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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]
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