Case 3 concluded B.C. is concerned about weight gain, her friends making fun of her need for injections, and hypoglycemic reactions while playing varsity volleyball. Her concerns are explored and intensive counseling is undertaken. At the same time, she is referred to an endocrinologist for further evaluation, and the diabetes care team initiates therapy with an insulin pump.
After an initial rocky period, B.C.’s therapy is stabilized and her hypoglycemic episodes reduced. B.C. discusses her concerns with other teens in a diabetes support group and is introduced at the local college to a star volleyball player (who also suffers from diabetes). As B.C. graduates, she is offered a scholarship at a top university. Her HbA1c is at normal levels.
Comment Younger individuals with diabetes face substantial challenges in adjusting to their disease. The incidence of disordered eating, depression, anxiety, and adjustment disorders is increased.
What’s more, diabetes in children and adolescents affects the whole family. Parents and siblings are often stressed over the patient’s care needs and mood swings, and may also present with mental disorders.
Related resources Oriented to mental health issues
- Wirshing DA. Adverse effects of atypical antipschotics. J Clin Psych. 2001;62:(suppl 21)7-10.
- Goodnick PJ, Henry JH, Buki VMV. Treatment of depression in patients with diabetes mellitus. J Clin Psych. 1995;56:4,128-136.
- Carney C. Diabetes mellitus and major depressive disorder: an overview of prevalence, complications, and treatment. Depression Anxiety. 1998;7:149-157.
- Jacobson AM. The psychological care of patients with insulin-dependent diabetes mellitus. N Engl J Med. 1996;334(19), 1249-53.
- Glasgow RE, Fisher EB, Anderson BJ, et al. Behavioral science in diabetes. Contribution and opportunities. Diabetes Care. 1999;22(5):832-43.
- Hoffman RP. Eating disorders in adolescents with type 1 diabetes. Postgrad Med. 2001;109(4)67-74.
- Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care. 2000;23(10):1556-62.
- Rubin RR, Peyrot M. Psychological issues and treatments for people with diabetes. J Clin Psychol. 2001;57(4):457-78.
- Golden MP. Special problems with children and adolescents with diabetes. Primary Care Clin. 1999; 26(4):885-94.
Drug brand names
- Alprazolam • Xanax
- Atorvastatin • Lipitor
- Bupropion • Wellbutrin
- Buspirone • Buspar
- Carbamazepine • Tegretol, Epitol, Atretol
- Enalapril • Vasotec
- Fluoxetine • Prozac
- Nefazodone • Serzone
- Phenytoin • Dilantin
- Risperidone • Risperdal
- Triazolam • Halcion
- Valproate • Depacon
Disclosure
The author reports that he has been a speaker or consultant for SmithKline Beecham, Organon, Wyeth-Ayerst Pharmaceuticals, and Pfizer.