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[IP] From U.K. - "food for thought"

Diabetes Metab Res Rev 2001 Jan-Feb;17(1):67-74

Achieving optimal diabetic control in adolescence: the continuing enigma.

                        McConnell EM, Harper R, Campbell M, Nelson JK.

                        Diabetes Unit, Ulster Hospital, 700 Upper 
Newtownards Road, Dundonald, Belfast, Northern Ireland BT16 1RH, UK.

  The transition from childhood through adolescence to adulthood is a 
difficult stage, particularly for patients with type 1 diabetes. The 
yearning for autonomy and independence, as well as the hormonal changes 
around the time of puberty, can manifest in poor glycaemic control. The 
focus on diet and weight increases the prevalence of eating disorders, 
compounding the difficulties in supervising diabetes patients. This can be 
exacerbated by the realisation that hyperglycaemia induces weight loss and 
the use of this knowledge to further manipulate diabetes control to gain a 
desired body image. The management of adolescents with type 1 diabetes is 
therefore challenging and requires close collaboration between 
psychological medicine and diabetes teams. This review describes the 
difficulties frequently encountered, with a description of four cases 
illustrating these points. Case 1 demonstrates the problem of needle phobia 
in a newly diagnosed patient with type 1 diabetes leading to persistent 
hyperglycaemia, the recognition of weight loss associated with this and the 
development of bulimia. The patient's overall management was further 
complicated by risk-taking behaviour. By the age of 24 years, she has 
developed diabetic retinopathy and autonomic neuropathy and continues to 
partake in risk-taking behaviour. Case 2 illustrates how the lack of 
parental support shortly after the development of type 1 diabetes led to 
poor glycaemic control and how teenagers often omit insulin to accommodate 
lifestyle and risk-taking behaviour. Case 3 further exemplifies the 
difficulty in managing patients with needle phobia and the fear of 
hypoglycaemia. Case 4 adds further weight to the need for parental support 
and the impact of deleterious life events on glycaemic control by 
manipulation of insulin dosage. Copyright 2001 John Wiley & Sons, Ltd.

                        PMID: 11241893 [PubMed - indexed for MEDLINE]

Jim S.
email @ redacted
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