “don’t test in class response” is a result of ignorance. Once someone knows what a low/high blood sugar experience looks like and how difficult it can be, he or she couldn’t possibly feel that someone shouldn’t test. If not, you’re a pretty rotten person deep down!

I agree teachers should be able to take a little course at there inservice to educate them on diabetes and hypoglycemia. She’s being extremely good about the situation even though she doesn’t get it intirely. If she had said no I would have made a point of doing it specifically in her class. It’s great though that I have a Tpye-1 teacher he gets it no effort in explaining. Plus it’s nice to know if I’m in a low someone else other than my buds knows.

Here!Here! David yes you are one amazing guy!!!!! Everyone here is amazing.

Quote:

Hear hear, David. Trying to see it from a teacher���s point of view, I guess they think it���s a distraction in class, but monitors are so quick and sophisticated these days, that I don���t think that really holds water.

The other reason that has been mentioned to us in the past was a suspicion that our daughter was doing it for attention, but she doesn���t make a song and and dance about it, she just quietly gets on with it. And how many people ��� of any age ��� test themselves unnecessarily? Really?

My moniter beeps really load but I havn’t found it a distraction! My only distraction is when Kids start asking questions or try to help. I’m patient though I have to be I can’t expect people to understand if I’m not polite. My least fave question is “Can you test my blood sugar?”

and I’m always like “No you can’t share meters”

I don’t test myself unnecessary I would give anything in the world to test less than I do!

I test when I wake up,before after and inbetween every meal and it seems all I do is TEST TEST TEST!

I’m actually having problems drawing blood now!

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studiu

Specific questions answered by patients 18 years and older, showed that young adulthood was perceived as a moment in life with increased concerns about glycemi control and the development of late complications of the disease. There was a tren for diminished DKA episodes and more episodes of hypoglycemia. Young adults described how they experienced the transition period from adolescence to young adulthood. Some of their main comments were the following: ���I am more worried no but I just can���t stay under control; I had a very negative and pessimistic perspective���; ���As an adolescent I was ���untouchable���; ���I couldn���t accept my illness���; ���I was very rebellious���; ���I did not take my illness seriously���; ���I wa always frustrated���; ���I used to feel sad and inferior to others���; ���I have learned to live with diabetes���; ���I am more responsible���; ���I have stopped letting diabetes run my life���; ���I am recovering happiness after living many years as if I where in a hole (antisocial and frightened)���; ���It changes from a sickness to a life-style���; ���My control has nothing to do with my age, it depends on other circumstances like problems at home school or work���; ���I felt my mother on my back all the time���; ���Before I was not alone, I had my family���s support���; ���Since my parents have not been paying much attention I have not taken care of my health���; ���I knew that even if I didn���t pay attention to the doctors or my parents, nothing was going to happen to me���; ���I lied and was bothered by the doctors, who made me feel guilty about my HbA1c levels���; ���My new doctor examined me and asked me about my diabetes, but he is not really interested in me���; ���It helped me a lot to meet other young people with diabetes���; ���Now I am worried about complications and my future���; ���I was not in control until I became pregnant���; ���Now with so many activities and responsibilities, its more difficult to care for my health���; ���Now I realize that I could have prevented the complications���.

Discusi��n

The present study was done with the main objective to describe the emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes. Adolescents as a group had higher scores in emotional dysfunction related to diabetes (PAID), and diminished knowledge in diabetes-related areas. The 25-30 age group, which was composed mostly by women, showed a trend for a better glycemic control and lower PAID scores; however, fewer individuals were doing BG monitoring or had intensive insulin treatment programs. The improvement in metabolic control in this age group is likely related to a better adherence to the diabetes treatment program. It does not mean, however, that intensive programs do not result in a better glycemic control.

The Problem Areas in Diabetes Scale19-21 is a brief self-report measure of diabetes-related distress that has been found to be valid and clinically useful in type-1 and type-2 diabetes patients. PAID scores have been found to show positive associations with HbA1c, and are a major predictor of poor adherence to treatment not involving general emotional distress. In the present study, an inadequate emotional response to diabetes was mainly associated with poor glycemic control, and inversely, with higher educational levels and recent evidence of severe hypoglycemia. Adolescents had higher scores in the following items; feeling scared about living with diabetes; feeling guilty about not complying with treatment programs, and dissatisfaction with their attending physician. There was also a trend towards feeling more discouraged with the diabetes regimen and uncomfortable with interactions related to diabetes issues with family/friends.

In a study comparing type-I diabetic subjects in US and Dutch population,22 the mean PAID score was 33+22 and 25+19 respectively, compared with 48+21 in the present study. The differences observed are only partially related to the youngest age in our studied population. As in the present study, lower HbA1c levels were associated with less emotional dysfunction related to diabetes, and a younger age was related to higher PAID scores.

Critical tasks of young adulthood include the development of a comfortable identity, the capacity to enjoy intimate relationships, the ability to preserve a previously developed sense of autonomy and productivity, and the acquisition of more mature defenses against adversity. Concerns about the presence of a chronic illness may inhibit this progression. Some young people make decisions based on incomplete information, which changes the course of their lives. For example, some avoid marriage or permanent relationships, or fail to get involved in long-term commitments. 9-11,14-16

Most of the medical literature includes information from patients who have had an adequate medical follow-up. In a previous report,23 we studied 209 type-1 diabetes patients who attended two of the main Pediatric Endocrine Clinics in Mexico City, and left those Centers because of age (as they became young adults). We could not obtain information or confirm a medical follow-up in 71% of them; eight were known to be dead (seven from diabetes-related complications). Presumably, most patients were seen by primary care physicians, or by no physicians at all. Only 62 (29%) of the patients, could be reached by phone, telegram or during their routine clinical appointments. Reviewing their old clinical records as adolescents, two thirds had poorly controlled diabetes and 16% had proliferative retinopathy. This information leads us to reflect upon the true story of diabetes, particularly in underdeveloped countries or in very low income groups.

Why are so many patients lost to follow���up?, and What happens to them?, are two important questions that deserve an answer, and are likely related to a diversity of actors: The scarce economic and social resources compel patients to not leaving their work for a medical appointment (consequently, most of them do not even mention that they have diabetes for the fear of losing their job). Others, as young adults, may lose the family health coverage offered by the Social Security System. There may be erroneous attitudes towards a disabled child (in this case with diabetes), more common in the poor income classes, that leave these patients with no other alternative but to deny their illness. Patient attitudes such as reluctance to see another physician, take on more responsibilities, be overwhelmed by other problems, and the belief that they will be safe just by following the usual indications, are some of the coping strategies used by patients. Unfortunately, patients usually return too late to be followed and treated for their diabetes, when the majority of them have already developed serious complications of the disease. The latter is usually the main reason why they return for medical follow-up.

Only a few studies have examined the impact of diabetes in patients as they experience the transition into young adulthood. Lloyd et al10 observed that type- 1 di
abetes patients where more socially isolated than healthy controls. Tebbi et al 11 found that general wellbeing was lower in diabetes patients, but that they wereable to adjust well in terms of employment-related issues. Increased rates of depression and high, but significant rates of suicide have not been observed.12,13 Other authors have suggested that there may be an increased prevalence of eating or other psychiatric disorders.24 As it has become obvious, diabetes in someone with mmature psychosocial defenses is more likely to require increased structure and support for treatment.1-3,15

Other studies suggest that type-1 diabetic young patients do not experience lower self esteem, more symptomatic distress, or personality disorders.14-16 Adolescents were found to be carrying out the developmentally appropriate tasks involved in the transition to adulthood. However, they perceived a lower competence in social relationships, but diabetes did not have a clear negative impact on their adjustment as young adults. These findings were observed in a Caucasian population reasonably well educated and with few individuals from lower socioeconomic strata. It is likely that type-1 diabetes causes more serious psychosocial problems in patients from minority populations, who are often less educated and from a lower socioeconomic class.14

In the present study, young adulthood was associated with a better metabolic control in females (those reached by the survey and who had a medical follow-up). This could be related to the fact, that they became more concerned about the near future (marriage, motherhood, complications).

Adolescence and early adulthood is different in Mexico than in most developed countries. The family bounds are closer, young adults must obtain their own economical support at early ages and independence from the family occurs only several years later.

In a recent study comparing health care indicators in type-1 diabetes patients, it was concluded that other components of the health care structure (including free, and/or easy access to insulin pens and selfmonitoring of blood glucose supplies) may be critical.24 In Mexico, because of poverty and scarce medical and family resources, intensive insulin treatment programs are a real option for less than 5% of our diabetic population. 17

Diabetes regimens include many aspects that are difficult to comply with; it is a chronic disorder, lifestyle changes are required, treatment is complex, intrusive, and inconvenient, and prevention instead of symptom reduction or cure is usually the main goal. Variables that are known to affect adherence to treatment include the type and duration of diabetes, evidence of late complications, availability of socioeconomic resources, educational background, culture, and the individual���s personality.1,2,25

As evidenced in this and other studies, most young adults have no clear concept of chronic illness and prevention, therefore, this is not a problem exclusive of this age group. It is a great challenge, particularly during the transition period from adolescence to early adulthood. It is necessary to discuss carefully the prognosis of the quality and duration of life and to review the known facts about the long-term outcome of diabetes. The relevance of relationship building, assessing expectations, realistic goal setting, and team and family support is unquestionable. Cost-effective approaches and optimization of resources must always be kept in mind.

In conclusion, the identification of psychological and behavioral problems in adolescents and young adults with diabetes is mandatory. There is a need to develop new strategies that may help to improve the follow-up and treatment of type-1 diabetic patients.

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