Wit and Wisdom for Kids with Diabetes (for Teens)

Talk About Bad Timing

Right in the middle of yelling "I can take care of myself!", your body starts making changes which are out of your control. Growth spurts. A voice that manages three octaves in one sentence. Menstrual periods. And emotions that swing like a wild carnival ride. All caused by hormones.

Besides bringing about serious body changes, hormones-- such as the growth hormone, estrogen, and testosterone--can really mess with insulin and your blood sugar control. How? Well, in a couple of ways. First of all, in puberty your body has a lot of
growth hormone in you. This growth hormone affects your body’s reaction to insulin—causing insulin resistance and making it harder for your body to use. So, maybe you used to take 30 units a day when you were 10, and now you’re 14 and you need 60. Not surprising.

The other thing you’ve got going on right now is related to the increased levels of estrogen and testosterone in your body. These higher levels can cause a serious rollercoaster effect on your blood sugar. You may see some really crazy ups and downs. So, even though you work hard to balance your meals and snacks with exercise and insulin, there will be times when your body goes off and does its own thing, leaving you hanging. And that causes all kinds of frustration for you and the adults who help you with your diabetes .

This is the time to lighten up. Don't be too hard on yourself if you end up with high blood sugar readings several times a week. It could be caused by raging hormones. Keep doing all the things you know that work best to control your diabetes because there's no controlling the hormones. Record your blood sugar levels and check in with your health care team frequently to talk about changes you might try.

Healthy Eating

Eating a healthy diet and staying active are important parts of managing diabetes. But what about teens who take diet and exercise too far? Or who manipulate their insulin in efforts to lose weight? Restricting what you eat, binging, purging, or manipulating your insulin dose can all have very serious effects on your health.

Does any of this sound familiar? Let’s take a closer look:

Anorexia Nervosa is a condition where a person severely limits caloric intake, eating far less than the body requires. Often, this is combined with extreme levels of exercise in efforts to burn off perceived fat. People with anorexia see themselves as fat, even though their body weight may be normal or below normal (even WAY below normal), and others tell them they look too thin.

In Bulimia Nervosa, a person binges—eating a huge amount of food in one sitting-- and then purges, usually by inducing vomiting or using diuretics or laxatives to get rid of the extra calories consumed during the binge. Both of these are serious eating disorders that have serious risks for all teens, especially teens with diabetes.

People with anorexia or bulimia are more likely to have trouble with all areas of diabetes control— from giving insulin shots and checking blood sugar to following a meal plan and eating healthy foods.

And then there is insulin manipulation. A lot of teens, especially girls, think it’s the best thing since summer vacation. They
reduce the amount of insulin they take, or skip doses entirely, in efforts to get that ultra-thin bod. The basic overview is that they’re keeping their blood sugar levels way high, processing less food, and eliminating a lot of extra sugar (calories) from their blood stream in their urine. (Remember all that weight you lost right before you were diagnosed? Remember how terrible you felt? This is the same thing.) Do we even need to tell you what this does to your blood sugar? Yeah, we know, “thin is in,” but  playingaround like this with your insulin can land you in the hospital. Or worse.

All of this has serious short- and longterm impact on your health. Short-term, you’re more likely to experience extreme blood sugar levels (and all of the associated symptoms). And longer-term, you have a much higher risk of developing complications, particularly eye, kidney, and nerve damage.

Girl Talk

Okay, guys, this is where you may want to turn the page early. Your call. We get a lot of questions about this one: How does
menstruation affect blood sugar? And vice-versa. Some teen girls may find that they need more insulin right before they begin their period, and less insulin during.  This is because of changing hormone levels. (Remember all that stuff we said earlier about uncontrollable hormones? Here they are again.)

If you think this sounds like you, check your blood sugar even more often for a week or so right before and during your period. Then, with help from your log book, you ought to be able to figure out how to adjust your insulin to make up for it. Ask a parent, other adult, your doctor, or other member of your diabetes care team for help.

Smokin', chewin', spittin'

In the meantime, have a serious talk with yourself about some of the other things in life – things you can control. Every day 6,000 teens try their first cigarette. That means a lot of people your age are increasing their risk of lung, mouth, or nose cancer as well as heart disease. That also means that you probably have several friends who smoke and would like you to join them. Here's
some information for you to base your tobacco decision on.

Smoking or chewing tobacco has little or no effect on blood glucose. Good news for people with diabetes. The bad news is tobacco does mess up your circulation and damages blood vessels. And since diabetes already increases the risk of heart disease, smoking or chewing is a double whammy. Simply having diabetes has an effect on your health that’s as if you’ve already had a heart attack.

If you already smoke or chew, quitting can protect you from further damage. Quitting is not easy but if you talk to your doctor, she or he can help you figure out the easiest way to break the habit.

Drinking and Diabetes

Unless you've been living alone on an island, you've heard more times than you can count about the dangers of drinking too much and of drinking and driving. Even though you have heard that information over and over, still it's easy to shrug your shoulders and say "it'll never happen to me."

Unfortunately, the facts are that thousands of people just like you are involved in alcohol poisonings and car crashes every year. So think about these things when you think about alcohol. Pure alcohol doesn't raise your blood sugar. But most people don't drink pure alcohol. Most people drink alcohol mixed with sugary, sweet, fruity mixers or in beer and wine. And those do raise
blood sugar levels. Counting carbs or calories and doing finger sticks are not usually high on the list while someone is
drinking. So it's easy to end up with very high blood sugar levels.

Alcohol on its own can lower blood sugar. In a bad way. When people with diabetes drink alcohol, it's difficult to distinguish
between the signs of hypoglycemia and the effects of alcohol. Even if your friends know you have diabetes, they may think
you're acting weird just because you've been drinking.

Alcohol also lowers your body’s ability to recover if you get low. So, say on a normal day, you go home, crash, and forget to eat your nighttime snack. This isn’t a good thing, but if you get low while you’re sleeping your body can probably release some extra glucose from the liver to keep you going (and conscious) until you can treat for hypoglycemia. But, if you’ve been drinking, your body may not be able to release glucose and you may not wake up to treat. Add to this the fact that, if you’re drunk you’re less likely to remember to eat a snack in the first place, and the risk is even higher.

Probably every person on your health care team will flat out tell you "Don't drink." They're right. Given the life and death risks, mixing diabetes and alcohol just isn't a smart move. Still, a lot of kids with diabetes try alcohol. If you find that you're one of them, keep these guidelines in mind.

• Choose light beers, dry wines, or distilled liquor with non-caloric mixers.
• Keep it to a minimum. One or two drinks can be added to your normal meal pattern without much of an effect on blood sugar.
• Don't drink on an empty stomach. The danger of hypoglycemia is too great.
• On the other hand, avoid hyperglycemia (high blood sugar) by not eating everything in sight.
• Always wear your medical I.D.
• Make sure someone in your group knows about your diabetes and what to do about low blood sugar.

Drugs (and We're Not Talking about Insulin)

The dangers of illegal drugs for people with diabetes are very similar to those of alcohol. Some drugs lower blood sugar and others raise it. Too often it's difficult to tell if it's drugs or diabetes that's messing with you. Some drugs ruin your appetite and others make you want to pig out. Like alcohol, once you're feeling the effects of the drugs, taking care of your diabetes just isn't a priority.

If you choose to use drugs (and we’re not saying that’s a smart or a legal choice), think about all of this. There are some guidelines you should follow to decrease your chances of ending up in the hospital. But when you’re on drugs, following guidelines isn’t going to be top on your list of priorities. If you choose to use drugs, think about this beforehand. Then find a way to follow these guidelines.

• Set a limit for yourself ahead of time.
• Set a time to check your blood sugar, then do it.
• Ask a friend who's not on drugs to watch you for signs of hypoglycemia (low blood sugar). Then agree that as soon as he or she notices symptoms, you will check your blood and treat, if needed.
• Always wear your diabetes medical I.D.

Just Saying No

Sometimes people end up doing something they don't really want to do because they're afraid to say no. Or they think it's not cool to say no. Or they don't know how to say no.

You don't need to be afraid to say no. It's your right. And when you exercise that right and say what you do or don't want to do, it's called being assertive. Assertive is good.

The most important person to be cool with is yourself. When you make the best choices for yourself and stand up for those choices, that's when you're cool. And if you don't know how to say no, here are some ideas.

"No, thank you."
"No thanks, my diabetes doesn't mix well with that stuff."
"Thanks but no."
"Hey, if you had spent as much time in your life paying attention to your health as I have because of my diabetes, you wouldn't be doing that either."
"No, I've decided not to do that."
"No thanks. I can't tell if my blood glucose is low when I do that, and I don't think you want to spend the rest of tonight in the emergency room."

Volunteer to be the designated cool head in the group. If you're old enough to drive, ask for the keys. You don't have to "party" to enjoy the party.

Taking Diabetes on the Road

Not many things make teens feel more independent than seeing their picture on a driver's license. And for good reason. You get to sit in the driver's seat (and you can make your little brother sit in the back). You can leave when you want (no more waiting for Dad to get off the phone). You can come home when you want (as long as it's by curfew, of course).

Before you get a license, there's a lot you have to learn. Rules of the road. City driving. Highway driving. And worst of all, parallel parking. When you have diabetes, there are a few more things to learn.

Low blood sugar can slow your responses and reaction time. This not only puts you in danger but it puts pedestrians, other drivers, and your passengers in danger. Not to mention the poor dog walking along the road. So follow these tips to be sure you’re safe while driving.

• Check your blood sugar before driving, especially before a long trip. If it's low, treat the hypoglycemia and wait until you're at a safe level before taking off. Your health care team can tell you what the cut-off point is for safe driving.
• Keep a stash of glucose tablets and snacks in the car. (After all, who keeps gloves in the glove compartment these days?!)
• If you start feeling low while you're driving, pull over IMMEDIATELY and check your blood sugar. Don’t wait until the next rest area, gas station, or until you get where you’re going. Stop and check right away. Don't begin driving again until you have treated and gotten back to the cut-off point set by your health care team.
• Always wear your diabetes medical I.D.

Taking Diabetes on a Date

As if dating isn't stressful enough, now you have to decide how to handle the issue of diabetes while you're out with someone. If the person you're going out with is a good friend or you've known them for a long time, there's a good chance they know you have diabetes. And might even be familiar with your routine of taking care of yourself.

But if this is someone new, you have some decisions to make. The first one is whether or not to tell your date you have diabetes. Thinking through the following questions might help you make that decision.

• Will it be easier to stick to your meal plan if your date knows about your diabetes? Will your date wonder why you need a snack at a certain time?
• What happens if your blood sugar takes a nose dive while you're with your date?
• Will you need to check your blood or take an injection while you're out?
• What physical activities will you be doing? How long will the date last?

You might avoid some awkward moments if you tell your date about your diabetes beforehand. Be prepared for all kinds of reactions, from ho-hum bored to totally grossed out to tell-me-more fascinated. It's up to you to decide what you share and don't share about the disease. But remember, you're there to have fun. Don't feel you have to turn into a diabetes educator every time you go on a date.

Oh No! Not the Sex Talk!

Surely you didn't think we would cover alcohol, tobacco, illegal drugs, and NOT sex?!

Many of the risks of having sex are the same for teens who have diabetes as for those who don't. And they are big risks. In fact, they are huge. AIDS. Syphilis, chlamydia, herpes, and other sexually transmitted infections. Pregnancy. And to top it off, facing the displeasure of your parents.

Add to that the risks just for teens who have diabetes. Like low blood sugar while you're having sex. (It's that physical exertion thing.) This risk probably isn't life-threatening. But you might feel like you're going to die of embarrassment.

The other risk specific to teens with diabetes is much more serious. The possible bad outcomes of a pregnancy are much higher when diabetes is involved. Mother and baby are both at higher risk. Even in adults with diabetes, an unplanned pregnancy is a big risk.

As with tobacco, alcohol, and illegal drugs, everyone on your health care team will tell you to not have sex (abstain). But if you make a different choice, follow these precautions. They could save your life.

• Condoms -- using them properly and using them EVERY time -- are absolutely necessary. They are the best protection against AIDS and sexually transmitted infections.
• Birth control pills are an excellent form of contraception (to avoid pregnancy) for women with diabetes. They do not protect against AIDS and sexually transmitted infections, though. You still need to use condoms.

If you change your mind and decide having sex isn't the best decision for you, speak up. Say no. It's your body, your life, and your right to decide. And if you want to avoid dying of embarrassment from low blood sugar, check your blood before you have sex
and treat if you need to.

Growing up. Moving on.

Think back to a long time ago. When you were growing up. Back to that tub full of slimy bubbles. To that hot red sweater. To the unfortunate demise of your hamster. To a time when your actions were based on impulses instead of information. Now you know how to make wise choices. You're learning what things to consider and what will be best for you. You've come a long way.

It's a good thing. Because you have some big decisions to make. Some of these will be easy. Others will be a struggle. Sometimes you will have plenty of information to make a decision. Sometimes you'll want help.

Adults in your life -- parents, grandparents, teachers, counselors, ministers, and youth group leaders -- can be good people to turn to. Find an adult you trust and don’t hesitate to ask for answers or advice. Your health care team will have good information to share and sound advice about your diabetes.

Lots of the people are there to help. But it's your life to live. The choices are yours to make. Of course you'll make mistakes.
Everyone does. But bouncing back from dumb decisions is how you learn to make good ones.

String enough good choices together, and you'll prove your independence. To your parents. To the world. And to yourself.

To Learn More:

• Wizdom. The Wizdom books contain a lot of useful information for teens with diabetes. Your best bet is probably to download the books from our Web site at www.diabetes.org/wizdom. Or, call us at 1-800-DIABETES (800-342-2383) and we’ll mail you the full kit.
• Magazines: Diabetes Forecast is a monthly magazine published by the ADA for people with diabetes and their families. It’s free to members of the American Diabetes Association. Become an ADA member by calling us at 1-800-DIABETES.
• This is one in a series for and about kids and diabetes. We have titles about type 2 diabetes, school, family,
  discrimination, healthy eating, sports & exercise, and more. Download them by logging on to  http://www.diabetes.org/for-parents-and-kids/pods.jsp or call us at 1-800-DIABETES (800-342-2383) and we’ll mail you a copy.
• For more information log on to www.diabetes.org/wizdom/
• Questions or comments? Send us an e-mail at wizdom@diabetes.org