Diabetes Management in Children and Adolescents - Essay Example

?Diabetes describes a range of chronic illness that affects individuals with regard to predisposing factors in terms of lifestyle and risk. Diabetes mellitus is illustrative of an enduring metabolic infirmity, which is characterized by elevated blood glucose levels as a result of disturbances in carbohydrate, protein, and lipid metabolism (Levy 2011, p.2). This results from defects in insulin secretion, insulin action or both, which translates to long-term damage and dysfunction of various organs of the body. Within the pancreas, the Islets of Langerhans are responsible for secretion of insulin, which acts to regulate of blood glucose levels. In persons with diabetes, normal insulin function is impaired where it can be produced in insufficient quantities or is produced defectively. This phenomenon serves to classify diabetes mellitus further into Type I and Type II diabetes, which are distinct in aetiology and audience. Type I diabetes accounts for about 3-5% of all diabetes in the world and is more common in children and young adults but can occur at any age (International Diabetes Federation 2010, p.6). Type 1 diabetes presents as an autoimmune disease where insulin-producing cells within the pancreas are destroyed, and the patients are always dependent on insulin injections for survival. The destruction of Islets of Langerhans within the pancreas impair the ability to produce insulin adequately thus affecting the process of glucose regulation negatively (McDonald et al 2011, p.1028). Such destruction may be facilitated by the presence of external factors such as viral infections, which may alter the orientation of the host immune system. A number of predisposing factors ordinarily initiate the destruction of essential cells including genetics, viruses, insolitis among others. Type I diabetes is characterised by severe symptoms on its abrupt onset with high tendency to ketoacidosis. As such, it is important to establish diagnosis and initiate management of the condition on detection. However, there exists various psychological factors that affect the management of type I diabetes, especially in children and adolescents, that require addressing in order to facilitate treatment, such as stigma and identity issues. Stigma Since time in memorial, the social acceptance of diabetes has remained ambiguous to facilitate various perspectives into the study of the condition. This is attributed to social perceptions about diabetes that are often misguided and inaccurate. Some regard diabetes as an infectious disease that can be transmitted conventionally association or contact with the affected persons. This is especially so with type I diabetes, which more prevalent among children and adolescents resulting discrimination (Smeltzer et al 2010, p.1219). Notably, prejudice and discrimination may be in form of blatant avoidance or lack of consideration by others. Due to lack of relevant knowledge about the condition, many young people regard those diagnosed with diabetes type I as ill with the capacity to spread the infection. In addition, the patients, mostly young children and adults, are treated differently by their peers owing to their ‘delicate’ nature. As such, those affected by the condition often face rejection from their peers who relate differently by virtue of their illness. In addition, the chronic nature of the condition agitates peer reaction further considering that diabetes cannot be easily resolved overnight or by some magic pills. Similarly, society regards diabetes as a self-inflicted health condition owing to lack of control in lifestyle habits. What they fail to recognise is the difference in aetiology and onset of the various kinds of diabetes. It is difficult for the young to spot the difference between type I and II diabetes and as a result attribute type I with lifestyle as a predisposing factor. This is a common misconception in the society, which attributes type I diabetes to childhood obesity. As a result, parents are often on the receiving end as they are accused of neglecting their children to the extent of being diseased. Parents are obligated to make decisions on behalf of their children with regard to their way of life since they (children) are limited in their capacity to understand the risks and benefits of their actions. Such obligations lie within the ethical scope since parents ought to look out for the welfare of their children. The decisions are mainly with regard to nutrition and activities that serve to benefit the child on long-term basis. As such, parents should provide relevant interventions, be it medical or family-based, to resolve emerging health concerns. These interventions include advocating and providing healthy lifestyles for their children with an aim of reducing childhood obesity. With this in mind, parents with children suffering from type I diabetes are seen as incompetent at some level of their parenting culminating in the condition. Treatment and management of diabetes also has its elements of stigma owing to the elaborate procedures involved (Shiu et al 2003, p.150). First, the patient is expected to monitor his/her dietary requirements as a way of controlling blood glucose levels. As such, affected children and adolescents are put under special diets that accommodate their blood glucose requirements to prevent deficiencies or excess. In most instances, the meals are distinct from the rest in terms of nutritional composition to reduce the amount of carbohydrates and sugars. These diets are often unpopular among their peers resulting in teasing and bawling acts directed at the affected individuals. Evidently, such acts have their negative toll on their intended parties leading to stigmatisation. In addition, a defining characteristic of diabetes type I is the dependence on insulin injections to modulate glucose levels in the blood. Such injections can be mistaken easily for drug abuse tendencies, which a critical vice among teenagers. Stigmatisation results from the confusion of diabetes management with illegal drug use (Lydon n.d., p.177). In this way, patients find it difficult to administer insulin shots in public, which make management of the condition difficult. The negative connotations contribute towards the difficulty experience in management of early onset diabetes among children and adolescents. Such negativity has its toll on the young patients who device new methods to prevent or evade public scrutiny and stigmatisation. At the tender age associated with type I diabetes, the affected persons tend to withdraw from the society, keeping to themselves. Consequently, young patients are prone to psychological torture, which leads to anxiety depression, eating, and adjustment disorders (Delamater 2009, p.176). They opt not to disclose their condition to their peers owing to societal ignorance and fear of discrimination. These are among the defence mechanisms geared towards alleviating the negativity associated with diabetes. In most instances, patients prefer hidden spaces such as public toilets for the administration of insulin injections to avoid public scrutiny and curiosity. The negativity accorded diabetes type I affects the patient’s adherence to treatment plans among adolescents, resulting in lack of consistency. Individuals suffering from diabetes type I find themselves at crossroads where they have to decide whether to face stigma or disregard medication. With this in mind, it is critical that social factors are taken into consideration when developing management protocols, particularly among children and adolescents. Therefore, social support is a fundamental element to the management diabetes among the young and a lack thereof, results in worsening of the condition. It is essential that a viable framework be established to bridge the gap between biological and social factors that affect the resolution of diabetes type I. Public education campaigns are necessary to dispel the various misconceptions about diabetes, which should see the alleviation of negative attitudes. In addition, prevention campaigns involving the affected and their peers serve to promote health while providing awareness about the diabetes. Identity Concerns The occurrence of diabetes type I and adolescence can be destructive to the affected teenagers owing to various aspects of the significant period. Adolescence refers to the period of transition from childhood to adulthood where a one achieves sexual maturity while establishing an identity. As such, the early onset of type I diabetes often complicates the critical development period among teenagers and young adults (Rasmussen et al 2011, p.1984). This follows the diagnosis of a chronic illness that the patient learns he/she has to contend with for the rest of their lives. Children and adolescents alike have to adjust their way of life in order to accommodate the condition with regard to treatment and management regimens. The onset of diabetes creates an individual crisis where one seeks to maintain his/her persona gearing towards achieving a desired goal or social status. The crisis is precipitated by the realisation that a new lifestyle is to be adopted and maintained in order for one to maintain a healthy life. For this reason, various aspects of the patient’s habits and routine are radically revised in accordance to the doctor’s advice. Such lifestyle changes include dietary requirements and an insulin injection on need-to basis. As earlier indicated, these are subject to social scrutiny among children and adolescents, which only works to agitate the crisis. The gradual transition into adulthood generates a wide range of emotion that impact the establishment of an identity separate from the individual’s family. These emotions strive to maintain a connection into the aspiration of the young patient while adapting to disruptions to daily routines and activities (Silverstein et al 2005, p.190). Such a conflict within the self affects how one responds to the diabetes diagnosis and treatment plans with the responses ranging from acceptance to self-loathing. It lies within the parents to offer guidance to the young patients on administration of insulin among other lifestyle adjustments (Guthrie et al 2003, p.9). This serves to establish independence in self-management with regard to dietary needs and insulin adjustments as they transition into adulthood. In most cases, parents are more inclined to turn over the management of the condition to teenagers considering their performance in self-management activities; however, some issues should be addressed for an effective management programme. The sudden changes of lifestyle and daily routine are a major source of anxiety among young children and adolescents (Cameron et al 2007, p.2717). Studies indicate that individuals strive to continue with some aspects of their previous routine in an effort to maintain a coherent identity. Such traits have been regarded as a normal occurrence and attributed to the identity crisis that seeks to defy change. The frequency of these behaviours among children and adolescents serves as a determinant in the acceptance of diabetes as part of their identity. Acceptance is the key to management of the condition among the affected individuals while denial results in reluctance to adherence of the designated treatment plan. Anxiety among the young patients can be attributed to the monetary and emotional impacts the condition has on the family. These translate directly on the patient’s response to resolution of the identity crisis and management efforts. The realisation that the rest of their lives a needle stick of insulin may determine how long they live may prove an enormous obstacle to the young minds. The psychological demands of living with diabetes can be depressing on realisation that they are physiologically different from others (Williams 2009, p.911). This defines the fine line between establishing a new identity and rebelling against the diagnosis. In essence, if an individual fail to establish a new identity incorporating diabetes, then the success of the management efforts remains in jeopardy. Since parents act as decision makers for their children, it is critical that they take responsibility to ensure that the young patients adhere to management regimens (Lewin 2010, p.17). In conclusion, the consideration of the above psychosocial factors is critical for the success of management efforts into diabetes type I among children and adolescents. It is essential parents are involved in the establishment of modified routines for their children. Moreover, public education is crucial in order to eliminate the high prevalence of stigma associated with diabetes. As such, management frameworks and specially designed models should be established and expanded to address issues affecting children and adolescents diagnosed with diabetes type I. This serves to establish social support for the young patients, which promotes acceptance of their diagnosis to guarantee an efficient management module. Acceptance is described as a fundamental element to management of diabetes owing to its influence on adherence to treatment. It is important that further studies into the psychosocial factors affecting self-management of diabetes in young children and adolescents be carried out in order to understand fully the scope of this little explored area. References Cameron, F. Ambler, G., Northam, E., & Daneman, D. 2007. Routine Psychological Screening in Youth With Type 1 Diabetes and Their Parents, Diabetes Care; Volume 30, Number 10, Delamater, A. 2009. Psychological care of children and adolescents with diabetes, Pediatric Diabetes Vol. 10 (Suppl. 12): 175 – 184. Guthrie, D., Bartsocas, C. & Konstantinova, M. 2003. Psychosocial Issues for Children and Adolescents With Diabetes: Overview and Recommendations, Diabetes Spectrum International Diabetes Federation. 2010, A call to action on Diabetes, International Diabetes Federation. [Online] Available at, http://www.idf.org/webdata/Call-to-Action-on-Diabetes.pdf [Accessed 22 May 2013] Levy, D 2011. Type 1 Diabetes, Oxford University Press. Lewin, A. 2010. 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Brunner & Suddarth's Textbook of Medical-surgical Nursing, Lippincott Williams & Wilkins.Volume 16, Number 1, Williams, L., Laffelt, L. & Hood, K. 2009. Original Article: Education and Psychological Aspects Diabetes-specific family conflict and psychological distress in paediatric Type 1 diabetes, Diabetic Medicine Vol.26, 908–914 Read More