1. Dr Lesley-Anne MacRae [L.MacRae@gcu.ac.uk]
Life with Type 1 diabetes
Dr Lesley-Anne MacRae

2. Incidence of T1 in Scottish children
Steady increase in the incidence in Scottish children over the last 40 years.
Patterson et al., (2009) predict a European increase of 70% in the under 15’s by 2020.
For the under 5’s, the rate is expected to double.
(Scottish Diabetes Survey, 2012).

3. T1-A Little Bit of Background
Symptoms at diagnosis?
Cause?
Treatment?
Implications of having diabetes? (physiological and psychological)

5. DIABETES Exercise Blood glucose control Insulin Diet
Avoiding ‘lows’ and ‘highs’
Lowers blood glucose
Improves heart health
Achieving/maintaining ‘target’ range
Exercise
Improves effectiveness of insulin
Blood glucose control
Lowers risk of complications
DIABETES
Too much=low blood glucose
Precise matching CHO to insulin
Required 24/7
Constant counting of carbohydrate (CHO)
Too little=high blood glucose
Insulin
Diet
Healthy diet
Extra when eating carbs/blood glucose rising

6. More than adolescent rebellion?
I: “…….at one point you hadn’t done any injections for quite a few days ……. what’s the thing about them, what do you think?”
R: “…….can’t be bothered...[...]... I don’t know why……… I think most of the time I would only take the one insulin injection one day, take the other the next day ...[...]...and I would miss one and I wouldn’t take one and I would forget and just different things. I mean I was comin into, like growin’ up te be a teenager, it was hard enough goin’ out and getting drunk and havin’ boyfriends and all that and then you had to take your insulin before you had your dinner and then you would go out and drink and have a hypo and end up lyin’ in the park and I couldn’t be bothered with that, so I just never took it.”
(female 18 yrs)

7. The crux of the matter (missing injections)
R: “…….. I should really be takin’ somethin’ but I’m scared of hypos...[...]... I hate them. So I don’t take it in case I have a hypo.”
I: “Right.”
R: “…….Just the feelin’ of it, it’s just, ye kind of feel yourself just goin’
down and down and down and ye’re just gonny get worse and yer face
goes all white and ma eyes go all black and it’s just a terrible, terrible
feelin’, mignin’. Ye’re sweatin’ and ye’re shakin’ and just different things…
…..it’s scary, really scary. Hate takin’ hypos.”

8. Anxiety & Hypoglycaemia
Has been described as being, ‘‘the single greatest barrier to achieving and maintaining good glycaemic control’ (Frier, 2008, p. 87).
Q-Why might that be?

9. HbA1c
(measure of
metabolic
control)
Age (years)

10. Peers Can be a positive thing!
Cox & Hunt (2015) reported that parental (and NOT peer) influence was main factor underpinning non compliance…………
Small yet significant improvements in HbA1c reported for those receiving peer support intervention (Chen et al., 2014).
Most common form of support is emotional support (companionship).
Instrumental support is reported as being less desired and received (Palladino and Helgeson, 2012).

11. However…………………
It has been reported that diabetes-specific, as opposed to generalised peer support has a detrimental effect (Doe, 2016)
Q-Why do you think this might be????

12. Relationship with peers-anxiety
I: Some people feel that because they have diabetes they get treated differently. What do you think?
R: No. Well a, a lot of people pick on you. Not me because I just end up hitting them, giving them a do-in.
I: ……How, what sort of things do they say? How do they pick on you?
R: At school they says, “Aye, you’ve gotty take jags!” and generally what happens they’ll make something, a big fuss out of you.
(male 13 yrs old) (MacRae et al., 2003)

13. Relationship With Health Care Provider
Relationship between patient and their health care provider (HCP) is crucial for good metabolic control (Curtis-Tyler, Aria, Stephenson & Roberts, 2015).
However, the inclusion of children and young people in decisions relating to their condition is often ‘tokenistic’ (Curtis-Tyler et al., 2015).
Review by Curtis-Tyler et al., 2015) reported that a key concern of adolescents was that appreciation was given for the wider, social, impact that diabetes had and not a sole focus on physiological factors and outcomes.

14. Hopefully……….
You now have a greater appreciation and understanding of adolescent life with diabetes.
There is more to it than sheer ‘rebellion’.
You have increased knowledge of psychological factors that may underpin self-management difficulties.
An appreciation for the fact that Health Care Providers can play a central role in the journey towards improved metabolic control.