Building Competency in Diabetes Education THE ESSENTIALS

4-18 | CHAPTER 4

Deterioration in control may occur due to: • Inadequate or inappropriate insulin dose adjustment because of failure to monitor and act on BG results. • Lack of parental involvement. • Psychosocial factors, such as disordered eating habits and behaviours, and/or depression. • Social factors (i.e. discrimination, bullying, weight issues). • Poor family functioning. In their adolescent years, patients with diabetes are at a higher risk of developing psychiatric problems, eating disorders, as well as substance abuse than their non-diabetic peers (52). Female adolescents have a higher rate of depression which is associated with decreased compliance to diabetes self-care and poor adherence to medication (53). Eating disorders and disordered eating is seen in approximately 8-30% of adolescents with diabetes, being more common in girls than boys (53). Insulin manipulation is seen more frequently in this age group with deliberate omission or under-dosing of insulin (diabulimia) for weight loss (8). A complication of insulin omission in type 1 diabetes is an increase in episodes of diabetic ketoacidosis. Eating disorders in this age group are also associated with an increased prevalence of long-term complications, including retinopathy, neuropathy and nephropathy (52). Although this can be a difficult age to treat, research suggests that family and multisystem therapy can be effective (51). Identifying causative factors and directly targeting the behavioural problems has proven to be one of the most successful approaches. The use of the CSII has also been shown to help reduce family conflict and contribute to better glycemic control in the adolescent years (52). The health-care professional needs to play a key role in identifying the high risk adolescent and referring them for early and appropriate therapy (52). Sexuality With the surge in hormones and adjustment to puberty, the adolescent frequently has a difficult time controlling emotional responses, especially in the area of sexuality. Adolescence is described as the age of experimentation and “defining me” and this concept directly relates to their sexual behaviour. Sexual activity often is initiated in this age group, with the adolescent attempting to define their sexual identity. However, a risk that is regularly ignored in heterosexual encounters is the potential for pregnancy. Due to