Commentary by Karen Soren, MD and Margaret Grey, DrPH, RN
Managing type 1 diabetes during the teenage years is challenging. Physical changes, social pressures, and stress can make it harder for teenagers and young adults to control their blood sugar levels. Researchers at Columbia University have found that it is important to watch out for signs of depression, anxiety, and eating disorders that may make it even harder for teens and young adults to keep type 1 diabetes under control.
The researchers found that 11% of 150 teens and young adults (ages 11 to 25 years) with type 1 diabetes had depression, 21% had anxiety, and 20% had disordered eating. In addition, those teens and young adults with mental health issues were twice as likely to have poor diabetes control, putting them at risk of a number of complications.
Mental Health Screening
Screening for these mental health issues in teens should be done at “least yearly—and probably also at times when their disease appears to be unexplainably out of control,” said a coauthor of the study, Karen Soren, MD, Associate Professor of Pediatrics and Population and Family Health, and Director of Adolescent Medicine at Columbia University Medical Center, in New York, NY.
“Several years ago, the American Diabetes Association recommended that all youth with type 1 diabetes be screened for depression once per year,” explained Margaret Grey, DrPH, RN, Dean & Annie Goodrich Professor Yale University School of Nursing, New Haven, CT. These findings by Dr. Soren and colleagues suggest, “that screening for anxiety and eating disorders should be considered, at least in the age group 11 years and older,” Dr. Grey said.
Ask for Help
If you think you or a family member has depression, “Ask a provider or parent or a trusted adult for help,” advised Margaret Grey, DrPH, RN, Dean & Annie Goodrich Professor, Yale University School of Nursing, New Haven, CT.
If you skip your insulin dose regularly, talk to your doctor. “If it is a regular occurrence, the youth needs to see a mental health professional because of the risk of diabetes complications,” Dr. Grey said. “If it is a rare occurrence, I would explore what leads to [skipping the dose] and suggest alternative approaches. For example, girls will sometimes withhold insulin to lose weight. Helping them make healthier choices may be effective,” Dr. Grey said.
Get Help For Eating Disorders
Some teens may skip their insulin dose to lose weight or may purge their food, which is dangerous. “Thinness from untreated illness is a bad thinness,” Dr. Soren said. “Teens feel much better when their sugars are normal,” she said. “Work with a nutritionist in order to eat correctly, so that you do not gain unnecessary weight when treating your disease,” Dr. Soren said.