Some teens may experiment with new things, such as smoking, drug or alcohol use, or unprotected sex. For teens with diabetes, these behaviours can be extra hazardous to their health.
Caregivers also need to understand that diabetes routines may become a target for risk-taking behaviours. Teens may skip blood glucose (sugar) checks or meals. They may not wear their MedicAlert bracelet, which could help if anything went wrong.
Risk-taking behaviour can seriously affect diabetes control for teens who are injecting insulin. The result can be missing lots of school, hospitalization (due to diabetic ketoacidosis), poor growth, or weight loss. In this case, caregivers will need to start giving the injections and doing the blood sugar checks, regardless of the teen’s age. Caregivers have to keep assisting their teen until they are sure that it is safe to allow the teen to manage on their own again.
Smoking
One of the best things your teen can do for their diabetes, and overall health, is to not start smoking, or to quit smoking if they have already started. Smoking increases the chance of getting many kinds of cancers, and also increases the risk of blood vessel damage, heart attacks and strokes. People with diabetes already face these risks and every puff of a cigarette or exposure to second-hand smoke increases their risk of these serious health problems even more. Your teen and the entire family should keep in mind the following points about smoking:
- If you are a non-smoker, do not start
- If you smoke, try to quit as soon as possible
- Get help from your doctor or health-care team. There are proven ways to help people quit
- Quit together with other smokers in your house, so you can support each other
- Ask friends and family to help and to be supportive of your efforts
- You may struggle to quit smoking. It may take several tries, but do not give up
Quitting smoking can be difficult and a support system is necessary for success. Your child’s doctor and diabetes team have experience helping other teens break the habit. Ask for their help. There may be a smoking cessation program your teen can take. The day your teen stops smoking, their body will start repairing the damage done and they will be on their way to leading a healthier life.
Alcohol and drugs
Teenagers may be offered alcohol or drugs, and may have to decide whether they will try it. Teens with diabetes have to think about these decisions extra carefully because diabetes and alcohol or other drugs are not the best mix.
Alcohol
Alcohol has a powerful effect on blood sugar levels. Alcohol is processed in the liver. It blocks the liver from releasing sugar into the bloodstream. This can lead to low blood sugar levels (hypoglycemia).
If your teen is taking insulin or oral medications to lower their blood sugar level, the risk of hypoglycemia is higher. If your teen is going to drink alcohol, they should eat food with carbohydrates to help prevent hypoglycemic episodes.
A teen who is under the influence of alcohol may miss the early warning symptoms of hypoglycemia. Things may move quickly to a severe episode. Others who have been drinking may not recognize the problem; or they may smell alcohol on your teen’s breath and think they have passed out from being drunk. Your teen should be with friends who know about the diabetes so they can help them should their blood sugar go low.
Teenagers with diabetes are subject to all the other risks associated with alcohol use, such as drinking and driving. However, because of the risk of hypoglycemia with alcohol, teenagers with diabetes need to be even more careful to avoid driving if they have been drinking.
Many teens experiment with alcohol. If your teen has diabetes, they will need to think carefully about drinking. Help them understand the risks and take the necessary steps to drink safely and responsibly if they choose to do so.
Ideas for talking about alcohol with your teen
As a general rule, teaching teens with diabetes about safe alcohol use works better than forbidding it. You cannot assume that your teen will not try a drink at some point.
Here are a few tips to pass on to your teen if you think they might be experimenting with drinking:
- Wear a MedicAlert bracelet, which will give the necessary medical information if anything happens
- Drink in moderation as drinking too much alcohol is very risky
- Choose light beer and dilute white wine with club soda. Liqueurs, fruit drinks and drinks mixed with regular soft drinks have more carbohydrates
- Never drink on an empty stomach. Eat carbohydrates when drinking
- Test blood sugar level before, during and after drinking
- Stick with a friend who knows about the diabetes and can recognize signs and symptoms of hypoglycemia
Marijuana and other drugs
Marijuana, is a drug that can increase the appetite and affect judgment. Impaired judgment can blur how much food has been eaten, food choices and the balance between food intake and insulin or medication administration. This results in poor blood sugar control.
For teenagers with type 2 diabetes, this increase in appetite can result in extra snacking and get in the way of weight management.
Other street drugs can also contribute to poor judgement and risky behaviours, such as unprotected sexual intercourse.
Eating disorders
Eating disorders are common among teenage and young adult men and women. The exact causes of eating disorders are unknown. Generally, eating disorders result from a mix of social factors, stressful life events and genetics.
Teenage and young adult women with type 1 diabetes are more like to have ongoing disturbances in eating attitudes and behaviours.
Diabetes-related factors may sometimes increase the chances of an eating problem. At the time of diagnosis, teens have often experienced weight loss. With insulin therapy, they regain the weight quickly. The body is righting itself as it regains stable blood sugar levels. However, this may trigger body image dissatisfaction. A vulnerable teen may harbour the desire to be thinner again.
Moreover, meal planning, which is a key part of diabetes treatment, means that there will be some restraints on eating. This is another trigger to an eating disorder. Some teens who take insulin discover that by skipping or reducing their insulin dose, they can keep themselves underweight. This leads to poor diabetes control and potentially life-threatening diabetic ketoacidosis. In the long run, this can lead to earlier onset of diabetes-related
complications.
Warning signs of an eating disorder
Eating disorders in people with type 1 diabetes can lead to wild, unexplained changes in blood sugar levels, often outside the safe range. Some other signs of eating disorders include:
- many hypoglycemic or hyperglycemic episodes
- a preoccupation with food and weight, beyond what is needed in diabetes management
- a stated desire to lose weight beyond what seems appropriate
- requests for a change to low-calorie, low-fat, or other diet trends to lose weight
- binge-eating episodes
- insulin omission
- weight loss.
What you can do to help
If you are worried your teen is developing an eating disorder, here is what you can do to help:
- Be a healthy role model for your teen by promoting a healthy body image for your teen and yourself. Avoid saying negative things about your own physical appearance and weight
- Eat meals together as a family. Emphasize health and nutrition to help your teen develop a healthy relationship with food. Eating as a famliy also promotes strong family bonds and better communication
- Talk about more flexible meal plans with the diabetes dietitian. Perhaps the current meal plan restricts eating too much and reinforces the idea that the person with diabetes is different and deprived
- Express your concern to the diabetes team and get support for your teen
- For more information, see our section on eating disorders