Rosemary Flynn helps us comprehend what children with diabetes encounter when they transition through puberty.
When children become teenagers, they go through a huge transition. They rapidly develop in all areas of their lives: physically, sexually, emotionally, mentally, and socially. As if that is not enough to negotiate, teenagers with diabetes have extra challenges to face during their puberty years.
In early puberty, insulin works together with growth hormones to enable normal growth. When the growth hormones get going, insulin resistance increases. So, it’s important for those with diabetes to ensure they have enough insulin to allow growth to proceed as normal.
With diabetes, the insulin levels depend on how well the teen manages their diabetes. Sufficient insulin is the key to reaching their normal final height. They also gain weight as their body grows into a more adult body. With self-image being of great importance to them at this stage, the rapid weight gain often makes them feel very self-conscious. One of the most important tasks of adolescence it to accept these dramatic physical changes as normal and develop a positive body image.
Teenagers develop a keen interest in the opposite sex during this time. Many teenagers become sexually active, and for the teen with diabetes, this presents extra risk. For girls, there is the risk of an unwanted pregnancy even if they take precautions. In all pregnancies, women have to keep their blood glucose levels as normal as possible before, during and after the pregnancy. This ensures the baby is protected from birth defects. Unplanned pregnancy puts the baby at high risk. For both boys and girls, information about their sexuality and advice about contraception should be given well before they need it.
Another development of adolescence is that they are able to start taking responsibility for their lives and their diabetes. Teaching children and adolescents to take up this responsibility is a parental task. If teenagers are never asked to be responsible, they will have a tremendous battle to take up the challenge of managing their own diabetes. They will always expect others to be responsible or alternately, they will neglect it. The teen will have to consciously make a choice to take on the responsibility of diabetes. Some are resistant to this transition and may take longer to do so.”
Changes in the brain
During puberty the brain is going through impressive intellectual changes. Knowledge increases in leaps and bounds and teenagers are able to absorb much more information. They can imagine ideas which are actual possibilities, and use these to reason with and solve real problems. Their ability to pay attention and concentrate increases a great deal and they can remember much more than before. All this development means they are ready to make a transition from a dependent child to a responsible teenager.
It is worthwhile for teens to remember that poor control of diabetes can have a negative effect on the developing brain and prevent it from developing fully. Maintaining good control will protect their intelligence and allow it to develop to its full potential.
The teenager’s attitude towards their diabetes can be influenced by how they perceive the illness. If they see it as a life-threatening disease over which they have no control, they will have a sense of hopelessness. They will always feel like a victim and have a very negative attitude towards their diabetes.
If they understand that diabetes can be controlled and believe they can learn to manage it effectively, they can develop a positive attitude and feel empowered to participate in all the activities that other teens do. They then believe and see that they can also do well at school.
Teenagers’ social lives become very important to them. The idea of being different from their peers is very threatening. Especially in early adolescence when they are finding their place in social groups.
They may struggle to be open about their diabetes and try to conceal the testing and injecting from their peers. This may mean that they miss injections or eat whatever the others are eating, even if it has a bad effect on their blood glucose levels. Sadly, the resulting poor control can mean missing lots of school, or being hospitalised due to diabetic ketoacidosis. In turn, this removes them from their social environment, or when it leads to poor growth it reduces their self-image.
The quest for social acceptance may lead them to try risky behaviours, like smoking, drinking alcohol and having unprotected sex. Somehow, they have to find a balance between having a good time socially and remaining responsible for their diabetes care.
Many teens have successfully negotiated their puberty years and have developed a maturity which exceeds that of their peers. With lots of support and encouragement, they can all succeed if they can get their minds around the challenges they face.
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Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.