Teens and Diabetes: Sex, Drugs, and Rock and Roll.

Presented by Francine Kaufman and Richard Rubin, Diabetes123 Conference, Orlando Fl, 7-19-2001

 Having diabetes makes the passions and pitfalls of the teen years a little more challenging. This session addressed ways to meet these challenges. This was a very insightful overview of the kinds of challenges that teens in high school, and starting college face.

 As kids grow into their teen years and beyond, we are working to transfer the responsibility of their care from the parents to the teens. It is very hard to know when and to feel comfortable with that change. The best decision is one worked out between the parents, teen, and medical professional. Asking the teen to put together a plan and asking them how they will solve diabetes problems without their parents can facilitate this. This activity will give the parents reassurance and will let you evaluate the ability the teen has.

 Many times Parents and teens will split the diabetes control from their regular life. It is very important us to try and help them package diabetes as part of their regular life.

 There are many issues to deal with, peer pressure being one of the biggest. As your teens spend more time with their friends and less time with their parents it will become important for you to help the teens work through safe ways to do risky behavior. Although not many of the things that teens do carry no more risk in diabetes patients vs. non-diabetes patients, there are some that require extra care. The 2 most critical are alcohol consumption and driving.

 As you know alcohol consumption can cause the liver to not release glucose so severe hypoglycemia can occur. Because of this our teens and especially our freshman college patients, can have real problems. While non-diabetic children can pass out from excess alcohol consumption, an insulin dependant teen could be unconscious due to severe hypoglycemia. It is important that the teen monitor food and insulin intake as well as current glucose levels. You should encourage the teenager in your care to always have buddy who can be with them.

 As the teen’s diabetes care person, you can bring a lot of clarity and safety into what they do. Many teens will reach an age when they want to see you without their parents. We encourage you to offer this as your patients reach their teen years.  They will appreciate the chance to go over the tough issues that they may not want their parents to know about, and this helps to build a trust between you and your teen patient.

 It will also help if you do some role-playing with them and let them see how this can all work in the real world. In addition if you and your patient can work through all the things they are doing and how they can incorporate their care into their everyday live you may be able to avoid the “straw that breaks the camels back” in their diabetes care.

 When your teen patients leave for college, you need to work out a way for them to easily stay in contact with you. Usually their HbA1c will go up the freshman year. It is a good idea to have them contact someone at the medical, pharmacy, or nursing school at their university and establish a contact with that person. For many your patients you will have to do that for them.

 Your best way to be a good friend and caregiver to the teenage patient is to offer “open communication without judgment”

 Francine Kaufman, MD, Chair, Division of Endocrinology and Metabolism, Children’s Hospital. Los Angeles, and Professor of Pediatrics, University of Southern California Medical School.  Dr Kaufman is the President-Elect of the National American Diabetes Association. 

 Richard Rubin, Ph.D., C.D.E., Psychologist, Private Practice, Baltimore, and Associate Professor in Medicine and Pediatrics. Johns Hopkins School of Medicine, Baltimore, Maryland.  Author of Psyching Out Diabetes and Sweet Kids.