OHSU

For Teens

Teen

Being a teenager is hard enough without having to deal with diabetes 24 hours a day, seven days a week. However, the reality is that diabetes is always with you. It never goes away.

The information on this web page can help you to manage your diabetes to the best of your ability.

For Teens with Diabetes-Family and Friends

Being a teen and having diabetes is not easy. At this stage of your life, it's normal to want and need more independence from your parents or caregivers. In most healthy families, this happens gradually over the teen years. Over time, managing your diabetes can also become your responsibility. How much responsibility you can handle depends on your maturity level.

Doing more than you're ready for can result in poor diabetes care and even trips to the hospital. For teens with diabetes, it's a good idea to keep your parents or caregivers involved and take on new tasks gradually. With your family's support, you can actually take better care of your diabetes.

But sharing responsibility can be a tough balancing act. When it comes to diabetes care, you and your parents may disagree about who is responsible for what. If you're like most teens, you might also argue about other things, such as curfews or chores. Having a lot of family conflict can affect your diabetes self-care, and even your blood sugar levels.

On the other hand, getting support from your parents, talking with them about your diabetes and other challenges and finding solutions together can actually help you manage your diabetes better. Family support will help you take care of yourself and stay healthier.

If you feel like you are struggling to communicate with your parents about diabetes or other issues, you may want to talk with the social worker or psychologist at the Harold Schnitzer Diabetes Health Center. They are trained to help families and teens with diabetes, and can help find solutions.

At this point in your life, you may not want to do diabetes care at school or in social situations. Testing your blood glucose, taking insulin or eating or drinking something different can make you stand out or feel abnormal. Worrying about what other people think can be a barrier to good diabetes care.

A good solution is to teach one close friend about your diabetes. They can back you up by explaining what you need to do and why, if anyone asks. Having someone around who knows your diabetes care is important and can help you stick with your routine. A friend can give you emotional support, and might even make diet and exercise changes with you-something that would keep both of you healthier.

Coping with Diabetes

You can't ignore your diabetes. It doesn't go away, but you can't let it take over your life either. There is a give and take to diabetes, including physical, emotional, social and financial aspects.

The best way to cope with having diabetes is to be open about your thoughts, feelings and how you are coping in general with your diabetes care. Your family, friends and medical team are here to support you.

If your family is a source of stress, it may be helpful to talk with a school counselor or someone from your medical team. A support system can help you through the ups and downs of your care, and help you remember that you are not alone.

Diabetes Burnout

The challenge of having diabetes, and doing diabetes care, can cause a condition called diabetes burnout. This can happen differently for everyone. You may have been taking care of yourself and your diabetes for years, but slowly the realization that you will have diabetes for the rest of your life starts to sink in. Maybe your care has become so automatic that you are not as careful with your routine and start forgetting some things. Or you may have completely taken over your diabetes care without much support and are now feeling overwhelmed.

Signs of burnout include but are not limited to:

  • Skipping meals to avoid testing or just skipping testing.
  • Not recording numbers or recording different numbers.
  • Lying to your parents, doctor or both about diabetes-related things.
  • Reusing old needles because you don't feel like changing them.
  • Not bringing your diabetes supplies when you go someplace.
  • Forgetting or just deciding not to take your insulin.
  • Generally not caring about anything related to your diabetes.

Diabetes burnout is so common that the American Diabetes Association published an entire book on the subject: Diabetes Burnout, by Dr. William Polonsky. Dr. Polonsky explains that burnout involves dealing with the emotions and behaviors that come from realizing diabetes will always be part of your life, and that even with the very best care, your diabetes may not always be in control.

Looking at your diabetes like a problem to be solved-without emotion-is helpful in keeping burnout to a minimum. You can take care of issues as they come up, and avoid focusing on situations, like always having diabetes, that are out of your control. Instead, think about what you can control, like getting regular exercise, eating a healthy diet and managing your stress level.

Sometimes, it can be helpful to make tradeoffs in your diabetes care, as long as you can still manage it safely. For example, you might discover that avoiding sugary foods at all costs brings down your quality of life so much that you are not a happy person. But, because eating candy, cookies and cake makes it harder to control your blood glucose level, you try to avoid these foods. Using the tradeoff approach, you might choose to eat sugary foods on holidays, birthdays and other special occasions, and accept that diabetes care will be more difficult at these times.

If you think you have diabetes burnout, talk to your doctor and parents immediately. Even though you can't take a break from diabetes, you can get support and help from your medical team and family members. Talking to the social worker or psychologist at the Harold Schnitzer Diabetes Health Center can help you find ways to cope with diabetes and feel better again. There are also support groups available. Sometimes, connecting with other teens who can relate can be helpful.

Healthy Eating

Eating with diabetes is not really that much different than the way we would like to see most people eat. With diabetes, the goal is to eat balanced meals at least three times a day. A balanced meal contains carbohydrate (starch, fruit, milk, yogurt), protein (meat, poultry, fish, eggs) and some fat (olive oil, avocado, soft or liquid margarine, mayonnaise). From a blood sugar standpoint, the name of the nutrition game is carbohydrates. Although you may notice that protein and fat in your diet impact your blood sugar somewhat, the food that really raises blood sugar is carbohydrate. At some point, you will want to visit with our nutritionist to discuss the amount of carbohydrate that is appropriate to keep you healthy and growing.

During your teen years, you will experience a lot of growth that requires more food. You don't want to sacrifice calories that you need for growth for tight blood sugar control. Another important nutrition area during your teenage years is calcium. The recommendation for calcium is 1300 milligrams a day. An eight-ounce glass of milk or eight ounces of yogurt has about 300 milligrams of calcium. If you do the math on this, you will see that you need four eight-ounce servings of milk or yogurt to meet your daily calcium needs. If this is not realistic, you may want to consider adding a daily calcium supplement to your routine.

Fast Food

Most everyone knows it's not ideal to eat fast food all the time. But let's face it: sometimes it's just convenient, sometimes it's all that is available and yes-sometimes it just tastes good. Fast food can be part of a healthy diet if we have it occasionally. It's important to know how to count the carbohydrate in the food and how to make your fast food choices as healthy as possible.

Here are some ways to figure the carb content of foods when you're out and about:

  • Look for--or ask for--the nutrition information at the restaurant.
  • Check websites before going and find the nutrition information there.
  • There are lots of carbohydrate-counting books that are small and portable. Find one you like and keep it in a bag or in the car.
  • If none of the above give you the info you need, then use your past experience and give it your best educated guess.

By measuring your foods and checking labels somewhat often at home, you'll be prepared to "eyeball" what is on your tray or plate. The "Exchange Book" lists serving sizes of food that equal 15 grams of carbohydrate. Knowing those amounts can help you estimate how much total carbohydrate you are eating when you don't have the nutrition information available.

To select the more "healthful" of food items, look for dishes that are baked, choose things that include vegetables, try not to overdo it with condiments and resist ordering larger portions when offered to "upgrade" the size of your meal. Fruit and vegetables are great side orders, and diet soda doesn't contain all the sugar that regular soda has. If you have a choice of bread or tortillas, choose the whole grain or wheat version if available.

Eating For Sports

Exercise is great for your body, your health and your emotions. However, sometimes it can be tricky to be active and keep your blood sugar within a safe range. This is why it's so important to have a plan for exercising. Some people with diabetes can have their insulin adjusted before and after exercise, or both. Some plan to have a certain amount of carbohydrate depending on the duration and level of exercise. Some use a combination of the two.

It's important to come up with a plan with your medical team so you are prepared and confident for exercise. The team can also help decide on a blood sugar range that indicates it's safe for you to participate in activity.

Here are some other things to think about when you're active:

  • Wear a diabetes ID-maybe it's a bracelet, necklace, etc.
  • Drink plenty of water and have snacks ready if necessary.
  • Have a meter around.
  • Have sugar to treat lows: glucose tabs, juice, etc.
  • It's a good idea to have someone around you aware that you have diabetes.

To Learn More

Exercising with diabetes can be tricky, but check out this list of athletes who have haven't let diabetes get in the way of staying active: Athletes with Diabetes

Recipes

Kids Health Website- Choose "Recipes for Teens with Diabetes"
http://kidshealth.org/teen/recipes/

Diabetes and Eating Disorders

Lots of people pay attention to what they eat and exercise regularly in order to be healthy. Sometimes people do these things, but then develop more extreme dieting or exercise behaviors, or both. With all the changes in your development, a large focus on diet and exercise for your diabetes care, and peer and cultural pressures to look good, it is easy to become overly concerned about your weight. This can result in unhealthy weight loss or unhealthy thoughts about your body.

There are several types of eating disorders, and all can be very dangerous. Restricting your food too much and/or playing around with insulin and blood sugar levels can have dangerous effects.

If you find yourself trying to control your weight in unhealthy ways, being tempted by extreme behaviors or having negative thoughts about your body, please talk to your doctor, social worker, dietitian or nurse. If you need it, they can refer you to a mental health provider, like the psychologist at the Harold Schnitzer Diabetes Health Center or someone else. There are healthy, positive and safe ways to be at a healthy weight. Your medical team can help you or someone you know develop a healthy lifestyle and body image. For More Information

It's important to work with your medical team and address your thoughts and feelings about food and weight issues. Your team can help you find ways to make healthy choices and feel good about yourself.

Books for Teens

Getting a Grip on Diabetes by Spike and Bo Loy. These two brothers, who have type 1 diabetes, have written a book that offers their thoughts about living successfully with diabetes. It covers topics ranging from school, to athletics and parties. It also has comments from a doctor each section that offer some medical guidance.

The Diabetes Game by Nora Coon. This author also has diabetes, and the book is a realistic account of diabetes from diagnosis to all aspects of care. Nora describes issues teens face and making diabetes a normal part of your life.

Alcohol and Drugs

The problem with alcohol and drug use is that it can lead to physical and psychological addiction, in addition to negatively affecting your diabetes. If you choose to drink alcohol, talk to your doctor or diabetes educator about ways to be safe.

If you do decide to drink some alcohol, it is very important not to drink on an empty stomach. Food (carbohydrate) should be eaten with alcohol.

Contrary to popular belief, the body does not convert the alcohol you drink into blood sugar. Although a 12-oz. regular beer has about 15 grams of carbohydrate, this carbohydrate is in addition to the alcohol in the beer. The major issue with alcohol consumption is actually the risk for low blood sugar. This is because alcohol interferes with blood sugar being released from the liver if your blood sugar drops.

Teens & Alcohol- Learn More

Teens & Drugs- Learn More

Transitions: Becoming an Adult with Diabetes

Becoming an adult is the biggest challenge of your teen years. For teens with diabetes, this is also a critical time. This is because you gradually take on the responsibility for your future: your diabetes care, your health in general and the way you function emotionally and socially.

At this point in life, you are probably making major decisions and going through major milestones. These can include:

  • Driving
  • Graduating from high school
  • Deciding on college
  • Having more in-depth intimate relationships
  • Planning to live on your own
  • Living with a roommate
  • Thinking about your career, or
  • Starting your career.

Driving & Diabetes- Learn More

Sex & Diabetes- Learn More

Roommates & Diabetes- Learn More

With all this going on, you need to pay careful attention to your diabetes in order to stay healthy. However, making the transition from a teen with diabetes to an adult with diabetes can also pose some challenges.

First, teens with type 1 diabetes can lose track of their medical team when they become adults. They have trouble finding a new doctor or building a good relationship with their medical team. When you were a kid with diabetes, your medical team focused on you and your family. Now that you are becoming an adult, your doctor will focus just on you. This can be a major change, and affect your diabetes care.

Second, teens and young adults can also be at-risk for behaviors like smoking, unprotected sex and experimenting with drugs and alcohol. These behaviors can affect your diabetes care. The challenges of becoming an adult make it very important to have a diabetes doctor and medical team.

Third, just changing doctors can be a challenge. If you have type 1 diabetes, you were probably diagnosed at a fairly young age. Your relationship with your health care team might be one of the longest relationships in your life. If you are attached to your doctor and support team, it might be stressful to end that relationship when you become an adult.

Finally, just the transition from being a teen to being an adult can make it very hard to control your diabetes. Changing doctors and health care teams can make diabetes care even more difficult. You might be tempted to skip visits, or put off finding a new doctor and medical team.

The Harold Schnitzer Diabetes Health Center is set up to help you face these challenges. Because we know the transition can be difficult, we care for children and adults in the same place-under one roof. This means you don't have to leave the center when you become an adult. You can keep coming to the same place and getting the same kind of support.


Web Sites for Teens with Diabetes

Students With Diabetes: http://www.studentswithdiabetes.com

Kids Health Website: http://kidshealth.org/teen/
Not just about diabetes, but has lots of helpful general health info.

Teen Section of the JDRF website: http://kids.jdrf.org/index.cfm