Diabetes Mellitus in Adolescents
Description General and supportive measures Medicine treatment ICD-10 Code: E10 DESCRIPTION Adolescence is the period between 10 to 19 years of age. The adolescent and the transition should be managed with special planning, i.e.: the admission policy of the hospital, observing the wishes of the adolescent, emotional and physical maturity considerations, and the presence of any co-existing medical
General and supportive measures
ICD-10 Code: E10
DESCRIPTION
Adolescence is the period between 10 to 19 years of age. The adolescent and the transition should be managed with special planning, i.e.:
- the admission policy of the hospital,
- observing the wishes of the adolescent,
- emotional and physical maturity considerations, and
- the presence of any co-existing medical, surgical or psychiatric disorder that may be more appropriately managed in the paediatric service.
Aggression and agitation may be features of poorly controlled diabetes.
GENERAL AND SUPPORTIVE MEASURES
Promote:
- normal growth and pubertal development,
- psychological development,
- maintenance of glycaemic control and adherence,
- avoidance of risk-taking behaviours (smoking, substance abuse), and
- sex education.
Adolescents with diabetes may have concomitant behavioural and psychiatric disorders. Anxiety disorders are common in adolescents and should be differentiated from hypoglycaemic and hyperglycaemic episodes.
MEDICINE TREATMENT
Failure of current insulin regimens may be attributed to the endocrine changes of puberty which results in poor glycaemic control.
Insulin resistance occurs during puberty, being maximal in late puberty.
Other causes of poor glycaemic control include family dynamics (e.g. resistance to parental supervision), emotional lability and risk-taking behaviour (e.g. intentionally neglecting to inject and substance abuse).
Normal insulin requirements during puberty:
- 1.0–1.4 units/kg/day.
This may occasionally be higher (up to 2.0 units/kg/day), but as a general rule, a higher requirement generally necessitates the search for non-adherence and poor absorption through injections in lipohypertrophy sites.
After puberty, the insulin requirements fall to prepubertal levels.
Failure to reduce insulin requirements in the late adolescent stages may result in excessive weight gain.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 7: Endocrine, 7.5 Diabetes Mellitus, 7.5.3 Diabetes Mellitus In Adolescents