There is evidence that glycaemic control deteriorates during adolescence and there is an increased risk of admission to hospital with diabetic ketoacidosis. In addition the early signs of microvascular complications of diabetes may begin to appear in those who have had a significant duration of diabetes.

Aims of Diabetes Care during Adolescence

  • Promotion of physical and psychological well being
  • Normal growth and development
  • Avoidance of diabetes related hospitalisation
  • Achievement of good glycaemic control to limit the risk of long term microvascular complications
  • Regular screening (annually) for the detection of complications ie urinary microalbumin excretion, blood pressure, and retinal examination.
  • Integration into the school, social and working life of people in their age group

Insulin Regimens

  • Once daily insulin regimens are not appropriate for teenagers and young adults as they can neither achieve the degree of glycaemic control necessary to prevent long term complications, nor the flexibility to accommodate a busy teenage lifestyle.
  • Some teenagers manage with twice daily injections of premixed soluble and isophane insulins prior to breakfast and the evening meal.
  • Use of intensive insulin therapy (either multiple daily injections or insulin via continuous subcutaneous infusion) has become the preferred regimen over the last few years. Using this more intensive insulin programme along with more careful matching of insulin dose to carbohydrate (carbohydrate counting) allows greater freedom in the timing and quantity of meals and the spontaneity to join in sport and other activities.

 

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Monitoring

  • Home blood glucose monitoring is the method of choice
  • Young people with diabetes are encouraged to perform sufficient tests to be confident of their control and to record results in a log book. For those using intensive insulin regimens this may require very frequent monitoring (at least 4 tests per day). There is now software available to download blood glucose meters in the out-patient clinic –this can be a valuable teaching tool.
  • All young people with diabetes should be able to check for ketones using either urine ketone test or blood ketone meter.

Life-style issues

School/College

Young people with diabetes should not have to miss more school, apart from visits to the clinic, than anyone else. They can undertake all normal activities and their academic and sporting achievements should not be limited. Diabetes UK provides information material for teachers, which may be obtained from the Paediatric Diabetes Specialist Nurses.

School/College

Many young people with diabetes enjoy sport and some participate at a highly competitive level. With careful planning and monitoring of blood glucose levels, insulin doses and food sporting performance can be optimized. For further information visit www.runsweet.com

Alcohol

  • Most young people with diabetes use alcohol to the same extent as their peers and this can have serious consequences.
  • Alcohol excess is one of the common causes of ketoacidosis in this age group
  • Alcohol consumption is also a major contributing factor towards hypoglycaemia
  • Alcohol excess in the longer term can lead to weight gain and deterioration in glycaemic control
  • Information about the effects of alcohol on blood glucose levels should be given along with sensible advice regarding moderate and safe consumption.

Sexual Health

  • Contraception and pregnancy should be routinely discussed because of the adverse effect of poor glycaemic control on fetal development.
  • Young people with diabetes run the same risk of sexually transmitted infections
  • It is important to optimize glycaemic control prior to becoming pregnant to ensure the best health outcomes for both mother and baby.
  • Unplanned pregnancy can be associated with major problems – including difficulties in controlling diabetes and serious complications in fetal development
  • Counselling and contraceptive advice is available to those attending the Young Adult Clinic. For further information visit- www.fpa.org.uk

Recreational drugs - Use of recreational drugs is illegal

  • Use of illicit drugs by young people with diabetes may result in potentially serious adverse metabolic consequences eg ketoacidosis, severe hypoglycaemia.
  • Ecstasy has been associated with severe dehydration and the development of ketoacidosis.
  • For further useful information visit: www.talktofrank.com

Other Activities

Many young people with diabetes respond well to the opportunity to meet socially to develop their own support structures. The Youth Diabetes (YD) Project started in 1983 and provides a nationwide network of young people to meet and share experiences of diabetes.

Events include:

  • The Firbush project, run by Dr Alan Connacher from Perth Royal Infirmary, which provides an annual adventure camp for 16-21 year olds on Loch Tay.
  • An annual Youth Diabetes Conference, held in Spring and aimed at 15-25 year olds
  • Locally, an activity day is arranged every 2 years for young people aged 14-18yrs with diabetes

Further information can be obtained from the Youth Diabetes Group of Diabetes UK or from the local Diabetes team.

 

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