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(39) Diabetes

 Care Plan Presentation: Type 2 Diabetes in the Adolescent Population

Diabetes and Teens

Diabetes39

Diabetes and the adolescent

My 16-year-old son is only 5' 2" (157 cm) and very immature. I have heard that children with diabetes reach puberty a year or two later than anyone else. Will he grow later?

If your son is sexually underdeveloped, then he will certainly have a growth spurt when he goes into puberty. However, 5' 2" (157 cm) is undersized for a boy of 16. It could be poor diabetes control that has stunted his growth but there are other possible factors, including the physical stature of his father and yourself. If you are both a normal height, there could be some other medical reason for your son’s short size. It would be worth consulting your doctor or clinic doctor rather than blaming it automatically on his diabetes.

My daughter and I are getting extremely anxious although our doctor tells us there is nothing to worry about. She developed diabetes when she was 14 years old; 1 year after her periods had started. They stopped completely with the diabetes and have never started again, although we have now waited for 2 years. Is our doctor right to be calm and patient, or are we right to be worried?

A major upset to the system such as diabetes may cause periods to stop in a young girl. It is a little unusual for them not to reappear within 2 years and we should like to be certain that your daughter’s diabetes is well controlled and that she is not under-weight. Your doctor will be able to answer these two questions. If her control is good and she is of normal weight, then it would be reasonable to wait 1 or 2 years before embarking on further investigations. There is a very good chance that her periods will return spontaneously. If they do not return, nothing will be lost by waiting for another 2 years.

I am nearly 16 and have not started menstruating yet.  Is this because I have diabetes? Since I was diagnosed, I have put on a lot of weight.

On average, girls with diabetes do tend to start their periods at an older age. We assume from your question that you are now over-weight and this may be another cause for delay in menstruation. Presumably you have begun to notice other signs of puberty such as breast development and the growth of pubic hair. If so, you should make a determined effort to lose weight and control your diabetes carefully. This will involve a reduction in your food intake and probably an adjustment in your dose of insulin. If, after another year, you have still not seen a period then you should discuss the matter with your doctor.

My son has just heard that he will be going to university next year. While we are all delighted and proud of him, I worry because he will be living away from home for the first time. For the 7 years since he was diagnosed, I have accepted most of the anxiety and practical arrangement of his meals and he has done his best to ignore his diabetes. How is he now going to face it alone?

If your son is bright enough to get into university, he should be quite capable of looking after his diabetes. However, you are right to point out that your son’s attitude towards his diabetes is also important. All mothers worry when their children leave home for the first time and it is natural for a child with diabetes to cause extra worry. You can be sure, however, that the training you have given him over the years will bear fruit. Most children like to spread their wings when first leaving home and you can expect a period of adjustment to his new responsibilities. Provided that he realizes why you regard good control of his diabetes as important, he will probably become more responsible in good time. It would also be sensible for your son to contact the diabetes clinic in his university town, so that they can give him support if necessary.

How does diabetes affect my prospects for marriage?

We have never heard a young man or woman complain that diabetes has put off potential marriage partners, although we suppose it could be used as an excuse if someone was looking for a convenient way out of a relationship. If your diabetes has affected your own self-confidence and made you feel a second-class citizen, then you may sell yourself short and lose out in that way.

I have Type 1 diabetes and have recently made friends with a super boy but am frightened that he will be put off if I tell him I have diabetes. What should I do?

The standard answer is that you must tell your new boyfriend at the beginning. However, you have obviously found this a problem or you would not be asking the question. There is no need to broadcast the fact that you have diabetes. It would be possible to conceal diabetes completely from a close companion, although sooner or later he will inevitably discover the truth. Once you get to know him better, your best plan would be to drop a few hints about diabetes without making a song and dance about it, perhaps during a meal together. If the relationship grows, you will want to share each other’s problems – including diabetes. We have never known a serious relationship break up because of diabetes.

My 15-year-old son developed diabetes at the age of 12. Initially he was very sensible about his diabetes but recently he has become resentful saying that he is different from everyone else and blaming us for his disease. What do you suggest?

You must first realize that most people of all ages (and their parents) feel resentful at some stage about this condition, which causes so much inconvenience in someone’s life. Many 12-year-old children conform with their parent’s wishes and generally do as they are told. However, by the age of 15 other important pressures are beginning to bear on a developing young person. In the case of a boy, the most important factors in life are first his friends and secondly girls – or possibly the other way round! While you as parents are prepared to make allowances and provide special meals for example, most young lads want to join the gang and do not wish to appear ‘different’.

At a diabetes camp (which was restricted to hand-picked, well adjusted young adults with diabetes), the organizers were horrified to discover how angry the young people felt about their condition. Of course this anger will often be directed at the parents. We can only give advice in general terms that apply to most adolescent problems.

• Keep lines of communication open.

• Boost his self-esteem by giving praise where praise is due even if your own self-esteem is taking a hammering.

• Allow your son to make his own decisions about diabetes. If you force him to comply, he will simply avoid confrontation by deceiving you.

• Remember that difficult adolescents usually turn into successful adults.

Our 15-year-old daughter has had diabetes for 4 years and until recently has always been well controlled. Now it is very difficult to get her to take an interest in her diabetes and she has stopped doing blood tests. At the last clinic visit, the doctor said that her HbA1c was very high and he thought she was probably missing some of her injections.

I really do not know what to do.

This is a very upsetting situation for all concerned and unfortunately it is not uncommon. Diabetes is difficult because it places great demands and restrictions on people but in the short term they have nothing to show for their efforts. Non-compliance (not following the prescribed treatment) is very common and the reasons for it are very complex. Like most girls of her age, your daughter probably wants to lose weight and she may have discovered that allowing her glucose levels to float up is a very effective way of quickly losing a few pounds in weight. Thus there may be positive gain to your daughter in missing a few insulin injections.

There is no easy solution to this problem especially as many girls in this situation brightly turn up at the clinic and announce that ‘everything is fine’. Simply challenging your daughter and threatening her with the long-term complications of diabetes is unlikely to do much good. It is better to try and get her to realize that you understand that living with diabetes is not easy, and allow her to express her own feelings about it. Of course she may be at a stage of feeling that parents are light-years away from her own experience in which case she is more likely to unburden herself to a close friend, especially someone else with diabetes.

 

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