Risk Taking Behaviours in Adolescents Living with Type 1 Diabetes

INTRODUCTION

The organ responsible for producing insulin is call the pancreas when the immune system begins to destroy cells within the pancreas called betta cells the hormone responsible for converting carbohydrates into energy no longer exist and a chronic autoimmune condition call Type 1 diabetes (T1D) is established. The daily regime of someone living with T1D involves the management of multiply daily, blood glucose monitoring, insulin injections and dietary management. Those living with T1D need to be attentive of hyperglycaemia which is when you experience particularly levels of high blood glucose or low blood glucose levels known as hypoglycaemia. The serious long term health complications associated with TID are hard to comprehend as a teenager as quite often they are living for the here and now. Many trials have been conducted over the years by the Diabetes Control and Complications Trial research group (DCCT) and have been able to establish that with intensive management complication such as; retinopathy (blindness) kidney disease, heart disease, neuropathy and vascular disease can be reduced (DCCT/EDIC Research Group, 2016).

This report will outline evidence to support the importance of providing ongoing support for adolescents in their diabetes self-management in relation to risk taking behaviours. A session plan has been developed addressing the information for adolescents providing outcomes appropriate diabetes self-management. Although research, clinical management, technology, psychosocial and behaviour of diabetes has improved diabetes care these factors are less documented. During the teenage years they are trying to negotiate many changes including physical, cognitive and psychological, it is at this time that the susceptibility of engaging in risk taking behaviours such as alcohol and other drug use is increasing, this for some will lead to developing mental health problems (Schreiner, 2017).

Even though the threat of risk taking behaviours has been similar to adolesces without those living with T1D has been seen to be comparable in teenager with and without T1D, poor self-care and metal health conditions have been a higher for those diagnosed with T1D (Moore et al, 2013).

NEEDS ASSESSMENT

At diagnosis most education and management is directed to the parents and it is not until the child is older that the responsibility/focus of self-management is placed on the child, for some teenagers they can understand the clinical processes of giving insulin and blood glucose monitoring but not understand why these things are done. The DAWN youth study looked at some of the goals identified by adolescents along with the unique challenges of childhood diabetes (DAWN study, 2007). Some of the goals identified included: improving access to education, psychosocial support, age appropriate care, and, improved peer support with better educational and psychosocial support for parents and families (DAWN study, 2007). The DAWN Youth programme aimed to assist advocacy and action while improving the lives of children living with diabetes and their families, while particularly focusing on disabling psychosocial barriers through the use of the DAWN call to action goals. Being able to provide ongoing education in a trusting environment for your patient is essential in the long term for their development in self-management. Goal 3 in the DAWN study was defined by offering individual assistance to manage a healthier and more active self-management lifestyle.

The success of reaching a supportive and motivating diabetes care team is essential when trying to achieve effective care and good outcomes when establishing an active diabetes self-management result (Betschart Roemer, 2016). When creating a treatment plan health care professionals need to take into account the patient’s individual needs, circumstances, issues and resources, because if the plan is to be followed effectively it is essential in the management of their diabetes. When encouraging/fostering diabetes self-management for all patients it can be challenging, before considering the other demands of teenage life in an adolescent with T1D. As changes to their bodies are happening being able to maintain blood glucose levels can be increasingly challenging, adolescents are often expected at this stage to take on more accountability in the management of their diabetes. At the same time, the increasing demands of school, the possibility of getting part-time employment, and diabetes management can become increasingly less important with an evolving social life in the mind of a teenager. Some teens find it easier to quit taking care of themselves due to the competing pressures and demands (Betschart Roemer, 2016). Evidence by Moore et al 2013, found that during adolescence adherence to your diabetes self-management is particularly poor. Not only can peer pressure and the normal changes of teenage development cause conflict let alone living with a chronic condition and trying to manage it, this strain alone can form a platform for major personal, family stress and even mental illness. Part of the makeup of an adolescent is that they do not recognise that harmful things can happen to them and therefore cannot foresee potential negative consequences of their actions. Teenagers have a difficult time deciding whether to doing something or not doing something. Sadly when already confronted with T1D some risk-taking behaviours engaged in today will have an effect on them in the future. Teenagers are risk-takers and it has been shown through research by developmental experts that risk-taking behaviours are a big part of adolescent behaviour (Moore et al 2013).

Being able to provide ongoing support and education to adolescents in the prevention and guidance in risk taking behaviours may provide some insight into what can occur when consuming alcohol, taking drugs, unprotected sex and driving. Betschart Roemer (2016), reports that, risky behaviours are common among adolescence such as tobacco use, drug use alcohol consumption and unprotected sex. Adolescence don’t consider the potential consequences for their actions and those living with diabetes will often test the boundaries or are preoccupied with something else therefore skip blood glucose monitoring or insulin injections (Betschart Roemer, 2016) . The education session plan that will be covered in this assessment will look at adolescents living with T1D, focussing on education on risk-taking behaviours. Research has shown us that adolescence is naturally a time of increasing independence and self-assertiveness, but also of risk-taking (Moore et al, 2013). Therefore, determining the appropriate extent of parental involvement can be challenging. Although adolescents should be responsible for the day to day management of their diabetes, minimal or no parental supervision has been known to results in poor glycaemic control (Schreiner, 2017). While shared management between the adolescent and parents is associated with better glycaemic control, parent-child conflict over daily management leads to poor control, and adolescent depression of even a mild degree can interfere with family involvement and diabetes control (Schreiner, 2017). Levisky and Misra 2018 found that by providing family-focused teamwork sessions focusing on parent child responsibility and strategies to avoid conflict showed an overall improvement in the care of an adolescent with diabetes. The trial looked at children ranging from 8-17 years, they changed the practice in how they managed diabetes by making it more family focused compared to the normal standard multidisciplinary approach by establishing a responsibility for both the child and the parent/carer to be more involved in establishing an active family discussions resulted in increased family involvement and better glycaemic control down from 93% to 8.8% (Levisky & Misra 2018). Developing a session that can provide strategies for adolescents to understand what is happening to their bodies and provide them with options of what they need to consider before initiating drinking, drugs, blood glucose monitoring, insulin omission and sexual activity will hopefully decrease some risk-taking behaviours associated with long term diabetes complications and establish open and active family discussions.

Presentation Plan

Topic: Risk taking behaviours in adolescents living with T1D Date: 21/07/2018

Learner Profile: ­To support adolescents living with type 1 diabetes in developing the appropriate knowledge and skills in understanding the effects that risk taking behaviourshas on their body.­­­­­­­­­­­­­­­­­­­­­­­­

 PROGRAM OBJECTIVES / LEARNING OUTCOMES:

Being able to identify risk taking behaviours

Short-term implications – here and now

Recognise long term complications associated with risk taking behaviours

Be able to plan/prepare for risk taking situations

Be able to communicate appropriately with educators and parents regarding risk taking behaviours

Be able to self-manage their diabetes whilst continuing an open relationship with parental support

LESSON STRUCTURE:

CONCLUSION

This report looks at some of the risk-taking behaviours of adolescents living with T1D. Diabetes care today seems far from the norm as what it was in years gone by when one, two or three injections was the management. Today those living with diabetes are expected to self-manage their diabetes at an earlier age and is likely injecting a basal insulin once or twice a day along with fast-acting insulin at meals or use an insulin pump. Even with the advances in technology they are still being asked to check blood glucose level multiple times a day, eat healthy foods, count carbohydrates, carry supplies, exercise, maintain an insulin pump, and keep records of their blood glucose levels, it is understandable that adolescence want to escape from it all through risky behaviours (Schreiner, 2017).

While adolescents live a very active and full life, and tell us they assure us they will abstain from alcohol, cigarettes, drugs, and sex, they may also just as quickly change their minds. The session plan provided evidence why these risk taking behaviors are important in covering whether run in a group session for adolescents so that they can freely ask questions and explore ways of meeting these behaviors. By assessing behaviors regularly in clinic appointment the diabetes educator or provider can report if any risk taking behaviors have been established and ensure counseling and education is provided regularly (Moore et al, 2013). Adolescents with T1D are regularly seen every three months, establishing an open patient/educator relationship by reinforcing positive behaviors for avoiding risk taking activities. Ensuring that you allow for education and discussion about relevant risk-taking behavior appropriate for the age of the adolescent and if concerned about their management to seek the appropriated health professional to assist with ongoing management (Funnell, 2013).

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APPENDIX 1

Assessment Questions for Adolescents with Type 1 Diabetes

(Jaser et al, 2011)