There is no widely accepted precise definition of what adolescence is, but it is commonly referred to as the transitional period between childhood and adulthood. As this not the place to discuss the social, cultural, historical or political construction of adolescence, for the purposes of this chapter adolescence is taken as referring to young people between 12 and 20 years old, thereby mapping fairly closely the teenage years.

Whatever definition you use, the adolescent years are clearly a period of rapid change and development. Children progress through the education system to compete with adults for resources and jobs. This is accompanied by continued cognitive development, enabling young people to think in increasingly abstract ways and to become less receptive to authority figures. As they compete for jobs or higher education places, teenagers are attempting to establish their identity and lifestyle, and quite early on have to make choices that will affect their long-term career aspirations. Adolescents spend increasing amounts of time away from home, and their leisure activities become less structured, with ever-diminishing adult supervision or involvement. It is during this period that we learn how to form and maintain friendships and close intimate relationship with our peers. With puberty comes the adjustment to a changing body and interest in sexual relationships. The timing of puberty can also have a substantial impact on adolescent development, with early or late onset of puberty having markedly different effects on boys' and girls' psychosocial development. With all these changes occurring in a relatively short period, probably ending with the adoption of lifestyles that will endure through adulthood, it would seem reasonable to suggest that adolescence provides us with the opportunity of having a lasting and significant impact on the health and well-being of individuals.

Adolescence is a particularly critical time for young people with diabetes. Whether diagnosed in childhood or adolescence, it is during the adolescent years that the individual learns to take increasing responsibility for the management of his/her diabetes1 -3. As they start to integrate their diabetes management tasks into their emerging lifestyles, teenagers directly experience the relationship between their actions and blood glucose tests, if they do any. This will in turn influence their beliefs about diabetes, its treatment and how they will manage it. Therefore, these will be formative years in the development of such beliefs, which, once fully integrated and accepted by the young person, may prove difficult to change.

Adolescence is also frequently seen as a time to change and intensify insulin regimens. Whether this is in response to trying to make diabetes management more flexible to fit with the young person's lifestyle, or in an attempt to improve diabetes control, intensifying regimens adds to the demands of diabetes. The additional pressures to test blood glucose and adjust insulin can mean that intensification will result in increasing intru-siveness making the social life of young people even more difficult.

Research consistently demonstrates that during adolescent there is a marked decline in metabolic control4-6. Although this decline is partly attributable to the physiological changes occurring at this time7'8, the decline in self-care seen during adolescence is of equal if not greater importance9-11. This deterioration is particularly marked and of concern in the area of insulin administration. Although self-report data suggested that missed insulin injections were common, the pharmacy record data from the DARTS database demonstrates that about 28% of young adults do not even obtain sufficient insulin to meet their prescribed regimen11.

In addition to insufficient insulin resulting in hyperglycaemia, repeated failure to inject insulin can result in diabetic ketoacidosis (DKA). Post-diagnoses and recurrent DKA, in the absence of other medical complications, is commonly caused by low levels of insulin administration12, with the incidence of recurrent DKA peaking during adolescence22.

As if these diabetes burdens were not enough, for many young people, especially those diagnosed early in life, their annual review will begin to include screening for the complications of diabetes, adding to their anxieties and emotional burden. It is not surprising, then, that young people are more likely to drop out of the system and not attend outpatient clinics47'48. Furthermore, with the emphasis on monitoring diet and weight, young people, particularly young females, are at a greater risk of developing disordered eating patterns74'75, which may lead to clinical eating disorders.

This brief summary makes it clear that adolescents with diabetes are in the unenviable position of facing the same developmental tasks and demands as other young people, in addition to learning to manage and live with their diabetes. This poses healthcare professionals and parents with numerous challenges as they seek to maintain or improve diabetes control through this transitional phase, without depriving young people of the appropriate age-related experiences to enable development and growth.

This complex array of diabetes and general developmental issues has generated a wealth of literature on the psychological aspects of paediatric chronic illness, and diabetes in particular. In order to review this literature and consider the implications for diabetes care, the determinants of three outcomes will be considered: the mental health of individuals (commonly referred to as adjustment, adaptation, well-being); the health behaviour of the person with diabetes (incorporating compliance, adherence, self-care and self-management); and the health status or metabolic control of diabetes. Quality of life will not be considered in this review, as it is a relatively new construct to be incorporated into paediatric health psychology, and there is little research using validated measures upon which to draw.

To provide this chapter with a relatively coherent structure, it will move progressively from more individual psychological constructs, such as personality and beliefs, to increasingly social constructs, such as stress, and coping, before considering the role of the familial, peer and professional support the adolescent receives. Throughout, the practical implications of the research will be highlighted and areas for future research considered, with these practical implications being summarized again at conclusion of the chapter.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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