The Management of Diabetes in Adolescents
In this podcast, Jennifer Smith, RD, LD, CDCES, discusses the impact of hormones, parents/guardians, and technology in diabetes management in adolescents.
• Diabetes Wise. Accessed September 17, 2023. https://diabeteswise.org/
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Hello everyone and welcome to another installment of Podcast 360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard, with Consultant360, a multidisciplinary medical information network.
The epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric diabetes are often different from adult diabetes. Registered and licensed dietician and certified diabetes care and education specialist, Jennifer Smith, is here to discuss the impact of hormones and technology in the management of adolescents with diabetes.
My name is Jennifer Smith and I'm a registered dietician and certified diabetes care and education specialist. I work with Integrated Diabetes Services, a worldwide coaching service for those who are intensively managing their diabetes. We see people with type 1 and type 2 diabetes, all age ranges, and I have a special interest in women's health and work with a lot of women through pregnancy.
Perfect. Well, welcome back to the podcast. You mentioned there, are patients of all ages. So to start out today we'll talk about diabetes management in teens. What impact do hormones have in diabetes management in preteens?
Yeah, there's a broad topic certainly. I mean, we've got teens, and preteens who are in the stage of growth. So there are growth hormones that make them get taller and develop the structure to their body. They go from kind of like kid body type to the preteen teen where they're really filling out, and that's a host of different growth hormones that are enabling that movement towards a more mature kind of an adult body person. And so in terms of diabetes management, those hormones can definitely play a role in blood sugar management and then also what goes with that is insulin management, right? Learning how to use insulin is kind of the first and foremost in navigating this time period and honestly all of life with diabetes or those who use insulin, but teens, preteens especially, the growth and change is going to make a very big impact on their blood sugar management. Learning how to navigate a shift in insulin need, adjusting it, adjusting back a little bit, adjusting up a little bit.
So that's one thing from a hormone perspective, both for males and females. From the female perspective though, there's another layer of hormones that may start to come into the picture. And for those who are really paying close attention to what normal blood sugar levels and insulin needs kind of look like, for females in preteen, teen years, there's also another flux of those hormones that's going to start leading towards a show of menstruation. And so with that, in the preteen years before a visible period comes, you might start to find some cyclic changes to glucose. Time periods that might be every four weeks, every six weeks, every eight weeks. There's just this high resistance to insulin and needing a lot more blood sugars that are widely higher than they typically have been.
And so starting to track those can be a management tool so that you don't just feel like you're fighting high blood sugars for no reason, there might actually be a reason for it. And then leading into once a period does start, there will be changes around that monthly cycle that need to be followed, and those are based on hormones as well.
It sounds like a lot to keep track of, so I'm sure support is probably great as well. What kind of role do parents and guardians play in the management of diabetes in teens?
I guess that's a many-branched tree branch, I guess. There are lots and lots of roles that the guardians certainly play from the angle of just navigating this hormone shift. I think because teens have the type of brain development that they do, what we're looking at is the need for those guardians to be looking at data and to understand how to interpret the data so that they can help their teen make adjustments. Leaving it all to a teen is certainly not going to lead you down a path of optimized glucose management.
So working together with your teen is going to be really, really important. Whether it's sitting down weekly and just doing a download of the data or going over it, even if it's just a 15 to 30-minute time period with your teen, it's a really important time to spot trends that are outside of what the normal has been. I think in terms of the other avenues of diabetes management, even outside of hormones, I mean the life of a teen is busy as it is for many people, but on a different level of homework and school and sports and extracurricular and weekend things and friends and going out and eating out and all of those things. I think parents taking a more active role in helping the teen to figure out how to navigate those variables or those scenarios can be the first step to that teen in having more optimized management.
And you brought up maybe the start of a menstruation cycle. Why is it important for clinicians, parents, and guardians to talk with teens about diabetes and accidental pregnancy?
And that's such a hard one to bring into discussion. In the teen years, I remember as a teen myself, it's such a weird thing to talk to about even with your parents or oh my goodness, with the doctor. It's an embarrassing thing for many teens to talk about, females especially. So in terms of importance, when we talk about the management of pregnancy with diabetes, we're talking about really, really tight control. And so the importance of understanding preventative, most, I would say teens really don't want to get pregnant, right? They don't want that and they certainly don't want it to be accidental, but it would bring on a layer of additional management that the teen is by no means ready for. And so discussing that ahead of time brings in the ability to show a reason for navigating away from the potential for pregnancy in whatever way that discussion needs to go.
Whether it's with birth control or abstinence or whatever it might be, that discussion needs to be something as a family, you sit down and you talk through and without blaming or assuming something about your teen, which you may or may not know, but just from an overall of, "We're navigating your diabetes this way, things are going really awesome." Or, "Hey, we're trying to clean up this. Now that you have your period, it could be more likely that there would be an accidental pregnancy if such happened. So we want to try to prevent that because it would bring on a load more for you to manage because you have diabetes."
I think it's a hard thing to bring in because you don't also want to lay the groundwork for future worry in that girl, in that teen that, "Oh my goodness, it's going to be such a struggle. Maybe I'll never consider being pregnant. Maybe I'll never consider wanting to be a mother." So I think it's a fine line of walking, understanding why it's not necessarily appropriate at this point in life, but at some point when you're ready, it can be managed well, but we just don't need that right now. It's a hard discussion to have.
Absolutely. But I think that that makes sense. What would you say is the role of technology in the management of teens with diabetes? I know specifically we had talked about tracking and menstrual cycle. I'm sure that could really, with AI, could potentially play a role in noticing those patterns and trends, but tell us a little bit more about that and other technology as well.
Absolutely. Technology has certainly bloomed in the past 5 to 10 years. A lot of changes, especially in the most recent years. And so with that, I think there's peace of mind from the caregiver or the parent who has a teen with diabetes, or even for the kids who have diabetes too because there is background ability to see where glucose levels are trending. You bring in the potential that AI or the databases that gather all of the information from glucose management technology such as continuous glucose monitors or even blood glucose monitors. If it can bring all the data together and put a form together, that essentially gives you direction to, "Oh, I see this trend." Or, "It looks like every other month it looks like this is happening." You have a focal point then. As the caregiver for the teen, again, this kind of goes back to looking at the data frequently enough that you can spot some of those trends along with the software that puts it all together in one place.
And so technology can clear up some of the questions about why is blood sugar high here. Why is it low here? I feel like this is a trend. Is it really a trend? Going back and using that technology in the databases that are available, can give you a little bit more ability to navigate adjustments and to explain to your teen why these adjustments are being made, right? Rather than just telling somebody to do it, explain why, and use it as a teaching tool. So going forward in life, as you send them out the door to college or travel the world or whatever they're going to do as an adult after graduation, essentially you've given them some tools of analysis and you've taught them how to use those tools.
And thankfully our tools are getting smarter very quickly as we kind of move forward. So lots of technology. I mean, even watches that can give reminders, there's technology for different apps that provide alerts at different levels. All of that kind of stuff can certainly play a very big role in just staying connected in a way, without being the hovering helicoptery type of parent, right?
Do you have any examples from your practice or experience that you'd like to share about managing teens with diabetes at all?
Yes. I mean, I work with a lot of ages, but especially the teen population. I think like any age, it's a really unique age group in that there's a lot of independence that's desired. And from the parent-teen angle of working together, depending on when the diagnosis was, the teen may already have a good idea if they've had diabetes since they were five and now they're 15, that's 10 years of their experience. And so when we learn to start to turn over some of the management to that teen, it has to be individualized based on their knowledge base. And so in working with some more newly diagnosed teens, I would say in the past two or three years, initially, parents may take on almost a hundred percent of the role. There might be some teens who are very willing and want to have a little bit more of it in their grasp too. That's fine as long as it's not too much for them to handle along with all the other things that teenage years bring.
So I think in terms of managing them, it's a give and takes and learning eventually that turnover of if they're on an insulin pump or they're on a continuous monitor, are they able to do some of the changes for their sites? Are they able to navigate low blood sugars? Do they know how to read their glucose data? Do they understand if a CGM value is rising or falling or stable? If they're involved in a sport or anything extracurricular, what do you have set up in terms of communication between you and your teen? And then what are the things that you've taught them so they can go into some of these settings with some confidence again, without always having to check-in?
And eventually, some really good cases that I've had a chance to work with eventually, the teen, especially with our very automated systems that are much more common to be in use now, the automated insulin pumps can take a lot of that background micromanagement a little more out of the picture, which gives the teen a little bit more confidence of relying on a system and a little bit of a backstep of the parents because the system is navigating a lot of that behind the scenes for managing rises that would get too high, or managing drops in blood sugar that might get too low. So I think in terms of managing, it's an individualized basis, certainly depending on where the teen and the family is together, and then taking it step by step to again, get to a functional level of you are going to be heading out the door, are you ready for this so that I don't have to text you every single day to tell you what to do. Right?
That makes sense. Is there anything else that you'd like to add regarding teens and the management of diabetes?
One thing, as I kind of talked about just with this last little question. I think understanding that your teen is an individual and may very much need you at times more, even if they have taken over a lot of their management, expect at times where they need you to offer a step in and say, "You know what? You've got a lot of exams, or you've got a lot on your plate this week, is there something that I can help with for you? You've been doing a lot of this on your own. Is there something that I can take back for a short amount of time to allow you to navigate this?" So I think that's something that, again, in discussion and good relationships, having a good kind of conversive relationship with your teen about diabetes specifically becomes important to understanding what are their needs, especially in overloaded settings.
I think another piece to teen management is understanding that your teen is a teen, just like a child is a child and at times there's going to need to provide feedback that is not relative to diabetes. And so if you can take things like high blood sugars and low blood sugars at the moment of whatever you need to discuss with them out of the picture, then there's no reason to treat them with the kind of like they're glass slippers, that they're breakable. They're still a teen, they still need to know right from wrong. And despite the diabetes, you still have to navigate that part of being a parent or a caregiver to a teen. I think sometimes, especially more newly diagnosed teens, there's a feeling like you have to provide this sort of protective bubble or ease off on reprimand, and that's not necessarily really what's needed.
Well, Jennifer Smith, thank you for joining us today.
Of course. It was great. Thank you so much.
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