Common Nutritional Challenges for Teenagers: Adolescent Diabetes
Angela Oswalt Morelli , MSW, edited by C. E. Zupanick, Psy.D.
Diabetes is a chronic disease that impairs the body's ability to use food properly. This occurs because the body cannot make enough insulin or cannot use the insulin properly. Insulin is a hormone produced by the pancreas that converts food into energy. When the body doesn't produce enough insulin it causes blood glucose (sugar) levels to rise. In the short term, high blood glucose levels can cause a range of negative effects from irritability, stomach pains, mood swings, or even a coma that may lead to death. Chronically high levels of blood glucose have long-term, cumulative effects including vision loss, amputations, kidney failure, and death. But high blood glucose is only one half of the diabetes equation. Low blood sugar can also occur when food and medications are not timed and balanced correctly. Mild low blood sugar levels can cause shakiness, irritability, and slurred speech. Severely low blood sugar will result in seizures, a loss of consciousness, and an inability to swallow.
Youth who have diabetes need to carefully monitor what they eat, so as not to eat foods that will flood their bloodstream with sugar in a short amount of time, such as cakes, cookies, heavily breaded foods, or processed food items. Instead, they should be eating lots of fresh produce, lean protein, and whole-grain breads, as these food items will give them the nutrients they need and will break down slowly and steadily in their digestive system. Some diabetic youth may need to "count carbs" (calculate exactly how many grams of carbohydrates are in their foods) before they eat them, so they know how many units of insulin to give themselves. Making these choices about food selections and counting carbs can be extremely difficult for teens.
Adolescents eat much of their daily food away from home. They have to find food options in the school cafeteria, at the fast-food restaurant their friends want to go to, at their friends' houses, or even in their own dorm room or kitchen, if they're living on their own for the first time. Finding healthy choices can be extremely difficult in places that don't normally serve healthy fare. Not only do teens need to be able to know what to eat, they need to be able to deny temptations that their friends or classmates are indulging in. So, even if there is a green salad with grilled chicken on the restaurant's menu, it may become too tempting for youth to go ahead and order the greasy burger dripping with cheese and sugary barbecue sauce that's served with a mound of French fries filled with simple carbohydrates that will later cause a blood sugar spike.
Beyond food choices, adolescents can struggle with how to fit blood sugar monitoring and medication and/or insulin into their daily routine. In order to test blood sugar levels, people have to take a drop of blood from some part of the body, normally a finger or forearm, and input that into a hand-held device that reads the blood sugar concentration. Diabetic people use this information to know what or when to eat, how much insulin to give themselves, or if they need to treat their blood sugar levels in another way, such as drinking extra water or briefly avoiding intense physical exertion. Some diabetic people can treat their diabetes with balanced nutrition and prescribed daily oral medications only. Others need to give themselves synthetic insulin several times throughout the day. The synthetic insulin has to be injected so that it can enter the bloodstream and break down the excess blood sugar their so the body can use it. Some youth inject the insulin every time they have to administer it. Other youth have a computerized pump surgically implanted, and the computer on that pump continuously provides the body with the insulin it needs. However, youth may still need to problem-solve a pump that's clogged or out of insulin or give themselves a booster insulin shot if their blood sugar readings are off.
Early adolescence is characterized by self-consciousness. Many teens can become embarrassed or annoyed to have to stop at the nurse's office at school throughout the day or to have to slip away from their friends during a day of fun or a party to test their blood or to administer insulin. During early adolescence teens place a high premium on peer relationships. Teens do not want to seem to be too different from their friends and peers, and the need to regularly test blood sugar levels and administer insulin injections can cause young, diabetic teens to feel very different from their peers. They may not want anyone other than their family or closest friends knowing about their condition. Therefore, they may skip monitoring or insulin shots to avoid that discomfort. Caring for diabetes also requires a lot of planning and forethought, which many teens struggle with naturally, as their frontal lobes in their brains are still forming. For instance, when youth leave their home they must remember to bring their blood sugar monitoring kit and sufficient medication. If they use insulin, they need to have a plan about how to keep the insulin cold, as it needs to be kept at a certain temperature to keep the insulin working. Early adolescents are often rebellious and defiant, and this may include rebellion against a disease over which they have no control. They may begin taking more risks with their eating, blood sugar monitoring, and insulin habits as a form of rebellion against the disease, their parents, or their doctors. Youth who were first diagnosed with the condition during their teen years may rebel from the beginning, if they do not fully appreciate the long-term consequences to their actions. But even youth who were successfully managing their disease during childhood may suddenly become defiant about the strict regimen they must follow to properly care for their disease.