Balancing a healthy diet, carb counting and insulin doses can be very tricky during the teenage years, writes Sheila O’Kelly.

All teenagers have concerns about body image and what their friends are doing, about their body shape and their social activities around it. Then you have type 1 diabetes thrown in the mix and that is where it becomes complicated for them, says Deirdre Moyna, Diabetes Nurse Specialist, Cavan and Monaghan Hospital Group.

Warning signals

• Warning signs of eating problems can be when your teenager:
• Starts eating different foods to usual
• Says ‘I’m not hungry’ when they come home from school
• Is eating less than they used to and says ‘I don’t feel like it’
• Leaves carbohydrates off their plate.

Parents should also try to be aware:

• Of what your child’s eating patterns are
• Of any small changes in eating habits
• If your child is missing meals
• If your child’s lunchbox is coming home and the food is not gone
• If your child’s sugar levels are tending to run a bit higher – are they taking their insulin at school?
• If parents are worried, they should contact their child’s diabetes team.

 Mature beyond their years

“The biggest problem is that what we are teaching or asking teenagers with type 1 diabetes to do, is probably completely at odds with what they should be doing as a teenager. We are expecting them to be mature beyond their years, to have some level of organisation in their life.

“They need to plan, they need to be prepared and that is not being a teenager,” says Deirdre.

Carbohydrate counting is popular with teenagers because it gives them some level of control. Thankfully teenagers no longer have to stick to the regimen of you need x amount to eat for breakfast, y for lunch, and z for tea; and that has to be at 8am, 12am, and 6pm. Adjusting insulin to suit food choices is now a really big benefit for teenagers. It means that, if for example, they want to go with their friends for a burger, there is no reason why they can’t.

“If there is any population in the country that knows about eating well, it is probably people with type 1 diabetes because they have grown up with it. They are very aware of their food,” says Deirdre.

 Eating and body image at early age

“Body image is now becoming an issue among girls as young as 11 or 12. That frightens me. This used to happen at mid teens. We try to encourage them not to look at being thin or fat, but their body shape. However, you don’t see that many teenagers with type 1 diabetes who are overweight, because they have been brought up on healthy eating,” says Deirdre.

As young people move into their twenties, they become more conscious of health, and of long-term chronic illnesses.

 Developing independence

Teenagers are starting to make their own decisions, while still being very dependent on their parents for support and advice. It is very difficult for parents to get that balance where you can allow them a certain amount of independence, but support them at the same time.

Eating problems are not as big an issue with children who are diagnosed with type 1 diabetes early in life, because they have carried this through from an early stage and they have never known anything else.

“It is so difficult for a child who is diagnosed in their teens. You can understand why. You’ve taken everything they have known away, throwing it out the window and flipping it on its head. It is very difficult.

“Boys deal with it differently to girls. Boys tend to exercise and play football. You’re cool looking if you’re a footballer. With girls it’s all about dieting and weight loss,” says Deirdre.

“You need to be careful. You don’t want to become accusatory because you will just drive them further away. We would be very upfront with teenagers, young teenagers especially, and say ‘Are you trying to lose weight? Is that what you want? If you are, tell us, so we can help you to get to a fit, healthy weight where you will look good. You don’t want to look too thin or to be overweight, so let us know and we will help you to look good,” said Deirdre.

If a teenager wants to lose weight ask your diabetes healthcare team to measure them, weigh them and get the dietitian to speak to them.

“We may say this is good, this is healthy where you are. If they have a bit of excess fat we will help them to get rid of that without doing anything drastic. We try to look at it in a positive way and steer them away from this whole thin/fat debate and look at looking fit.

“The huge thing is to get them to develop their own confidence. If you have a confident young teenager, they will cope with their diabetes better. But if they have a poor self-image or sense of identity, they will struggle all their lives with their diabetes.

Type 2 anger

Teenagers can get very angry at being mistaken for someone who has type 2 diabetes. People say silly things like, “You must have eaten an awful lot of sweets when you were younger”. The general public thinks diabetes is all about being fat and often don’t know the difference between type 1 diabetes and type 2 diabetes.

“Teenagers with type 1 are very annoyed over it. They didn’t ask for type 1 diabetes and they didn’t do anything to get it. It is so soul destroying for them if somebody says, ‘Are you sure you should eat that?’,” says Deirdre

Becoming more body conscious

Changes to how your child eats doesn’t mean that they are becoming anorexic, but it may mean they are becoming more body conscious.

“Talk to them as early as possible about it, take the elephant out of the room. For me this is more important. Throw it out there, just say, okay, your weight, are you happy enough? Teenagers can be quite practical and black and white. If you explain to them about foods, how they impact on your body, that often works for them.”

Encourage carbohydrate counting

“If there is carbohydrate counting available at their medical centre, I would encourage them to look at that. Because it certainly expands their ability and teaches them that foods are not bad, it’s about what you do with them.

“Nowadays most teenagers with type 1 diabetes will be taught carbohydrate counting. However, they don’t all adhere to it and keep it up. They’re teenagers.

“For some of them it is life changing and especially when they get into their twenties, they are willing to put the work in to it. When they are younger not so much. Some are inclined to let their parents do all the carbohydrate counting for them. But they all take something from it – they understand their foods better and how they affect them. It can help them to look at foods and figure out how to be healthy.

“In the general population I think children with type 1 diabetes come out much better in terms of a healthy weight than those without. They are very aware of what they are putting in their mouth. They have been doing it all their lives. They wouldn’t have that sweet tooth, they don’t do the fizzy drinks.

“They know the consequences in terms of higher insulin doses, sugars going high, feeling dreadful. So they tend to avoid it. They’re not saints, but they are much more conscious about how they feel by eating sugary foods. As a consequence they do avoid them and therefore they don’t tend to put on as much weight,” says Deirdre

Alcohol and teenagers

Teenagers with diabetes will drink just like their friends drink, even though they know the consequences.

“They are willing to run the gauntlet just to be out and about with their friends. The ones that do their first year in college scare me. Up until leaving cert, they are still at home so there is a certain level of supervision. Once they are in college, they make new friends and it is party, party, party,” says Deirdre.

Protect yourself while at college

If you are away at college, let people know that you have diabetes. It is dangerous not to. Your friends may think you’re sleeping off a hangover, when in fact you are in a coma. “Tell one of your friends when you are going, or tell two of them. Have some kind of a plan in place – have something in your bag. Then enjoy your night. Know when to stop.

Going to the chipper after the pub

“Go to the chipper on your way home, get pizza or something. The dangers when drinking is that blood sugars will go sky high and then crash. Cut back on long-acting insulin before you go out and get a takeaway or something on the way home,” advises Deirdre.

By the time young people are in second year of college, they are taking it a little more seriously and they tend to settle down a bit, but the first year can be dangerous, said Deirdre.

“We want teenagers to go out and enjoy themselves, but they have to learn how to draw a line in the sand. A lot of them learn quickly how to learn how much drink they can take without going over the top.

“They can control their drink and know how far they can go before it becomes an issue for their diabetes and pace themselves based on experience,” said Deirdre.

Advice for parents

Never knock teenagers on the head or start lecturing them about alcohol. Instead try to get them to understand how important it is that when they are going to have a few drinks they still have to be aware of their diabetes.

“Don’t nag them. Talk it through with them. Support them. Don’t be afraid to talk to them,” says Deirdre.

Diabetes Ireland has a good booklet, ‘Tips for College Life’, downloadable here.

This article was published in Diabetes Ireland Magazine – Spring Edition 2016