Youth Diabetes Concerns

Diagnosing Diabetes in Youth

There are several tests available to help diagnose diabetes in youth. A fasting blood glucose level is taken after fasting for 8-12 hours (usually in the morning). A casual blood glucose level can be taken at any time. A 2-hour oral glucose tolerance test measures the blood glucose level every 30 minutes and up to 2 hours after drinking a glucose solution. This is to see how fast the blood glucose returns to normal. Finally, hemoglobin A1c levels can be used to diagnose diabetes.

Youth may be diagnosed with diabetes if they meet any of the following criteria:

  • Fasting blood glucose > 126 mg/dL
  • Casual blood glucose > 200 mg/dL
  • 2-hour oral glucose tolerance test > 200 mg/dL
  • Hemoglobin A1c > 6.5%

Youth may be diagnosed with pre-diabetes or impaired glucose tolerance if they meet the following criteria:

  • Fasting blood glucose > 100 mg/dL
  • 2-hour oral glucose tolerance test 100-125 mg/dL
young girl holding diabetes monitor
Growing Up with Diabetes

The impact of diabetes during childhood can be psychological as well as physical. Diabetes and its demands can affect your sense of self and security and can challenge your independence and decision-making. The physiological changes that occur during adolescence promote insulin resistance, making diabetes control even more difficult. 

Here are specific concerns that typically arise as kids with diabetes grow older. These are generalities, so you may not see yourself here. 

Understanding 11- to 14-year-olds with Diabetes

General Characteristics
Impact of Diabetes

How to Approach

Worry about appearances/self-conscious
  • Not wanting others to see fingersticks, injection sites, or medical bracelet
  • Worrying that hypoglycemia will happen around friends or during sports
  • Offer alternatives to traditional ID tags (like shoe tags)
  • Use self-consciousness as a motivator to rotate injection sites
  • Use hypoglycemia as a motivator for proper blood glucose testing

Hormonal changes
  • Having blood glucosefluctuations
  • Increasing insulin resistance
  • Mood changes can mimic hypoglycemia
  • Using pre-loaded insulin pens or pre-mixed insulin to deal with rapidly changing blood glucose levels
  • Modify sick day rules
  • Monitor blood glucosemore often

Assert independence from family
  • Skipping insulin shots
  • Ignoring meal plan
  • Not ready for independent self-care
  • Being upset with overprotective parents
  • Use “experiment” approach: teens test out behavior with support and guidance from team
  • Have teen see diabetes team alone
  • Modify/simplify meal plan
  • Counseling for parents on changing roles

Are rebellious and defiant
  • Refuse diabetes self-care
  • Hate reminders
  • Take out anger on parents or school teachers
  • Provide counseling
  • Teach how to deal with anger

Place importance on peer relationships
  • Peers take priority over self-care
  • Child hides diabetes
  • Child uses diabetes to establish role within group
  • Discuss setting priorities
  • Plan for when diabetes care comes first

Question why things happen
  • Ask “why me?”
  • May experience depression
  • Offer counseling or find peer support
  • Look into diabetes camps

Aren’t thinking about the future
  • Don’t think about long-term complications of diabetes
  • Focus on immediate concerns
  • Avoid scare tactics

Are aware of emerging sexuality
  • Wonder if they are more at risk for STDs or AIDS
  • Wonder if they will be able to have children or be good parents
  • Health care provider should talk with child

Schreiner et al. Diabetes Spectrum 13 (2): 83,2000

Understanding 15- to 16-year-olds with Diabetes

General Characteristics
Impact of Diabetes

How to Approach

Have increased ability to compromise
  • Can make more decisions about diabetes care
  • Include teens in decisions
  • Negotiate and use behavioral contracting

Are more independent
  • Can better understand the relationships between exercise, diet, and insulin
  • Give more advanced diabetes education

Feel stressed by social, school, and family responsibilities
  • Stressed teens may eat more, which can result in weight gain or less controlled blood glucose
  • Teens trying to manage stress with physical activity may have low blood glucose events
  • Teach stress management
  • Assertive communicating training

Test boundaries and take risks
  • May try drugs, alcohol, smoking, unprotected sex
  • May skip medication
  • Educate on teen issues
  • Discuss logical consequences

Are figuring out what’s important to them
  • Are determining how diabetes fits into their life
  • Meet with a life coach or diabetes coach to help clarify values

Are learning to drive
  • Can experience low or high blood glucose which may impair driving ability
  • Educate on safety: checking blood glucose before driving, having fast-acting glucose sources in the car
  • Drive with someone else in case of emergency

Schreiner et al. Diabetes Spectrum 13 (2): 83,2000

Screening Youth for Diabetes

There is no screening test for type 1 diabetes, and it can’t be prevented. The odds of inheriting the disease are only 10% if a first degree relative has diabetes, and even in identical twins, one twin only has a 33% chance of having type 1 diabetes if the other twin has it.

Screening is much more effective for identifying youth who are at risk for type 2 diabetes. However, the U.S. Preventive Services Task Force does not recommend universal screening. Youth may be tested if they meet certain risk criteria:

  • They are overweight (they have a body mass index at the 85th percentile or above for age, sex, and weight for height)* and have any two of the following risk factors:
    • Family history in 1st or 2nd degree relatives
    • Belonging to a higher risk ethnicity group (Native American, African American, Hispanic/Latino, Pacific Islander, Asian American, Alaska Native)
    • The child has signs of insulin resistance or conditions associated with insulin resistance
    • The mother has had a history of diabetes or gestational diabetes

If a child is at risk for type 2 diabetes, testing may begin at 10 years of age or at the onset of puberty (if puberty occurs earlier than age 10). The child should be re-tested every 3 years.

*Note: Body mass index percentiles in children are different for girls than for boys. It is also important not to use the height-for-weight BMI calculated for adults when assessing youth because they are still growing. That factor is taken into account in the CDC growth charts issued by the United States government. 

Resources

Diabetes Resources for Parents

Diabetes Resources for Youth with Diabetes

Diabetes Resources for Schools and Teachers

Resources for Health Care Professionals