Risky Business

Your teenager with diabetes is just like other teenagers, and is just as likely to take risks with their health.

Risk behaviour occurs particularly in early teenage years when it is more important to be like their friends and to fit in socially, than it is to display healthy behaviour!

Teenagers see themselves as unstoppable and don’t believe they can become addicted to something harmful, or that anything can go terribly wrong in their lives.

It’s natural for you to worry that your teenager might make wrong choices.

Mistakes will happen and usually lessons will be learned. This is normal part of growing up.

SMOKING 

Smoking is harmful to the health of everyone, no matter what their age. Smoking should be discouraged in people with diabetes. Nicotine damages blood vessels. Smoking is also associated with high blood pressure, poor diabetes control and has additional risks in pregnancy.

 ALCOHOL

Teenagers with diabetes need to be aware of the additional risks of drinking alcohol. Alcohol blocks the body’s natural method of correcting hypos, and may lead to them going undetected. The combination of alcohol-induced confusion and a low BGL is dangerous. Reaction times during a hypo have been shown to be reduced. Hypos can also occur many hours after drinking alcohol.

Whether or not you allow your teenager to drink, they may experiment with alcohol anyway.

Your teenager is advised to:

  • Drink in moderation and avoid binge drinking
  • Not exceed the recommended safe intakes – 2 standard drinks a day for adults
  • Avoid consuming alcohol on an empty stomach
  • Test their BGL regularly during and after consuming alcohol
  • Eat carbohydrate foods while consuming alcohol – regular soft drinks or juice are suitable if there is no food available
  • Eat snacks and meals on time
  • Test their BGL before going to bed, eat a bedtime snack and make sure their BGL is above 7mmol/L
  • Not to count alcohol as part of carbohydrate exchanges.
  • Always carry some medical identification, so that if an emergency situation arises, appropriate action may be taken
  • Have a friend that knows about diabetes and can recognise the signs of a hypo and knows how to treat it
  • Try to check BGLs when combining alcohol with being physically active such as dancing at parties. This may not be possible in every situation.

Alternatively, check BGLs before going out and then again before bed, to prevent an overnight hypo. Asking a parent or family member to do a 3am BGL is another way of preventing an overnight hypo

  • There are ways of stretching drinks so that it’s still possible to be part of the crowd without feeling pressured to keep up!
  • Alternate alcoholic drinks with non-alcoholic drinks such as Diet Cola
  • Halve the serve of alcohol per drink. Two drinks can become four by ordering wine spritzers (half wine and half soda), half nips of spirits with soda/diet mixers in a tall glass, or shandy (half beer and half diet lemonade)
  • Choose low alcohol beers

DRUGS

Drug use, which usually occurs with other risk taking behaviour, is likely to be experimental or recreational and its effect on diabetes management may be minimal to severe.

Tobacco and alcohol are the most common substances which have the potential to lead to abuse. Regular drug use affects diabetes control and this may be denied by the teenager.

Recreational drugs may:

  • Alter awareness and understanding
  • Alter consciousness and sensation
  • Alter understanding and the ability to make judgements
  • Reduce capacity and interest in achieving good blood glucose control
  • Reduce interest in routines, injections and meal times
  • Reduce appetite and interest in food, increasing the risk of hypos
  • Increase the risk of hypos going undetected
  • Stimulate appetite (marijuana) leading to high BGLs
  • Teenagers need to understand the risks of drug taking and the additional risks because of diabetes.

 CONTRACEPTION

As teenagers may not actively seek contraceptive advice, discussion about sexual activity and the need for safe contraception should be a routine part of management for all adolescents. Contraception is essential in reducing unplanned pregnancies.

There are a number of risks during pregnancy for both mother and baby, but with careful planning, as well as support from a team specialising in diabetes in pregnancy, women with diabetes will usually have healthy pregnancies and healthy babies.

For more information on contraception and pregnancy go to www.pregnancyanddiabetes.com.au

ERECTILE DYSFUNCTION

Fear of impotence is very real in teenagers. It is unusual in the adolescent age group and may be minimised/prevented by good management of BGLs. Risk factors include increasing age, duration of diabetes and poor diabetes control.

Your teenager may feel more comfortable talking to their doctor, dietitian or diabetes educator by themselves to discuss practical aspects of living with diabetes (eg. parties, alcohol). This can help your teenager in managing their diabetes and taking more responsibility for their wellbeing.

For more information go to myd.ndss.com.au

DIABETES COMPLICATIONS

Your teenager needs to know about the possible health effects of diabetes, and this should be relayed in a sensitive way. Frightening stories of complications and long-term health problems will not motivate them but rather make them dwell on the negatives. It may cause them to give up their diabetes care altogether because “it won’t matter anyway”. Make sure they are up to date with diabetes education, and that they are well informed about how to minimise their risk of developing complications.

Screening for complications is usually carried out yearly, but depends on the advice of your teenager’s diabetes specialist. With a detailed screening program and regular health checks, any problems or early signs of complications can be detected before they affect health.

The following checks should be performed:

  • Eyes: 2 years after diagnosis then once a year – testing of the back of the eye (retina) by an ophthalmologist or trained optometrist is advised.
  • Kidneys: 2 years after diagnosis then once a year.
  • Feet: as recommended by your diabetes team.
  • HbA1c: every 3 months either at your clinic visit or at a pathology lab.
  • Weight and Height: every 3 months at your clinic visit.
  • Blood pressure: at least once a year or more often if needed.
  • Cholesterol/Coeliac/Thyroid function tests: as recommended by your diabetes team.

A diabetes doctor or educator can arrange these tests. How often these tests are done may depend on which diabetes centre you attend. Even small improvements in diabetes control can make a difference to the risk of long-term complications.

Early detection is positive because:

  • Prompt treatment in many cases results in improvement
  • It warns people to take extra care of their diabetes
  • Some doctors perform these tests in their hospital clinics or private rooms. For further information, contact your local diabetes centre or specialist paediatric unit.
  • It will help your teenager to receive some re-education, perhaps with a friend, and to be given some information regarding drugs, alcohol, contraception and complications.