This study explored the incorporation of type 1 diabetes mellitus (T1DM) into self-identity among adolescents. Guided interviews explored 40 adolescents' views of T1DM in relation to their sense of self and relationships with others. Responses were analyzed using thematic analysis. Results revealed that the entire sample described T1DM as a significant burden; many described how T1DM made them feel less "normal." Adolescents described both positive and negative aspects of self-management in social relationships, though most reported benefits in sharing T1DM with friends. Females were more likely to share information about T1DM and to describe positive changes in self-perception as a result of T1DM. The psychosocial processes related to integration of T1DM into self-identity described in these qualitative data provide hypothesis-generating findings that can guide future quantitative research examining incorporation of T1DM into adolescent self-identity in relation to measures of self-esteem, peer orientation, self-management, and glycemic control.
Postprandial hyperglycemia due to paradoxical hyperglucagonemia is a major challenge of diabetes treatment despite the use of the artificial pancreas. We postulated that adjunctive therapy with pramlintide or exenatide would attenuate hyperglycemia in the postprandial phase through glucagon suppression, thereby optimizing the functioning of the closed-loop (CL) system. Subjects with type 1 diabetes (T1DM) on insulin pump therapy were recruited to participate in a 27-hour hospitalized admission on 3 occasions (2-4 weeks apart) and placed on the insulin delivery via CL system in random order to receive (1) insulin alone (control), (2) exenatide 2.5 µg + insulin, (3) pramlintide 30 µg + insulin. Medications were given prior to lunch and dinner, which was a standardized meal of 60 grams of carbohydrates. Insulin delivery was as per the ePID algorithm via the Medtronic CL system and continuous subcutaneous glucose monitoring via Medtronic Sof-sensors. Ten subjects age 23 ± 1 years with a HbA1c of 7.29 ± 0.3% (56 ± 1 mmol/mol) and duration of T1DM 10.6 ± 2.0 years participated in the 3-part study. Exenatide was found to be significantly better in attenuating postprandial hyperglycemia as compared to insulin monotherapy (P < .03) and pramlintide (P > .05). Glucagon suppression was statistically significant with exenatide (P < .03) as compared to pramlintide. Insulin requirements were lower with adjunctive therapy, but statistically insignificant. Insulin monotherapy results in postprandial hyperglycemia in T1DM in the CL setting and adjunctive therapy with exenatide reduces postprandial hyperglycemia effectively and should be considered as adjunctive therapy in T1DM.
Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.
As children with diabetes enter adolescence, the physical and psychological changes of puberty add to the challenges of disease management. This often leads to increased stress for both parent and child and to poor overall glucose control with potential short- and long-term complications. During this period of transition, nurses play a central role in teaching patients and their families about the effects of puberty on insulin sensitivity and glucose metabolism, and in discussing how the emotional and behavioral changes associated with this challenging time can affect diabetes management.
It can be challenging to maintain euglycemia in children and adolescents with type 1 diabetes due to their eating habits, growing and changing bodies, erratic schedules, still developing cognitive systems, inability to manage their diabetes on their own, and presence of multiple care-givers. RT-CGM systems can be used in this group of patients to more closely monitor their varying glucose levels and help them achieve good glycemic control. Previously, studies of patients with type 1 diabetes using CGM did not show the same benefits in the younger population as in adults. [3][4][5] However, recent reports have found benefits of using RT-CGM in youth. 6-10 RT-CGM use in children and adolescents has increased, but it is still not as wide as in adults. Initial Research StudiesEarly studies of RT-CGM found that only patients with type 1 diabetes who were at least 25 years of age and who wore glucose sensors at least 60 % of the time significantly benefited from this technology. 3,5,11,12 This was the case, for example, of the Juvenile Diabetes Research Foundation (JDRF) study, which found that RT-CGM effectively lowered glycated hemoglobin (HbA 1c ) in such patients and decreased the time they spent in hyperglycemia. 3 A more recent study found glycemic benefits in those who wore glucose sensors at least 41-60 % of the time, 13 showing that RT-CGM can be beneficial even when used less frequently.Although RT-CGM has been shown to benefit patients, 2,5,6,11,13
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