Adolescence is a tough time of life for many children — and their parents, too. Being a teenager is difficult enough without also having to deal with a chronic illness. One of the most common serious chronic health problems of adolescence is diabetes.
Diabetes, or diabetes mellitus as it is formally called, is a disorder of how the body uses energy in the form of glucose. For your body’s cells to use glucose they need the hormone insulin, which is made in the islet cells of the pancreas. If there is insufficient insulin present, the amount of glucose in the blood goes up, and this can lead to a host of acute and chronic problems. There is an enormous amount of educational information available on the internet about the two most common forms of diabetes, so-called Type 1 and Type 2. In the first of these the body has a total lack of insulin; in the second the body is resistant to the effects of insulin. I’m not writing about what diabetes is; if you want more information, here and here are good places to start. I’m writing about some of the special challenges faced by adolescents who have diabetes.
I often see adolescents with diabetes in the PICU. The usual reason for this is their blood sugars are out of control and they develop an acute derangement in their blood chemistries called diabetic ketoacidosis, or DKA. The condition can be life-threatening. Most of the time their diabetes is out of control because they are not taking their insulin correctly; sometimes they are not taking it at all.
It is a cliché of psychology that adolescents regard themselves as immortal, which is why they can do dangerous things without worrying about the consequences. They are also establishing their independent, unique selves as adults but are simultaneously obsessed with being like everybody else. For teenagers with diabetes, having to take insulin every day is like being reminded every day they are not like everybody else, and that they are mortal because they need to take insulin to stay alive. More than a few rebel by refusing to take care of their diabetes. When they do that they often end up seeing me and my colleagues in the PICU.
This mental stage, like all those of adolescence, mercifully passes with time. But meanwhile teenagers with diabetes can do themselves serious harm. Parents of these children often become extremely frustrated with the situation, but it does pass. Our goal is to get them through it as best we can, recognizing that ultimately the emerging adult will need to be entirely responsible for his or her own health. If you are interested, you can read more about many of the psychosocial issues confronting children with diabetes and their families here. If you are a parent of such a child — it will get better.
Sachin on 