The teen years are associated with physical, mental and emotional changes and development. During this time, your teen may feel a growing desire to fit in with friends, to experiment, to test limits, and to seek independence from family. Self-image changes when a teen’s sexuality starts to emerge. Diabetes can affect these processes in different ways.
With or without diabetes, all teenagers develop differently. Once teenagers can start to reason and think about their future, they will understand the implications of diabetes and its management.
There are many factors such as peer pressure, parties and other social events, part-time jobs, and a busy life in general that may interfere with the teen’s ability to translate this new awareness into good self-care.
Even though it may seem that teens should be more responsible and more able to achieve good blood glucose (sugar) control, adolescence is often the time when optimal diabetes management is most difficult.
Normal developmental patterns during adolescence
| Normal developmental patterns during adolescence | |
|---|---|
| Age | Your child: |
| Early adolescence (ages 12 to 14), your child: | places enormous importance on body image |
| struggles with sense of identity | |
| seeks reassurance more and more from peers rather than family. | |
| Mid-adolescence (ages 14 to 17), your child: | struggles for autonomy and control of personal destiny |
| can be involved in teen–parent conflict stemming from relatively trivial issues such as hair length, clothes and curfew, as well as more serious issues such as smoking, alcohol and drug use | |
| may indulge in other risk-taking behaviours. | |
| During early adulthood (ages 18 to 21), your child: | becomes increasingly stable |
| begins to shape long-term plans such as career and personal goals. | |
How diabetes affects adolescents
Diabetes management needs a degree of responsibility and behavioural control that is not typical in many adolescents. It affects important developmental stages, including independence, body image, identity, sexuality, responsibility and self-esteem.
Many teens do not like checking their blood sugar levels and avoid doing it. They may think that checking their blood sugar level is inconvenient, a constant reminder of their condition, and makes them feel different. It is worthwhile having a discussion with your teen in an attempt to discover what the issues are in their particular case.
Blood sugar targets
The target range for children aged 12 and older is to achieve a pre-meal blood sugar level between 4 and 8 mmol/L. This range allows good blood sugar control while reducing the risk of severe “low blood sugar” (hypoglycemia). This is a tighter range than for children aged 6-12, who have a target range of between 4 and 10 mmol/L. Older children and teenagers should be able to recognize the symptoms of hypoglycemia, and should be able to effectively manage the reduced target range.
Taking insulin
Many teens may neglect to take their insulin. There are many reasons why this may happen:
- It is inconvenient and time-consuming
- They may forget to bring their supplies
- Each needle is a reminder that they have diabetes and they are different from their peers
- They may want to avoid dealing with their diabetes
Sleeping in
When taking any intermediate or long-acting insulin, your child should receive a dose routinely at the same time of the day. Sleeping in should be kept to a minimum as giving insulin at different times will cause swings in blood sugar levels and affect your child’s long-term health. It is acceptable to give insulin within a one-hour window. For instance, if your child is taking intermediate or long acting insulin at 8 a.m., they should take the insulin between 7:30 a.m. to 8:30 a.m.
You may want to discuss with your diabetes team about other more flexible insulin regimens (multiple daily injections or insulin pumps) that may better fit your teen’s lifestyle. Sleeping in is much easier if your teen is using an insulin pump or long-acting insulin (such as Lantus/Glargine, or Levemir/Detemir). The risk of either “low blood sugar” (hypoglycemia) or “high blood sugar” (hyperglycemia) should be very low.
Menstruation
Diabetes will have no effect on your daughter’s periods. However, the increase in hormones during menstruation can cause blood sugar levels to rise. Women who take insulin may need to take more during their periods. You can check this by observing the blood sugar pattern over the month.
Birth control
Teens with diabetes are no exception to the need for protection from sexually transmitted infections (STIs) and unwanted pregnancy. Teens with diabetes should be given information about sexuality, contraception and pregnancy well before they need it. These discussions should take place with members of the diabetes team and should be confidential.
To prevent STIs, condoms are a must for all sexually active teens. To prevent pregnancy, women with diabetes have the same options for birth control (oral contraceptive pill, IUD, etc.) as do those without.
Pregnancies in teenage girls are always considered high risk as there is a greater chance of things going wrong for both the mother and her baby. Babies who are exposed to high blood glucose levels when they are in their mother’s womb have a greater risk of:
- birth defects
- being larger than babies whose mother had no high blood sugar episodes during the pregnancy; having a big baby leads to a difficult delivery
- having multiple health problems after birth.
When the time comes to plan a family, your child should be reassured that the health-care team will be there to help them and their baby get the best possible start.
Driving
Driving a car requires sound judgement and responsibility. Because a low blood sugar level can impair judgement, young people with diabetes have an additional duty to make sure that their blood sugar level is not too low before they get behind the wheel of a car. A low blood sugar level can increase the risk of an accident.
All young people with diabetes should check their blood sugar level every time before they start driving. Teens with diabetes can generally easily get a regular driver’s license, as long as they have reasonable blood sugar control. Make sure your teen complies with traffic laws and local regulations. The Ministry of Transportation keeps people with diabetes accountable for keeping their diabetes management under control before getting behind the wheel.
Employment
There are many examples of people with diabetes who have succeeded in a broad range of careers such as doctors, lawyers, nurses, politicians, professional athletes, artists, actors, accountants, teachers and engineers. Please refer to the Diabetes Canada website for their position statement on employment.
MedicAlert identification
Teens wear MedicAlert identification for all sorts of reasons: because they have allergies to foods, medications or bee stings, or have asthma. The bracelet or neck chain gives emergency medical personnel information that could save a person's life. It is recommended that all people with diabetes wear MedicAlert identification.
Ask your diabetes team to show you samples of the kinds of identification available.