Without controlling diabetes: what happens if teenagers skip treatment

At these ages, the complications of type 1 diabetes can compromise mental skills such as calculation and memory.These are the implications of ketoacidosis: the danger that diabetic adolescents face

Bad control of diabetes during adolescence can cause serious future complications.Therefore, it is important not to give up on efforts to achieve good control despite difficulties.

Adolescence is, by definition, a complicated stage, since it is a time of transition between childhood and adulthood.In addition to the biological changes of puberty, new conditions derived from the redefinition of relations with family and friends and the beginning of sexuality that are formed by the adult personality of the person appear.

Sometimes it is not easy to recognize the warning signals that diabetes can be present:

- Excessive thirst.
- Frequent need to urinate.
- Lack of energy.
- Blurred vision.
- Wounds that do not heal or do it slowly.
- Numbness of feet and/or hands.

Once the problem has been identified and diagnosed, it is important to adapt to the disease and treatment according to age.

“Although many teenagers with type 1 diabetes achieve glycemic control within the objectives, others experience a deterioration of the same associated with endocrinological changes that involve insulin resistance, erratic patterns of food, exercise or sleep, difficulty following the guidelines ofTreatment, eating disorders and appearance of risk behaviors, explains Dr. Roque Cardona, head of the Unit of Infant-Under Diabetes of the Sant Joan de Déu Hospital in Barcelona.For the adolescent, there is only the present and that is why he is not able to perceive real future threats derived from a control out of the recommended objectives ”.

The insulin pump is a small device the size of a mobile phone that manages insulin continuously 24 hours a day.This is known as "perfusion or basal rate."The amount of insulin to be infused is previously scheduled by the diabetological equipment, the patient and/or his family based on the blood glucose controls.(Photo: Getty)

the insulin deficit

The most immediate consequence of the interruption of treatment in adolescent patients is the risk of diabetic ketoacidosis (CAD) or DKA, for its acronym in English.Likewise, the deterioration of glycemic control has been related in various studies with an affectation of the quality of life.

Some symptoms of this endocrine-methabolic disorder are nausea, vomiting, abdominal pain, fast breathing and, in severe cases, loss of consciousness.

In addition, according to Dr. Cardona "the repeated presence of ketoacidosis episodes can condition some mental skills including calculation and memory."

How to avoid it?

To prevent the lack of adhesion to the treatment of adolescents with type 1 diabetes, the specialist points out that “it is important to understand that the adolescent has unique and distinctive characteristics, and it is necessary to learn to listen to and understand the messages that, in their own way, wantscommunicate".

Likewise, it considers it essential to make systematic measurements and assessments through validated scales of the chances of developing certain psychological problems and risk behaviors."If objectivable risks are detected, the intervention of a psychologist or a psychiatrist is important, professionals who should be integrated into diabetes teams that attend adolescents," he emphasizes.

Some of these risks are mental health problems, such as depression, behavior disorderFood or consumption of toxic, frequent in this time of life and that, in some cases, involves the need for psychiatric treatment.In addition, the specialist indicates that the risk of ketoacidosis and severe hypoglycemia also increases in adolescents with irregular lifestyles and lifestyles, risk behaviors or insulin omission.

Finally, the biological changes of puberty and life habits condition an increased risk of microvascular complications, such as retinopathy, nephropathy or diabetic foot, and macrovascular (cardiovascular diseases).

you have to be more aware of ...

Behavior modifications and intrinsic changes at this age can make things worse.That is why it is convenient to be prevented from the stress of the exams, which causes a series of hormones to be released;as well as before the first night outings, since they can alter the routine of diabetes especially in terms of schedules, or given the temptation to start smoking or drink alcohol.

If there is a diabetic teenager in the family, it should be involved creating information networks to share the treatment of the patient, know what to do when sugar is high or low, and exchange ideas and feelings.

what happens when they grow

Regarding the passage of the adolescent patient from pediatric health care to adult care, Dr. Cardona recommends a structured transition program, with a recognized and experienced multidisciplinary team.

“The transition must be a gradual process that adapts to the maturational characteristics of each person.

Although there is no unified recommendation about the ideal age, the new clinical guides of the International Pediatric and Adolescent Diabetes Society (ISPAD) recommend the transfer between 18-21 years, always individualized for each person, ”he explains.

keys for adequate monitoring

Have a periodic contact, with the frequency that each one needs, and integrating, if necessary, face -to -face consultations with telematic contacts.

That there is mutual trust between the adolescent and his doctor, and set goals and objectives that are attainable.

Provide a structured education specifically aimed at adolescence.

That the family gets involved in the management of diabetes taking into account the maturity of each person.

What is the best advance so far?

The endocrinologist Ana Mª Wägner, of the Maternal-Infantile Insular University Hospital Complex of Gran Canaria and Professor of Health Sciences of the University of Las Palmas de Gran Canaria remembers that type 1 diabetes is a chronic disease whose prevention and cure is a reasonof research for decades.

“Nutritional interventions have been tested (gluten -free food or artificial breastfeeding without cow's milk proteins, for example) in babies and children at risk of developing it that have not shown to have an effect.

Another approach, used both in people at risk of developing diabetes and those who have recently been diagnosed, consists of the use of immunosuppressants that could stop the destruction of insulin producing cells, but the results are modest and, for the moment, littlerelevant from the clinical point of view.

Nor have interventions aimed at developing tolerance to insulin producing cells (vaccines) to avoid destruction, ”explain Dr. Wägner.

What is the best advance so far?

According to specialists from the Spanish Society of Endocrinology and Nutrition, which will have more impact in the short term for peopleWith type 1 diabetes is the use of technology to automate insulin administration.

This technology consists of the combination of a continuous glucose measurement sensor, a continuous insulin subcutaneous infusion pump and an algorithm of prediction and decision, housed in an external support, usually a mobile phone.

However, the expert asks for caution when predicting a cure for type 1 diabetes: “You have to be very careful to use this expression, since it generates expectations that we will not be able to meet in a long time.In my opinion, this term is abused when giving visibility to advances that can be relevant, but that most of the time are very far from being applicable from the clinical point of view. ”

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