Diabetes Flashcards
What is diabetes?
Diabetes is a chronic condition where there is high levels of glucose in the blood.
Caused by:
- Inability to produce insulin (Type I)
- Body unable to use insulin effectively (Type II)
What are the risk factors for Type II diabetes?
Cannot be changed - family history - age - ethnic background e.g. ATSI, Polynesian - GDM or baby greater than 4.5 kg - polycystic ovaries Can be changed - smoking - weight - low physical activity - high BP - diet - cholesterol
What are some potential diabetes management goals?
- hbA1c less than 7%
- blood pressure 130/80
- healthy blood lipids and urinary albumin creatinine ratio
- BMI in healthy range
- attendance at regular and comps reviews
- adherence to positive lifestyle behaviours that contribute to above e.g. pricks and injections, monitoring of blood glucose levels, reduce hypos/hyperglycaemia
- Type II oral meds, BP meds, lipid meds
What are some psychological issues to consider in children with Type 1 diabetes?
Impact of the diagnosis: intense emotions, grief, loss of control and perception of how child’s life might be; parents’ loss of competence, loss of health
Ongoing issues - see other card
Mental health issues (2 x more likely to have MH diagnosis by 18; 1.7 x more likely to attempt suicide)
How does emotional reaction impact upon diagnosis?
- Ability to take in information, decision make, cope, problem solve, may exacerbate pre-existing difficulties.
How do children feel at diagnosis of diabetes?
Children feel anxiety, depressions, friendless, fearful, cranky, socialise less. Resolves in six months.
How do parents feel at diagnosis of diabetes?
Parents feel range of emotions including disbelief, bewilderment, anxiety, anger, helplessness, guilt, grief
Loss of how they thought child’s life may be, loss of competence, health, control
What are the ongoing psychosocial issues for children and young people?
Feel different from peers Absence of spontaneity - having to compromise and make decisions between needs of diabetes and normal carefree life. Need for dependence - but sense of being judged and supervised Hypos as embarrassing Fear of complications Sibling rivalry Peer group pressure Drug and alcohol use Perceived or real burden on family
What are the ongoing psychosocial issues for parents?
Amount of time, energy, emotions that goes into managing diabetes
Reduced flexibility and increased responsibility of day to day management issues.
Conflict between being responsible versus over protective
Conflict in handing responsibility to adolescent
Daily routine-related stressors, ensuring
- BGLs
- insulin administered safely and correctly
- dosage adjustments
- adequate exercise and diet
- Frustration at never getting perfect BGL control
Fear of hypos and complications
Guilt
What are the other potential parental psychological issues?
Need to explain diabetes to others who may not understand the complexity
Financial costs
Caring for other family members
Social networks outside of home need to be maintained
What are the issues associated with eating disorders and diabetes?
Type 1 diabetes - roughly 2 x more likely to develop ED or sub-threshold eating disorder
BN and sub-threshold EDs more common
Characterised by insulin omission/reduction, dietary and body dissatisfaction
More persistent, triples mortality rate for people with Type I and ED compared to those with diabetes alone.
What are the issues associated with depression and diabetes?
2-3 times more prevalent in people with diabetes but probably under-diagnosed
Bidirectional relationship
Persistent
Hampers medical treatment
What are the issues associated with anxiety and diabetes?
Prevalence unclear, possibly 20% higher lifetime diagnosis
Fear of complications leads to rigid management
Fear of hypos so run BGLs high
Hypo symptoms resemble anxiety symptoms
