Coping with Juvenile Diabetes
Most teenagers want to be considered "cool," which often means blending in with their peers. For teenagers living with diabetes, that can be difficult, especially when they have to worry about sharing chocolate cake on dates or if they will have to sit out during games when they feel too dizzy to play.
As a starting varsity soccer player, 14-year-old Ryan Candice Branson is disappointed she cannot always play in the games. She even wonders whether her team would have won District if she could have played more. "I have to sit out for the first half because, oftentimes, I get low right before the game," she says. "Then, there is a pattern. I'll be low, so I drink juice. By halftime, my blood sugar is up. I'd have symptoms, like I'd be dizzy and wouldn't be able to perform my best."
For the past 10 years, Branson, a freshman living in Pearl River, La., has lived with Type I diabetes. She uses an insulin pump, a small beeper-sized device that delivers insulin to her body via a tube that is placed just under her skin, in order to control her disease. And while she plans to avoid certain activities in order to preserve her health, she also doesn't intend to let her diabetes stop her from experiencing all that life can offer. Branson is excited about being a student ambassador in the People to People International program, even though she will have to bring her diabetes supplies along. "I'm traveling to England, and my mom is driving me crazy because she is worried," Branson says. "She is worried about who will check my blood sugar."
David and Paula Smith of Chesterfield, Mo., are the parents of six boys, including two with Type I diabetes. David Smith says his youngest son, Carson, 5, was used to eating whatever he wanted before he was diagnosed with diabetes this past Christmas. Their oldest son, Tyler, 15, who uses an insulin pump, was diagnosed with the disease at 14 months old. "You never get used to it," Smith says. "It's part of your routine. You have to monitor with exercise, diet and insulin."
Like a typical teen, Tyler partakes in school sports, playing lacrosse and football. When he goes out on the field to play, he straps a glucose tablet to his water bottle, just in case he needs it. Unfortunately, his diet is also that of a typical teen. "His diet is Cheetos, ice cream and chocolate syrup, which is the stuff he should not have," Smith says. "He knows he should not be having that, but how do you stop him? I know he knows better. We see doctors frequently with the checkups, and everyone is on him to take care of himself."
Food is a real issue when it comes to diabetes and teens – the wrong kinds and too much. Dr. Ann Kulze, a physician and wellness consultant in Charleston, S.C., says a growing number of teenagers suffer with Type II diabetes, which used to be called adult-onset diabetes, because doctors rarely diagnosed children with the disease. "We are in the midst of a true epidemic of Type II diabetes," she says. "Unfortunately, it's occurring now in children as young as 5."
The Obesity Connection
Dr. Kulze says Type II diabetes makes up about one-third of the new cases of diabetes in children and teens. "Obesity is what seems to be the biggest driving force in the escalation," she says. "The second most powerful risk factor for Type II diabetes would be physical inactivity. The third would be genetic influences, and fourth would be specific dietary habits such as consumption of trans fats, refined carbohydrates, foods that have been shown to lead to insulin resistance, which is the underlying metabolic problem in Type II diabetes."
Although there is no known cure for Type I diabetes, 90 percent of the cases of Type II diabetes are preventable through the maintenance of a healthy body weight, physical activity and a healthy diet, according to Dr. Kulze. Being overweight increases a teenager's risk of Type II diabetes seven-fold. Moreover, Dr. Kulze says, being obese increases a teenager's risk of Type II diabetes 20- to 40-fold.
"My opinion as a nutrition and wellness expert, I think the most powerful intervention for helping a teen reach a healthy body weight would be promoting exercise, regular physical activity," Dr.Kulze says. She suggests teenagers log two hours of physical movement a day. "That does not have to be two hours of playing soccer across 24 hours, but, cumulatively, their bodies need to be moving for two hours. And we have studies that tell us 30 minutes of moderate aerobic activity, such as walking five days a week, will decrease the risk of diabetes 30 percent."
Dr. Kulze also advises parents of teenagers to limit the amount of time children watch television, play video games and use the computer. Also, restrict liquid calories such as soda and sports beverages. "Not only do these beverages increase the risk of obesity, but increase the risk of Type II diabetes," she says.
Another tip is to encourage teenagers to eat fruits and vegetables along with whole grains and lean proteins. "Limit fast food," Dr. Kulze says. "Why? It's got so many calories. It's calorically dense and also filled with the types of foods we are finding increase your risk of diabetes such as the sodas, the French fries, the white flour bun. There is also interesting evidence fast food actually increases appetite. One study showed children who consumed fast food eat more after that fast food meal. They eat more the rest of the day and end up consuming 187 calories more than a child who did not have fast food that day. That can translate over time to major weight gain."
Type I vs. Type II
When it comes to the differences between Type I and Type II diabetes, "Type I diabetes is a whole other ball of wax," Dr. Kulze says. "It was traditionally the only one that occurred in children and teens. It's an autoimmune phenomena where the cells that make insulin have been destroyed, and if you don't have insulin, you can't get your blood glucose to your cells. They have to be given insulin. They are on shots or a pump. We do not know what leads to that medical condition. There is no known preventive strategy for avoiding Type I diabetes."
Cathy Tibbetts of Fairfax, Va., a registered nurse and president of the American Diabetes Association's health care and education board, says some of the signs of high blood glucose include extreme thirst, frequent urination and fatigue. If a teenager's blood glucose levels exceed 250, they need to check their urine for ketones. This can be done at home with strips that are available to the general public at local pharmacies. "The doctor should be contacted any time ketone levels are found to be moderate or large," she says. "Common symptoms of low blood glucose include hunger, sudden weakness or dizziness, fast heartbeat or a change in personality."
With Type II diabetes, parents may see dark pigmented patches around the teen's neck or armpits, a condition called acanthosis nigrans. Up to 75 percent of teens with insulin resistance will have the condition. "A lot of parents think it's dirty spots, but it's a compelling warning sign there may be Type II diabetes developing or already fully developed," Dr. Kulze says.
Dr. Kulze says many people with Type II diabetes will require oral medication, and all require exercise and dietary changes. They should also have their blood sugar monitored on a regular basis at school. Teenagers with Type II diabetes who are not on insulin, still need to have their blood sugar monitored regularly.
Tips for Teens
"Dating is an important part of growing up," Tibbetts says. "It involves getting to know others in a more personal way. Before teens start to date, they may want to talk with parents, their doctor or diabetes educator about the types of situations that are likely to come up, for example, eating out. Would it be easier to handle this if your date knows you have diabetes?"
And while alcohol should be avoided by all teens, this is especially true for teens living with diabetes. "Alcohol increases the risk for extremely low blood sugars, and the use of illegal drugs adds the potential for life-threatening complications," Tibbetts says. "In today's world, most teens will be exposed to both of these and need to have a plan."
Teens with diabetes may also need to check their blood glucose or take insulin during a date or time out with friends, so plan ahead for this. Parents can make it easier by giving teens access to the latest gadgets and gizmos for managing life with diabetes. Tibbetts says the meters used to check blood glucose levels today are smaller and come with "interesting bells and whistles to help teens." The newer technology requires smaller amounts of blood and allows for testing on the palm, arms or thighs for less discomfort.
And of course, Tibbets advises teens with diabetes to wear a medic-alert necklace or bracelet and carry carbohydrates with them at all times.