Teens and Type 1 Diabetes: How can we make it better?
Mar 31, 2017, 17:47 PM
It’s the third time I have seen this patient in the hospital within the last six months – three consecutive visits for DKA – and I am frustrated. The nurse on the floor suggests the patient needs more education, but I know she understands her didactic education on diabetes management. She can teach back every corner of her individual diabetes management program: the frequency of testing, what basal and bolus insulin means and where they are found in the insulin pump. I’ve provided and reviewed handouts on sick day management and DKA prevention– and she can answer any questions I throw at her. She is right on when questioned about carbohydrates (as right on as one can be!). She will tell her teacher, the hospitalist, and her mother that she checks her BG four to six times per day, but I know it is not true – her pump download reveals few BG checks per week. And I know she is slowly killing herself with hyperglycemia.
And then I soften – and know having type 1 diabetes is never easy – and neither is being a teen, even without diabetes.
I am not a psychologist – but I am a diabetes educator, and part of my role is helping to find a way for persons to engage in their diabetes care. Whether it be from motivational interviewing, a soft approach to recommendations, or a more hard-lined approach. I have tried everything I can think of, and the problem keeps rearing its ugly head. Another visit, more excuses and more hyperglycemia. It is also disruptive to her family and she has missed more school days than I can count. She's seen multiple counselors, but hasn't connected with any of them.
She is a teenager – sound familiar?
And then I soften – and know having type 1 diabetes is never easy – and neither is being a teen, even without diabetes.
So what to do with this case (one of many in my world of working with teens with diabetes)?
As a diabetes educator:
- I can assess the child and family for their ability to function and follow up with responsible diabetes care.
- I can assess the patient for depression using a screening tool.
- We can discuss barriers to care such as fear of hypoglycemia, weight gain, and diabetes related distress.
- I can talk with the mother in regards to shared responsibilities and suggest that transition of care into adulthood does not mean an end to the family team for diabetes management.
- I can encourage her to attend diabetes camp – a place where having type 1 diabetes is the norm and the statistics would support better self-care post-camp – at least for the short-term.
- And I can always leave the door open. A place where the teen can come in and discuss diabetes management without fear; hoping that someday the light will come on and taking control of her diabetes will be more of a life adventure and less of a burdensome task, resulting in better self-care.
What do you do in your practice to enhance diabetes self-management in this challenging but wonderful group of patients?
About the Author:
Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.