Diabetes - issues for children and teenagers

Diabetes (known medically as diabetes mellitus) is a chronic and potentially life-threatening condition. It develops when the body loses its ability to produce insulin, or begins to produce or use insulin less efficiently. Managing it involves a combination of healthy choices, medication and regular glucose monitoring.

People living with type 1 diabetes must inject insulin several times a day, as must some people with type 2 diabetes. Many people with type 2 diabetes can manage their condition through healthy food choices and exercise.

Diagnosing diabetes in children and teenagers#

Until recently, almost all children and teenagers with diabetes were diagnosed with type 1 diabetes. Now younger people are also being diagnosed with type 2 diabetes, linked to factors such as being overweight, strong family histories and increasing rates of obesity.

A child or teenager who has recently been diagnosed may struggle with their own feelings, with the reactions of others, and with worries about returning to school. Teenagers may also have concerns about sex, alcohol, smoking, illicit drugs, driving and work.

Reactions to a diagnosis#

Children and families usually need a period of adjustment after diabetes is diagnosed. A newly diagnosed child or teenager will have a range of reactions and emotions. Common responses among children and their parents include shock, denial, anger, sadness, fear and guilt. These feelings usually ease with time and the right support.

Common responses to a diagnosis include:

• Anxiety about the condition
• A feeling of being overwhelmed by injecting and the other tasks that must be done every day
• Frustration over fluctuating blood glucose levels
• Feeling ‘different’
• Fear of experiencing hypoglycemia (low blood glucose, with possible symptoms such as dizziness, drowsiness and losing consciousness) in public
• Embarrassment about diabetes and how friends might react
• Difficulty coping with the emotional reactions of family members

The period immediately after diagnosis can be challenging. Emotional support from friends, family and a diabetes healthcare team can be very helpful and can improve how a child or teenager copes.

Helping children establish a routine#

Children with diabetes need help from parents and loved ones to establish a routine. This includes:

• Blood glucose monitoring
• Injecting insulin
• Learning how to count carbohydrates
• Coping with fluctuating blood glucose levels
• Seeing diabetes health professionals regularly

New challenges may arise as your child moves through different life stages.

Coping with diabetes day to day#

Living with and managing diabetes every day can be a struggle. Children are commonly concerned about:

• Feeling like a burden on the family
• Being treated differently or delicately, as if they are ‘sick’
• Coping with constant parental questions about their food, how they feel and whether they have taken their insulin
• Getting extra attention from parents or others, which may cause jealousy among siblings

It is normal for children and adolescents to feel sad, angry and fed up with their diabetes at times. Diabetes is a lifelong condition, so the tasks and skills needed to manage it must be continued over a lifetime.

If a child struggles with their diabetes management because they feel depressed, anxious or overwhelmed, seek help from your diabetes healthcare team. In some cases, support from a social worker, psychologist or psychiatrist may be necessary.

Diabetes at school#

Many parents and carers are understandably concerned when their child starts or returns to school after being diagnosed. Schools are responsible for your child’s safety and should make sure teachers understand diabetes and any potential risks. Parents need to provide the school with the information and resources it needs to support your child during school hours.

A school should be given both a diabetes action plan and a management plan. The plan should cover:

• Glucose monitoring
• Dietary needs
• Insulin administration
• Management of hypoglycemia and hyperglycemia
• Exercise
• Emergency contact details

If your child is going on a school camp, they will need a separate diabetes camp management plan. Request this from your child’s treating team well ahead of time.

For younger children, a ‘communication book’ can be used to tell the teacher about any important diabetes-related issues, and the teacher can use it to report concerns or events. For secondary students, email can also work.

Tell the physical education (PE) teacher about your child’s diabetes. Physical activity can cause a drop in blood glucose, so it is important the teacher can recognize and treat hypoglycemia. Encourage your child to tell their friends, at least their close friends, about their diabetes.

Moving toward self-management#

Parents of young children with diabetes are usually highly involved in day-to-day management. As children get older, it is important they develop the skills and confidence to manage their diabetes independently.

Increasing independence can be difficult for both parents and children. Parents may worry that their child is not ready for certain responsibilities, while the child may crave independence. There is a fine balance between supporting your child toward independence and allowing them to self-manage. Some suggestions:

• Involve your child in their diabetes management from the beginning to encourage independence. This may be as simple as choosing an injection site or turning on the blood glucose meter. Make sure the level of involvement suits their age, and ask your child’s diabetes educator about age-appropriate responsibilities.
• Encourage attendance at diabetes camps, where your child can meet others with diabetes and learn about diabetes care in a fun, safe and relaxed environment.

Making your child solely responsible for their care too early can leave them feeling overwhelmed. With support and guidance, your child can learn to fit diabetes care into everyday life and build lifelong skills and confidence.

Camps run especially for children and adolescents aged between 4 and 17 years who have type 1 diabetes aim to teach young people to manage their diabetes in a fun, safe and supportive environment, and to promote independence through adventure. Activities are designed to provide freedom and fun under professional supervision and with peer support.

Moving to adult healthcare#

Moving from adolescent to adult diabetes care usually happens around 16 to 18 years of age, although the process is ongoing and should begin soon after diagnosis. Some young people move first to a young adults clinic, and once they are 18 or 19 an adult diabetes specialist takes over their care. You and your child can prepare by discussing the move with your healthcare team.

Use the transition process to encourage your child to take a more active role in their care. Children can begin to schedule their own appointments and think of things to discuss with their diabetes team. It is also a good time to step out of the room for part of an appointment, so your child can raise issues they may not feel comfortable discussing with you present.

Body image and eating disorders#

Body image is a major issue for many adolescents, and having type 1 diabetes increases the risk of developing an eating disorder. Parents should be aware of this.

Some children feel pressured by friends and the media to conform to a certain body shape and weight. This pressure can lead to dieting, and dieting can lead to disordered eating, most commonly in girls but also in boys. Disordered eating can lead to glucose levels that are above target and unstable.

Some teenagers manipulate their insulin doses to try to lose weight or avoid weight gain. This can cause diabetic ketoacidosis (a dangerous build-up of ketones in the blood and urine), which is life threatening. Disordered eating, along with blood glucose that is out of target range, can also increase the risk of long-term complications such as damage to the eyes and kidneys.

If you think your child has an eating disorder or is overly concerned about body image and weight, talk to their diabetes treating team or dietitian about appropriate counseling and support.

Driving#

People with diabetes can hold a driver’s license or learner’s permit as long as their diabetes is well managed and they carry out certain self-management tasks before and during each trip. The main concern for licensing authorities is the risk of hypoglycemia occurring while driving.

A medical report, from the person’s treating doctor or diabetes specialist, is usually required before a license or permit can be issued, and at regular intervals afterward. Requirements vary, so check the rules that apply where you live.

Alcohol#

Alcohol can be a problem for teenagers with diabetes. It increases the risk of hypoglycemia both directly, through its effects in the body, and indirectly, by encouraging behaviors that add to the risk.

Ideally, teenagers with diabetes would not drink, but it is important that they and their friends understand what to expect if they do. Discuss alcohol with your child and develop strategies to reduce the risk of problems.

Alcohol increases the risk of hypoglycemia because it:

• Inhibits the release of stored glucose from the liver into the bloodstream
• Reduces the ability of a glucagon injection to reverse hypoglycemia
• Can mask the early signs and symptoms of hypoglycemia
• Can lead to confusion, which may affect a person’s ability to manage hypoglycemia
• May delay hypoglycemia until many hours, or even a day, after drinking

Combined with exercise such as dancing or sex, alcohol further increases the risk of hypoglycemia. It also affects blood glucose in varying and deceptive ways depending on the drink. Different drinks contain different amounts of alcohol and sugar, so they affect blood glucose differently. Sweet alcoholic drinks can initially raise blood glucose, giving a false impression that more insulin is needed or that there is no risk of hypoglycemia.

Indirect risks for a person who drinks include:

• Forgetting to take insulin as required
• Forgetting to carry diabetes identification in case of emergency
• Others mistaking the signs of hypoglycemia for simply being drunk, and not coming to their aid

If your teenager has been drinking, make sure they are woken at a reasonable time the next morning to check their blood glucose, take their insulin and eat. They may need help from a trusted friend or relative with some of these tasks.

Encourage your child to avoid alcohol or drink only in moderation. If they are going to drink, suggest they:

• Stay with someone who knows they have diabetes and understands the signs of hypoglycemia and how to treat it
• Eat some carbohydrate before drinking, every couple of hours while out, and before going to sleep
• Alternate between alcoholic and non-alcoholic drinks
• Carry hypoglycemia treatment and monitoring supplies at all times
• Check blood glucose, especially before bed, and keep monitoring the next day to detect hypoglycemia
• Discuss insulin adjustment with their doctor or diabetes educator beforehand, especially if they are likely to be very active, such as dancing
• Wear some form of medical identification

Smoking#

There is no safe level of smoking, whether or not your child has diabetes. Smoking increases the risk of serious health problems associated with diabetes. It can also raise blood glucose, because tobacco causes insulin resistance and stimulates stress hormones.

As a parent, you can set a good example by not smoking. If you are a smoker, support is available to help you quit. Always discourage your child from smoking.

Illicit drugs#

Illegal drugs can significantly damage health and cause death, whether or not your child has diabetes. For people with diabetes, taking drugs can result in glucose levels outside the target range, poor self-care, and an inability to recognize hypoglycemia and hyperglycemia.

Some researchers argue that teaching teenagers with diabetes how to reduce the risks is more effective than simply advising them to avoid illegal drugs. To reduce the chances of harm:

• Encourage your child to speak with their diabetes educator and other professionals with expertise in this area
• Educate yourself and your child about the possible risks
• Encourage your child to stay alert to signs of hypoglycemia and hyperglycemia, remembering that drugs may alter their ability to recognize symptoms
• Encourage your child to always carry hypoglycemia treatment
• Make sure some of your child’s friends know about their diabetes, the signs of hypoglycemia and how to help
• Encourage your child to stick to their normal routine as much as possible, always take their insulin, eat regularly, and check blood glucose often to see how a drug is affecting them, remembering that drugs vary in composition and may contain impurities
• Make sure your child always carries identification stating they have diabetes
• Remind your child to drink plenty of non-alcoholic fluids to stay hydrated

Sex and sexual health#

Adolescence is often a time of sexual experimentation. Your child may not want to discuss sex with you, so encourage them to speak with someone from their diabetes healthcare team. They may still ask you for information, so it helps to be aware that:

• Sex is a form of physical activity that can lower blood glucose
• Your child should have hypoglycemia treatment readily available

Women with diabetes can have healthy babies, but pregnancy should be planned with diabetes healthcare professionals to reduce the risk of complications for mother and baby. Effective contraception is vital to avoid unplanned pregnancy. Contraceptive advice can be sought from your child’s doctor, diabetes treating team or a family planning service.

Diabetes can contribute to sexual health problems for some people. Urinary tract infections and candida infections (thrush) occur more commonly in women, particularly if blood glucose remains high. After many years of diabetes, men may experience difficulty with erections. Anxiety, alcohol and some drugs can also cause this, so reassurance and accurate advice are important. Young people should be encouraged to discuss any sexual difficulties with their doctor.

Tattoos and piercings#

Diabetes can reduce the body’s ability to fight infection. If your child is considering a tattoo or body piercing, make sure they know about the increased risk of infection and that they:

• Are in good health, with diabetes well managed, to reduce the risk of infection
• Speak to their diabetes healthcare team beforehand for advice on lowering the risk
• Understand that regulation requirements and licensing standards vary, and check local rules
• Choose a reputable, clean and professional business that employs only properly trained staff
• Seek advice from a doctor promptly if there are any signs of infection, such as redness, swelling, discharge, pain or raised blood glucose

Key points#

• Diabetes is a lifelong condition, and the skills to manage it must be maintained over a lifetime.
• A new diagnosis often brings strong emotions such as shock, fear, anger and guilt, which usually ease with support.
• Children need help to build a routine, and as they grow they should move gradually toward independent self-management.
• Schools should have both a diabetes action plan and a management plan covering glucose monitoring, diet, insulin and emergencies.
• Teenagers face extra issues around eating disorders, driving, alcohol, smoking, drugs and sex, all of which can affect blood glucose and require planning and support.

Where to get help#