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Diabetes Concerns in High School

Alcohol and Drugs, Sports, Driving — How to Tackle Important Topics with your T1D Teen

High school brings with it a host of topics that need to be discussed with your teen/adolescent with type 1 diabetes. Keeping an open dialogue about important issues can enable your teen/adolescent to take more control of their diabetes care. During this pivotal life stage, when your teen should be attempting to increase responsibility, laying the groundwork so that he or she has the tools and knowledge to become increasingly independent is critical. The knowledge and support your teen gets now will also serve them well for years to come. However, it is important to understand that a discussion of topics that can impact diabetes should not be a “one and done” conversation. This should be an ongoing dialog to see if there are more questions or if a particular plan of attack needs to be revised.

Here are three areas that deserve discussion with your teen with diabetes:

Sports

High school sports can be very intense, and while your teen/adolescent can participate, he or she needs to know how often to check blood glucose levels during games or matches, what to do if they’re low, and even the basics of how exercise affects their body. They also need to know how to adjust their medications to reduce the risk of low blood glucose.

A good general guideline is to test blood glucose levels before and after all practices and games. If the practices or games will be greater than two hours, it may be a good idea to test blood glucose levels mid-way through the event. Testing blood glucose levels mid-way through a game or competition can help you understand how this activity affects blood glucose levels. With an increase in use of continuous glucose monitoring (CGM), having access to blood sugar levels at all times can really help with decision making.Some very general guidelines can include the need for carbohydrate (without insulin) to reduce lows during practice. If they will be consuming meals or snacks before or after their practice, insulin dose reductions may very well be required. For example, if the blood glucose levels before practice are 187, but the blood glucose level mid-way through is 93, this tells us a snack may be needed before practice to reduce the risk of hypoglycemia. They should also be aware that practices and games may affect blood sugars very differently. While practices tend to be consistent movement for one or more hours, this will have a greater risk of low blood sugar. While games tend to increase adrenaline and could cause the blood sugars to rise. While everyone is affected differently, it is good they understand that there could be different effects on their blood sugars. Since diabetes affects everyone differently, talking to your healthcare provider to create an individualized plan will be useful.


Alcohol/Drugs/Smoking

It is possible that your teen will drink in high school, even though they are not supposed to. However, since they have type 1 diabetes, alcohol can affect them in a different (and potentially dangerous) way. A few things about alcohol: it is processed by the liver. The liver stores sugar for the body’s use. While alcohol is being processed by the liver, it will not distribute any sugar, meaning that if your teen drinks several alcoholic beverages, the liver will not deliver sugar for several hours, which can greatly increase the risk of hypoglycemia and severe hypoglycemia.  Also, when alcohol is consumed, glucagon will not be as effective, it at all, meaning if your teen passes out due to low blood sugar, glucagon may not work to wake them up.Talk to your teen about how alcohol interacts with her body (always, of course, with the caveat that they shouldn’t be drinking before it’s legal). It may also be a good idea for you to talk to their healthcare professional to make sure this is discussed during one of their quarterly visits. They may need strategies in place to help them avoid peer pressure—when all their friends are drinking at a party, how will they say no? At the very least, giving specific guidelines on how to reduce the risk of hypoglycemia in the event alcohol is consumed, would be essential and a life-saving measure.

It does seem that recreational drugs and smoking or vaping are becoming even more popular than alcohol. The same great risks apply to teens with diabetes as their counterparts without diabetes. The old adage “Just Say No” still applies. Nothing good comes from experimenting with drugs, smoking or vaping.


Driving

Your teen needs to know that there will be times when he or she can’t drive because their blood sugar levels are too low. What is too low? How do they feel when they’re too low? What should your teen do should he find himself driving while experiencing a drop in blood sugar? This is also an excellent time to talk about problem solving strategies to keep them safe while driving.  If your teen does not want to currently wear a CGM, this may be a perfect opportunity to compromise and be allowed to drive.

Help your teen build a plan for driving safely—which includes knowing when they shouldn’t drive. It is also important for them to know that driving is a privilege, not a right. Many states require a medical report form to be filled out by their healthcare providers to confirm that a diabetic teen is safe to drive a motor vehicle. The American Diabetes Association offers a helpful guide “Drivers License Laws by State” that spells out what individual states require of drivers with a medical condition that may impair driving.

By late high school, your teen is much more independent In their junior or senior year. They generally should be able to attend appointments on their own (or at least a portion of them without you). Of course, whether or not your teen is willing and able to handle these appointments on her own depends on her maturity and comfort level. Getting your teen ready to leave home to go to college or into the workforce after high school is a big process. By taking advantage of the “teaching moments” that come your way during high school, you can help prepare them for good diabetes control later in life.

Updated on: August 21, 2019
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