“Can type 1 diabetes affect my child's behavior?”
My son is 14 years old and was diagnosed with type 1 diabetes recently. I've noticed, however, that his behavior has been more aggressive. Is it possible for type 1 diabetes to affect a child's behavior?
6 Answers
It is always best to check with your endocrinologist regarding concerns regarding diabetes. However any chronic medical condition and especially type 1 diabetes can affect mood and behavior in children due to the emotional stress of being diagnosed as well as fluctuating sugar levels and diet changes. So short answer is yes - it can contribute to a change in your 14yo behavior
Yes
Years, high blood sugars or low blood sugars may affect his mood.
Behavioral changes and type 1 diabetes:
Type 1 diabetes is the commonest chronic metabolic disease of childhood. Currently roughly about 220,000 children live with type 1 diabetes in the United States of America. Up to this day there is no cure for type 1 diabetes, though, it is easily treatable with insulin, and when treated properly and aggressively quality of life and life expectancy may be close to that of a non diabetic person. However in poorly controlled diabetes chronic complications are common and quality of life as well as life expectancy is shorter by about 15-20 years. It is therefore important to take a note that poor glycemic control is the risk factor for chronic and acute complications of diabetes.
Todate there is no commercially available oral insulin on the market. Insulin is only given either by injection, intraveneous or by inhalation. Insulin is not a dangerous or addictive medication. It will probably continue to stay this way untill other alternatives or cure is found.
When diabetes treatment is intensified early enough chronic complications of diabetes can be avoided even when treatment was not optimum in later years due to epigenetic changes that promote protective condition known as a metabolic memory. Conversely, when treatment of diabetes is suboptimum in the early days of diabetes, even intensifying treatment in the later years may not prevent chronic complications of diabetes due to the same process (metabolic memory). The glycemic or metabolic memory therefore plays both roles of protection or predisposition to chronic complications of diabetes (eye, kidney, heart, cardiovascular diseases).
Untill the day comes that cure type 1 diabetes, we will continue current insulin therapy. Currently there is a remarkable advancement in the treatment of type 1 diabetes. We have advanced tools to treat diabetes, including, smaller and sharper syringes, more sophisticated insulin brands, advanced blood sugar testers, various insulin infussion pumps and advanced blood glucose sensors. Despite these incredible advances in diabetes management only 20-30% of type 1 diabetes patinets meet the goal of A1C <7% in the United states of American and Europe. The majority of type 1 diabetes patients do not meet this goal and have poor glycemic controll.
Any chronic disease including type 1 diabetes have psychological burden on the individual person with chronic disease. This psychological burden imposed by type 1 diabetes especially, when there is functional impairment in the face of poor social support and poor coping skills, is a sett up for mood disorders.
Stress frome type 1 diabetes and other stressful events can manifest in two way.
1) internalization; Is when the stressful event is poited to wards the person him/her self. These are such as, depression anxiety, poor energy level, sleep disturbances anorexia, hyperphagia or suicide ideations.
2) Externalization is when the person poits his stress agains others. These are such as bullying, aggration to wards others, disobidience, cheating etc.
Type 1 diabetics experience about 3 fold more psychosocial ilness, (mood swings) and mood disorders than their non diabetic counter parts. These are due to psychological and emotional burden imposed by diabetes, and events causing functional impairment such as hyperglycemia and hypoglycemia that are common in type 1 diabetes.
1) Hyperglycemia may cause depressed mood and mood swings. Hyperglycemia is defined when glucose levels rise above 110 mg/dL when fasting and 140 mg/dL 2 hours after meals. Hyperglycemia affects the area of the brain that controls mood and cognition (hippocampus). When blood sugar is high it affects the hippocampus and may lead to neuronal atrophy and apoptosis of the neuronal cells. This leads not only to mood swings but also to impaired cognitive function. Hyperglycemia (lack of insulin) causes hypercotisolism that can disrupt the nueronal generation of the hippocampus leading to depression and other mood disorders.
When blood sugars are persistently high about 50% of people may have a depressed mood. Type 1 diabetic adolescents may have about 20% of depressed mood and about 25% may have subclinical depression. Over all transient mood swings or behavioral difficulties may be experienced by over 50% of type 1 diabetic patients.
There are some signs that indicate a person may be experiencing high blood sugar levels, such as feeling nervous, fatigue, poor energy level, confusion, difficulty thinking clearly and quickly. When the blood sugars return to normal the symptoms will resolve.
In type 1 diabetes cuases chronic stress and hyperglycemia from uncontrolled diabetes leads to excess cortisol production and prolonged sympathetic activation.These can promote insulin resistance, obesity high blood pressure and can lead to metabolic syndrome, also known as double diabetes. Chronic stress can also lead to type 2 diabetes through the same mechanism. These stress hormones that produce the fear (anxiety, anorexia or hyperphagia) and the reward system cause depression and cravings for food, other substances.
Hyperglycemia can lead to behavoioural disturbance (mood swings), depression and anxiety. Diabetes is therefore a risk factor for depression and anxiety or other behavioral disturbances. It can also cause chronic microvascular (eye disease, kidney disease and nerve disease) and macrovascular complications complications (stroke, heart disease, peripheral vascular disease) through the recriutment of stress mediators (interlikins, and cytokines, oxidative stress and advanced glycated end products).
Diabetes is therefore not only about blood sugars. It can lead to sudden mood changes. Cuases emotional burden affecting personal and social life of the person. It is a risk factor for depression, anxiety and other mood disorders. It can also lead to obesity, visceral adiposity, insulin resistance, metabolic syndrome and chronic complications throgh chronic stress and hyperglycemia.
2) Hypoglycemia (blood sugar levels drop below 70 mg/dl) can affect the mood and mental status of a person. The symptoms of low blood sugars include:
Symptoms of hypoglycemia are as follows;
Dizziness.
Headache.
Shakiness.
Hunger.
Irritability
moodiness.
sweating.
Anxiety or nervousness.
trouble speaking
fatigue
confusion
pale skin
aggression and irritability
personality or behavior changes
concentration difficulties
co-ordination and decision-making difficulties
twitching muscles
seizure
Low blood glucose can result in rapid mood changes. Depressed mood and irritability are common symptoms of hypoglycemia. during which blood sugar levels drop below 70 milligrams per deciliter (mg/dL).
The body compounds this pleasant sensation by releasing adrenaline in an attempt to convert any available glycogen in the liver back into glucose to boost levels in the bloodstream."
When blood sugars are low adrenalin surge drives the bodies defense system in to fight-or-flight mode. This stress response is mediated the activation of the pituitary adrenal axis and the sympathetic nervous system to produce adrenalin, catecholamine and cortisol to fight the danger and keep the person conscious and alive, and to correct the low blood sugar. When the blood sugars corrects the system is turned off since hypothalamis pitiutary adrenal axis and the sympathetic out put is strictly controlled. But if there is chronic hypoglycemia there may be persistent heightened response by the sympathetic nervous system and hypothalamic pitiutary system (HPS) leading to persistent mood swings. This contributes to mood swings, such as irritability, aggressiveness, depressed mood or elevated mood.
When blood sugars fluctuate it is not uncommon to experience rapid changes in mood in a very short period of time.
While symptoms of diabetes related stress may not be severe enough for a diagnose of as a mental illness, these symptoms can affect a person's social interaction and quality of life. On the other hand diabetes is a major risk factor in predicting major mood disorders such as Anxiety and depression.
3) Psychosocial issues. The psychological burden of type 1 diabetes causes persistent stress. The stress of living with diabetes contribute to both changes in mood and concerns about potential complications. The physical effects of diabetes may also lead to nervousness, anxiety, and confusion. The mood swings can be come suddenly and may last a short period of time. These changes may bring strains in personal life and social relationships or interactions.
The psychological burden imposed due to type 1 diabetes could be related to concerns about potential complications. Some diabetics feel powerlessness in managing their diabetes. Some may feel can not do enough to take care of their diabetes. Some patients worry about what others think about them and shy away from their friends. Others worry about social embarrassment that they may not recognize when their blood sugars change suddenly.
The symptoms of mood or behavioral changes are:
depressed mood
Low self-esteem
Feeling inadequate
Hopeless or helpless
Excessive guilt
Feelings of wanting to die
Loss of interest in pleasure
Difficulty with relationships
lack of sleep or too much sleep.
loss of appetite or
or over eating
weight loss or weight gain
poor energy energy
Difficulty concentrating
poor decision making
Suicidal ideation.
Frequent physical complaints
Running away or threats of running away from home
Over sensitivity to failure or rejection
Irritability
Hostility
Aggression
Type 1 diabetes take a termendeous amount of energy and time to manage. Focusing on managing type 1 diabetes day in day out reguires a lot of effort. Type 1 diabetes is in the majority of cases is not well controlled. Most patients are not engaged enough with managing thier diabetes. On this planet almost every one is motivated to live healthy and long life. Diabetic patients have also the same wishes and aspirations in life. Howeve the job of diabetes is very tough. It is a tiresome work in progress that has no end in sight or any break in between. The life time job of managing typpe 1 diabetes has to also balance with the rest of the person's busy life. Some of the daily job of a diabetic patient are as follow;
1) Checking blood glucose several times a day.
2) Give appropraite amount of insulin several times a day.
3) Monitor carbohydrate in take closely.
4) Avoid and prevent low blood sugars.
5) Give correction for out of range blood sugars.
6) Perform apropraite ajustment of food and insulin during illness.
7) See your doctor, diabetes educators and dieticians on regular basis.
8) Eat healthy diet (more friuts and vegatables) and limit sweets and fats.
9) Exercise regularly.
10) Have eye exam regularly.
11) Follow a routine in managing your diabetes.
12) Balance your busy life with your diabetes.
13) Develope a coping mechanism againist diabetes fatigue and burn out.
And the list goes on and on and the care is life time or untill there is a cure.
It is obvious that living with diabetes is about trying to live and balance diabetes care in a very difficult situation. One can be reasonable but should not expect a perfect balance living with type 1 diabetes. Only people who have no diabetes think that diabetes is easy. When you have type 1 diabetes, your main focus that you have to absolutely make sure are:
1) Get a reasonable blood sugar.
2) Avoid life threatening low blood sugars.
3) Balance your busy life with your diabetes.
Doing all these are not easy. One will need to have some compromise to do these things. This is a tough job and it can lead to fatigue and of course burn out. You feel lonely as you are limited by what you can and can not do by this disease. It is hard to fit in to the work of diabetes that you did not sign on in the first place. This job is 24 hours per day, seven days a week, and God knows until when?.
However it is not all doom and gloom. Well controlled diabetes can lead to a healthy and long life. Mainly poor glycemic control is the risk factor for chronic and acute complication of diabetes. About 30% of type 1 diabetic patients have good glycemic controll. And it is time to learn and take some motivationt from them. Who are these people?
1) They are more engaged but not overwhelmed with thier diabetes.
2) They have good A1C <7%.
3) They have minimum hypoglycemic episods and less erratic blood sugars.
The lesson to take from these people is that when motivated enough, one can be engaged to manage his/her diabetes like them. One should find that motivation to balance the diabetes with his/her busy schedule.
There are few theories to why some people do well with diabetes and why the majority don't. It may be due to some differences in our biological, personality or psycological endowment.
1) Biological difference may be due to the way our body handles diabetes. They probably have a better form of diabetes. These people may have more islet cells left to add some insulin or they are biologically made to minimize low or high blood sugars. Some of these people may have a very prolonged haneymoon.
2) Personality difference. Some people are psychologically equipped to hand the tough job of type 1 diabetes. They may have good consciousness and have problem focus approach. They have problem focused coping mechanism. They are great problem solvers.
3) Psycholgical discoveries. These are people who were not particularly doing well but started to pay attention to thier diabetes. They become more engaged with their diabetes and are motivated but not overwhelmed. Something click in them and are able to find a a good balance managing their diabetes and thier busy life. They enter in to this self discovery and are doing things right in a reasonable way
Diabetes managemenet rotates principaly around three major issues.
1) medical team
2) Diabetes management
3) Psychological factors.
1) The medical world (medical team) is composed of the nurse, diabetes educators, endocrinologist, social worker, and psychologist. The medical team usually measures your physical health (fitnes). Under stress physical health can also lead to physical complaints such as neck pain back pain, headaches etc. It can also associated with psycholgical issues, including anxiety, depression and mood swings.
2) Diabetes Management includes; These measures how you behave in taking your diabetes. This the easiest to measure using the following things.
Carbohydrate counting
Insulin injections Blood sugar testing
Eating healthy diet
structured excercise regimen and other routins of diabetes.
These measure how often and how much of the above you do or you don't do. This is your behavioral pattern arround your diabetes.
Some people test many times a day some test thier blood sugars less often. Some strive for perfection some wanted to get by (adequate). Some would give up and do noting.
Perfection is not attainable nor necessary. Even in a good day and you every thing right you may not get a perfect blood sugars. There are external factors that can affect the blood sugars regardless of how much effort you put in.The ideation of perfect blood sugars is not really achievable.
3) Psychological factores; This reflects our fleelings and attitudes about our diabetes. We have internal and external factors.
The external factors are those we can not controll. There may be days that we do every thing right and we end up with poor glucose controll.
Internal factors are those things that we internaliz, such as stress, anxiety, depression, motivation, confidence, mood swings, fatigue and burn out. These issues are hard to measure.
When the medical side, management and psychological realm fail, we may react in many ways.
1) Some may be motivated to change. One may test blood sugars more often, count carbohydrates correctly, give appropraite amount of insulin both for food and correction of high blood sugars, excercise more and eat healthy diet. They may find some courrage to change thier sitiuation for better diabetes control.
2) Others may not change. They will just continue their routine
3) Others will experience burn out. They get so stressed and overwhelmed and get into depression anxiety or mood disterbances. It can be short term or long term. Long term burn out needs proffessional help.
Burnout could be due to personal, interpersonal or environmental factors.
Barriers to reasonable glycemic control;
1) Personal barriers may be due to bliefes of invincibility (complications will not happen to me. Mostly in young people) or negative attitude about diabetes. Others may fears experiencing high or low blood sugars. These can create barriers to thier diabetes management.
2) Interpersonal Barriers: Stress arrising from family, friends, spouce etc. If a person gets hammed all the time about his/her diabetes management, this can lead to burn out. Social sitiuations may also lead to burn out. Incting blood sugars in the school, restuarants, social area and social events.
3) Environmental Barriers: These includes expenses, availabilty of the various insulins and guadgets. Diabetes is expensive and every available technology is not available for every one.
Copping with diabetes burn out:
1) exercise or some activity that you enjoy and makes you happy.
2) Take a little break but do not forget about your diabetes. Do not be negligent.
3) Stay posive. Do not see things as black and white. Blood glucose goals are challenging but possible.
4) Take even a small step. If you do not check your blood sugars try to check at least 1 or 2 times a day. Start somewhere.
5) Get back on track before things are worse; Do not forget about your diabetes.
6) Prepare for high or low blood sugars.
7) Take specific, realistic and achievable measures. Be realistic but not idealistic. There is no perfection in diabetes nor is it necessary. Understand that no insulin regiment will mimic the pancreas so perfection is a myth.
8) Realize that there is always hope that with good glycemic control HA1c <7% you can live a long healthy life with diabetes.
9) Do not do your diabetes alone. Get help and find out how you can access all the necessary resources. Your resources are; family members, friends, Peers,Diabetes comunity, social workers and psychologists; Utilize the ones that have positive impact on you.
10) Get motivation from other succesful diabetic people in various fields of life. One of our supreme court judges has type 1 diabetes since the age of 7 years. There are a lot of athlets engeers, scientists, lawyers, busnessmen and women, professors ETC with diabetes that are very succesful in life. Take a inspiration from them.You can do it too.Think positive.
11) Try to balance your diabetes with your busy life. You need to manage your time with your diabetes and daily life.
12) With positive attitude you should overcome the stigma of type 1 diabetes and mental health issues.
Going back to your son: Your son has type 1 diabetes. Behavioral issue are very common with people with chronic medical conditions, especially type 1 diabetes. It is also common to have behavioral issues in adolescents without chronic medical prolems because they are going through hormonal and developmental changes. They are striving to assert thier autonomy. When you add diabetes to it, it gets even worse. Most of the behavioral diffuiculties are transient. But some can persist and may be come progrssively difficult to handle. Many type 1 diabetic patients patients have psychosocial issues. Some internalize it and other externalize it. When they internalize it they will experience depressed mood, anxiety, fatigue, sleep disturances, poor apetite or over eating. When they externalize it, they become aggresive, agitated, disobidient etc.
When one is handed a diagnosis of type 1 diabetes he/she is given a tough job that does not have a break, it is hard to accept it. Type 1 diabetes is not an easy job. It reguires a lot of investment in time and energy. It is also metally exhausting. It is a job no one will sign on. It is unfortunate that life is not fare, and some people get it and others don't. When you don't have diabetes it is hard to understand it. For those who do not have it, it may seem so easy becuase they do not experience it. But there is nothing easy about type 1 diabetes. I have been doing this for many years and have seen many, many patients and honestly, it is very hard for me to understand it.
Only about 20-30% type 1 diabetic have reasonable glycemic control. Over 70% are not controlled. That tells a lot about type 1 diabetes. It also imposes a huge psychological burden on the individual. This psychological burden leads to psychosocial disturbances as the stress from diabetes becomes overwheming. When there is inadeguate social support with poor copping skills, behavioral disturbances can emerge that can be manifested in many different way. Many of the type 1 diabetes are not only poorly controlled but also experience many of the psychosocial disturbances.
At minimum type 1 diabetics need to think about thier glycemic control, prevent or treat low blood sugars and balance thier diabetes with thier normal life. Even doing these mimimum day in day out for a very long time with out a break is a very tough job that can overwhelm any human bieng.
Many of the signs and symptoms of hyperglycemia and hypoglycemia can mimic psychosocial illness. One need to check the blood sugars to make sure these symptoms are not from blood sugar flactuations. Low and high blood sugars need to be treated promptly. Mood swings from hypoglycemia and hyperglycemia will go away after treatment. Most of them are transient. However if blood sugar flactuations are more prevalent they can lead not only to psychosocial illnesses, but also cognitive dysfunction.
If your son is having serios difficulties in copping with diabetes, you should have him get a proffessional help. Psychosocial coucelling will boost his copping skills. Help your son get engaged with his diabetes, find some motivations and encouragment. Appriciate even when he takes little steps. Find him some positve hope that diabetes is not doom and gloom. That there are many bright futers in well controlled diabetes. Feed him with evidence based hope, that he will do well as others have done it.
Regular physical activity will help him cope better with his situation. Focus also on healthy diet. Help him cope will social stigma. Inform his that diabetes is a medical condition but not a crime and there is nothing to be ashamed of having type 1 diabetes. Invove him in positive social group. Avoid over control and let him have some freedom. work as a team. Let him not do diabetes alone. He should not feel lonly.
Check blood sugars as often as necessary, with out stressing him. Manage low or high blood sugars. With a posivive attitude he will do very well.
Discuss this issues with your doctor and diabetes team. You can also seek help from a psychologist. What ever works for you do not hesitate to do it.
Good luck.
Further reading references:
1)https://www.cdc.gov/childrensmentalhealth/data.html
2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863499/
3)https://www.psychiatrictimes.com/child-adolescent-psychiatry/psychiatric-issues-children-and-adolescents-diabetes
4)https://www.medicalnewstoday.com/articles/317458.php
5)https://www.hindawi.com/journals/jdr/2018/1684175/tab1/
5)https://care.diabetesjournals.org/content/32/4/575
Type 1 diabetes is the commonest chronic metabolic disease of childhood. Currently roughly about 220,000 children live with type 1 diabetes in the United States of America. Up to this day there is no cure for type 1 diabetes, though, it is easily treatable with insulin, and when treated properly and aggressively quality of life and life expectancy may be close to that of a non diabetic person. However in poorly controlled diabetes chronic complications are common and quality of life as well as life expectancy is shorter by about 15-20 years. It is therefore important to take a note that poor glycemic control is the risk factor for chronic and acute complications of diabetes.
Todate there is no commercially available oral insulin on the market. Insulin is only given either by injection, intraveneous or by inhalation. Insulin is not a dangerous or addictive medication. It will probably continue to stay this way untill other alternatives or cure is found.
When diabetes treatment is intensified early enough chronic complications of diabetes can be avoided even when treatment was not optimum in later years due to epigenetic changes that promote protective condition known as a metabolic memory. Conversely, when treatment of diabetes is suboptimum in the early days of diabetes, even intensifying treatment in the later years may not prevent chronic complications of diabetes due to the same process (metabolic memory). The glycemic or metabolic memory therefore plays both roles of protection or predisposition to chronic complications of diabetes (eye, kidney, heart, cardiovascular diseases).
Untill the day comes that cure type 1 diabetes, we will continue current insulin therapy. Currently there is a remarkable advancement in the treatment of type 1 diabetes. We have advanced tools to treat diabetes, including, smaller and sharper syringes, more sophisticated insulin brands, advanced blood sugar testers, various insulin infussion pumps and advanced blood glucose sensors. Despite these incredible advances in diabetes management only 20-30% of type 1 diabetes patinets meet the goal of A1C <7% in the United states of American and Europe. The majority of type 1 diabetes patients do not meet this goal and have poor glycemic controll.
Any chronic disease including type 1 diabetes have psychological burden on the individual person with chronic disease. This psychological burden imposed by type 1 diabetes especially, when there is functional impairment in the face of poor social support and poor coping skills, is a sett up for mood disorders.
Stress frome type 1 diabetes and other stressful events can manifest in two way.
1) internalization; Is when the stressful event is poited to wards the person him/her self. These are such as, depression anxiety, poor energy level, sleep disturbances anorexia, hyperphagia or suicide ideations.
2) Externalization is when the person poits his stress agains others. These are such as bullying, aggration to wards others, disobidience, cheating etc.
Type 1 diabetics experience about 3 fold more psychosocial ilness, (mood swings) and mood disorders than their non diabetic counter parts. These are due to psychological and emotional burden imposed by diabetes, and events causing functional impairment such as hyperglycemia and hypoglycemia that are common in type 1 diabetes.
1) Hyperglycemia may cause depressed mood and mood swings. Hyperglycemia is defined when glucose levels rise above 110 mg/dL when fasting and 140 mg/dL 2 hours after meals. Hyperglycemia affects the area of the brain that controls mood and cognition (hippocampus). When blood sugar is high it affects the hippocampus and may lead to neuronal atrophy and apoptosis of the neuronal cells. This leads not only to mood swings but also to impaired cognitive function. Hyperglycemia (lack of insulin) causes hypercotisolism that can disrupt the nueronal generation of the hippocampus leading to depression and other mood disorders.
When blood sugars are persistently high about 50% of people may have a depressed mood. Type 1 diabetic adolescents may have about 20% of depressed mood and about 25% may have subclinical depression. Over all transient mood swings or behavioral difficulties may be experienced by over 50% of type 1 diabetic patients.
There are some signs that indicate a person may be experiencing high blood sugar levels, such as feeling nervous, fatigue, poor energy level, confusion, difficulty thinking clearly and quickly. When the blood sugars return to normal the symptoms will resolve.
In type 1 diabetes cuases chronic stress and hyperglycemia from uncontrolled diabetes leads to excess cortisol production and prolonged sympathetic activation.These can promote insulin resistance, obesity high blood pressure and can lead to metabolic syndrome, also known as double diabetes. Chronic stress can also lead to type 2 diabetes through the same mechanism. These stress hormones that produce the fear (anxiety, anorexia or hyperphagia) and the reward system cause depression and cravings for food, other substances.
Hyperglycemia can lead to behavoioural disturbance (mood swings), depression and anxiety. Diabetes is therefore a risk factor for depression and anxiety or other behavioral disturbances. It can also cause chronic microvascular (eye disease, kidney disease and nerve disease) and macrovascular complications complications (stroke, heart disease, peripheral vascular disease) through the recriutment of stress mediators (interlikins, and cytokines, oxidative stress and advanced glycated end products).
Diabetes is therefore not only about blood sugars. It can lead to sudden mood changes. Cuases emotional burden affecting personal and social life of the person. It is a risk factor for depression, anxiety and other mood disorders. It can also lead to obesity, visceral adiposity, insulin resistance, metabolic syndrome and chronic complications throgh chronic stress and hyperglycemia.
2) Hypoglycemia (blood sugar levels drop below 70 mg/dl) can affect the mood and mental status of a person. The symptoms of low blood sugars include:
Symptoms of hypoglycemia are as follows;
Dizziness.
Headache.
Shakiness.
Hunger.
Irritability
moodiness.
sweating.
Anxiety or nervousness.
trouble speaking
fatigue
confusion
pale skin
aggression and irritability
personality or behavior changes
concentration difficulties
co-ordination and decision-making difficulties
twitching muscles
seizure
Low blood glucose can result in rapid mood changes. Depressed mood and irritability are common symptoms of hypoglycemia. during which blood sugar levels drop below 70 milligrams per deciliter (mg/dL).
The body compounds this pleasant sensation by releasing adrenaline in an attempt to convert any available glycogen in the liver back into glucose to boost levels in the bloodstream."
When blood sugars are low adrenalin surge drives the bodies defense system in to fight-or-flight mode. This stress response is mediated the activation of the pituitary adrenal axis and the sympathetic nervous system to produce adrenalin, catecholamine and cortisol to fight the danger and keep the person conscious and alive, and to correct the low blood sugar. When the blood sugars corrects the system is turned off since hypothalamis pitiutary adrenal axis and the sympathetic out put is strictly controlled. But if there is chronic hypoglycemia there may be persistent heightened response by the sympathetic nervous system and hypothalamic pitiutary system (HPS) leading to persistent mood swings. This contributes to mood swings, such as irritability, aggressiveness, depressed mood or elevated mood.
When blood sugars fluctuate it is not uncommon to experience rapid changes in mood in a very short period of time.
While symptoms of diabetes related stress may not be severe enough for a diagnose of as a mental illness, these symptoms can affect a person's social interaction and quality of life. On the other hand diabetes is a major risk factor in predicting major mood disorders such as Anxiety and depression.
3) Psychosocial issues. The psychological burden of type 1 diabetes causes persistent stress. The stress of living with diabetes contribute to both changes in mood and concerns about potential complications. The physical effects of diabetes may also lead to nervousness, anxiety, and confusion. The mood swings can be come suddenly and may last a short period of time. These changes may bring strains in personal life and social relationships or interactions.
The psychological burden imposed due to type 1 diabetes could be related to concerns about potential complications. Some diabetics feel powerlessness in managing their diabetes. Some may feel can not do enough to take care of their diabetes. Some patients worry about what others think about them and shy away from their friends. Others worry about social embarrassment that they may not recognize when their blood sugars change suddenly.
The symptoms of mood or behavioral changes are:
depressed mood
Low self-esteem
Feeling inadequate
Hopeless or helpless
Excessive guilt
Feelings of wanting to die
Loss of interest in pleasure
Difficulty with relationships
lack of sleep or too much sleep.
loss of appetite or
or over eating
weight loss or weight gain
poor energy energy
Difficulty concentrating
poor decision making
Suicidal ideation.
Frequent physical complaints
Running away or threats of running away from home
Over sensitivity to failure or rejection
Irritability
Hostility
Aggression
Type 1 diabetes take a termendeous amount of energy and time to manage. Focusing on managing type 1 diabetes day in day out reguires a lot of effort. Type 1 diabetes is in the majority of cases is not well controlled. Most patients are not engaged enough with managing thier diabetes. On this planet almost every one is motivated to live healthy and long life. Diabetic patients have also the same wishes and aspirations in life. Howeve the job of diabetes is very tough. It is a tiresome work in progress that has no end in sight or any break in between. The life time job of managing typpe 1 diabetes has to also balance with the rest of the person's busy life. Some of the daily job of a diabetic patient are as follow;
1) Checking blood glucose several times a day.
2) Give appropraite amount of insulin several times a day.
3) Monitor carbohydrate in take closely.
4) Avoid and prevent low blood sugars.
5) Give correction for out of range blood sugars.
6) Perform apropraite ajustment of food and insulin during illness.
7) See your doctor, diabetes educators and dieticians on regular basis.
8) Eat healthy diet (more friuts and vegatables) and limit sweets and fats.
9) Exercise regularly.
10) Have eye exam regularly.
11) Follow a routine in managing your diabetes.
12) Balance your busy life with your diabetes.
13) Develope a coping mechanism againist diabetes fatigue and burn out.
And the list goes on and on and the care is life time or untill there is a cure.
It is obvious that living with diabetes is about trying to live and balance diabetes care in a very difficult situation. One can be reasonable but should not expect a perfect balance living with type 1 diabetes. Only people who have no diabetes think that diabetes is easy. When you have type 1 diabetes, your main focus that you have to absolutely make sure are:
1) Get a reasonable blood sugar.
2) Avoid life threatening low blood sugars.
3) Balance your busy life with your diabetes.
Doing all these are not easy. One will need to have some compromise to do these things. This is a tough job and it can lead to fatigue and of course burn out. You feel lonely as you are limited by what you can and can not do by this disease. It is hard to fit in to the work of diabetes that you did not sign on in the first place. This job is 24 hours per day, seven days a week, and God knows until when?.
However it is not all doom and gloom. Well controlled diabetes can lead to a healthy and long life. Mainly poor glycemic control is the risk factor for chronic and acute complication of diabetes. About 30% of type 1 diabetic patients have good glycemic controll. And it is time to learn and take some motivationt from them. Who are these people?
1) They are more engaged but not overwhelmed with thier diabetes.
2) They have good A1C <7%.
3) They have minimum hypoglycemic episods and less erratic blood sugars.
The lesson to take from these people is that when motivated enough, one can be engaged to manage his/her diabetes like them. One should find that motivation to balance the diabetes with his/her busy schedule.
There are few theories to why some people do well with diabetes and why the majority don't. It may be due to some differences in our biological, personality or psycological endowment.
1) Biological difference may be due to the way our body handles diabetes. They probably have a better form of diabetes. These people may have more islet cells left to add some insulin or they are biologically made to minimize low or high blood sugars. Some of these people may have a very prolonged haneymoon.
2) Personality difference. Some people are psychologically equipped to hand the tough job of type 1 diabetes. They may have good consciousness and have problem focus approach. They have problem focused coping mechanism. They are great problem solvers.
3) Psycholgical discoveries. These are people who were not particularly doing well but started to pay attention to thier diabetes. They become more engaged with their diabetes and are motivated but not overwhelmed. Something click in them and are able to find a a good balance managing their diabetes and thier busy life. They enter in to this self discovery and are doing things right in a reasonable way
Diabetes managemenet rotates principaly around three major issues.
1) medical team
2) Diabetes management
3) Psychological factors.
1) The medical world (medical team) is composed of the nurse, diabetes educators, endocrinologist, social worker, and psychologist. The medical team usually measures your physical health (fitnes). Under stress physical health can also lead to physical complaints such as neck pain back pain, headaches etc. It can also associated with psycholgical issues, including anxiety, depression and mood swings.
2) Diabetes Management includes; These measures how you behave in taking your diabetes. This the easiest to measure using the following things.
Carbohydrate counting
Insulin injections Blood sugar testing
Eating healthy diet
structured excercise regimen and other routins of diabetes.
These measure how often and how much of the above you do or you don't do. This is your behavioral pattern arround your diabetes.
Some people test many times a day some test thier blood sugars less often. Some strive for perfection some wanted to get by (adequate). Some would give up and do noting.
Perfection is not attainable nor necessary. Even in a good day and you every thing right you may not get a perfect blood sugars. There are external factors that can affect the blood sugars regardless of how much effort you put in.The ideation of perfect blood sugars is not really achievable.
3) Psychological factores; This reflects our fleelings and attitudes about our diabetes. We have internal and external factors.
The external factors are those we can not controll. There may be days that we do every thing right and we end up with poor glucose controll.
Internal factors are those things that we internaliz, such as stress, anxiety, depression, motivation, confidence, mood swings, fatigue and burn out. These issues are hard to measure.
When the medical side, management and psychological realm fail, we may react in many ways.
1) Some may be motivated to change. One may test blood sugars more often, count carbohydrates correctly, give appropraite amount of insulin both for food and correction of high blood sugars, excercise more and eat healthy diet. They may find some courrage to change thier sitiuation for better diabetes control.
2) Others may not change. They will just continue their routine
3) Others will experience burn out. They get so stressed and overwhelmed and get into depression anxiety or mood disterbances. It can be short term or long term. Long term burn out needs proffessional help.
Burnout could be due to personal, interpersonal or environmental factors.
Barriers to reasonable glycemic control;
1) Personal barriers may be due to bliefes of invincibility (complications will not happen to me. Mostly in young people) or negative attitude about diabetes. Others may fears experiencing high or low blood sugars. These can create barriers to thier diabetes management.
2) Interpersonal Barriers: Stress arrising from family, friends, spouce etc. If a person gets hammed all the time about his/her diabetes management, this can lead to burn out. Social sitiuations may also lead to burn out. Incting blood sugars in the school, restuarants, social area and social events.
3) Environmental Barriers: These includes expenses, availabilty of the various insulins and guadgets. Diabetes is expensive and every available technology is not available for every one.
Copping with diabetes burn out:
1) exercise or some activity that you enjoy and makes you happy.
2) Take a little break but do not forget about your diabetes. Do not be negligent.
3) Stay posive. Do not see things as black and white. Blood glucose goals are challenging but possible.
4) Take even a small step. If you do not check your blood sugars try to check at least 1 or 2 times a day. Start somewhere.
5) Get back on track before things are worse; Do not forget about your diabetes.
6) Prepare for high or low blood sugars.
7) Take specific, realistic and achievable measures. Be realistic but not idealistic. There is no perfection in diabetes nor is it necessary. Understand that no insulin regiment will mimic the pancreas so perfection is a myth.
8) Realize that there is always hope that with good glycemic control HA1c <7% you can live a long healthy life with diabetes.
9) Do not do your diabetes alone. Get help and find out how you can access all the necessary resources. Your resources are; family members, friends, Peers,Diabetes comunity, social workers and psychologists; Utilize the ones that have positive impact on you.
10) Get motivation from other succesful diabetic people in various fields of life. One of our supreme court judges has type 1 diabetes since the age of 7 years. There are a lot of athlets engeers, scientists, lawyers, busnessmen and women, professors ETC with diabetes that are very succesful in life. Take a inspiration from them.You can do it too.Think positive.
11) Try to balance your diabetes with your busy life. You need to manage your time with your diabetes and daily life.
12) With positive attitude you should overcome the stigma of type 1 diabetes and mental health issues.
Going back to your son: Your son has type 1 diabetes. Behavioral issue are very common with people with chronic medical conditions, especially type 1 diabetes. It is also common to have behavioral issues in adolescents without chronic medical prolems because they are going through hormonal and developmental changes. They are striving to assert thier autonomy. When you add diabetes to it, it gets even worse. Most of the behavioral diffuiculties are transient. But some can persist and may be come progrssively difficult to handle. Many type 1 diabetic patients patients have psychosocial issues. Some internalize it and other externalize it. When they internalize it they will experience depressed mood, anxiety, fatigue, sleep disturances, poor apetite or over eating. When they externalize it, they become aggresive, agitated, disobidient etc.
When one is handed a diagnosis of type 1 diabetes he/she is given a tough job that does not have a break, it is hard to accept it. Type 1 diabetes is not an easy job. It reguires a lot of investment in time and energy. It is also metally exhausting. It is a job no one will sign on. It is unfortunate that life is not fare, and some people get it and others don't. When you don't have diabetes it is hard to understand it. For those who do not have it, it may seem so easy becuase they do not experience it. But there is nothing easy about type 1 diabetes. I have been doing this for many years and have seen many, many patients and honestly, it is very hard for me to understand it.
Only about 20-30% type 1 diabetic have reasonable glycemic control. Over 70% are not controlled. That tells a lot about type 1 diabetes. It also imposes a huge psychological burden on the individual. This psychological burden leads to psychosocial disturbances as the stress from diabetes becomes overwheming. When there is inadeguate social support with poor copping skills, behavioral disturbances can emerge that can be manifested in many different way. Many of the type 1 diabetes are not only poorly controlled but also experience many of the psychosocial disturbances.
At minimum type 1 diabetics need to think about thier glycemic control, prevent or treat low blood sugars and balance thier diabetes with thier normal life. Even doing these mimimum day in day out for a very long time with out a break is a very tough job that can overwhelm any human bieng.
Many of the signs and symptoms of hyperglycemia and hypoglycemia can mimic psychosocial illness. One need to check the blood sugars to make sure these symptoms are not from blood sugar flactuations. Low and high blood sugars need to be treated promptly. Mood swings from hypoglycemia and hyperglycemia will go away after treatment. Most of them are transient. However if blood sugar flactuations are more prevalent they can lead not only to psychosocial illnesses, but also cognitive dysfunction.
If your son is having serios difficulties in copping with diabetes, you should have him get a proffessional help. Psychosocial coucelling will boost his copping skills. Help your son get engaged with his diabetes, find some motivations and encouragment. Appriciate even when he takes little steps. Find him some positve hope that diabetes is not doom and gloom. That there are many bright futers in well controlled diabetes. Feed him with evidence based hope, that he will do well as others have done it.
Regular physical activity will help him cope better with his situation. Focus also on healthy diet. Help him cope will social stigma. Inform his that diabetes is a medical condition but not a crime and there is nothing to be ashamed of having type 1 diabetes. Invove him in positive social group. Avoid over control and let him have some freedom. work as a team. Let him not do diabetes alone. He should not feel lonly.
Check blood sugars as often as necessary, with out stressing him. Manage low or high blood sugars. With a posivive attitude he will do very well.
Discuss this issues with your doctor and diabetes team. You can also seek help from a psychologist. What ever works for you do not hesitate to do it.
Good luck.
Further reading references:
1)https://www.cdc.gov/childrensmentalhealth/data.html
2)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863499/
3)https://www.psychiatrictimes.com/child-adolescent-psychiatry/psychiatric-issues-children-and-adolescents-diabetes
4)https://www.medicalnewstoday.com/articles/317458.php
5)https://www.hindawi.com/journals/jdr/2018/1684175/tab1/
5)https://care.diabetesjournals.org/content/32/4/575
Yes it is. There are several reasons for this. 1) he may be rebelling for having the disease. They go through the same kind of phases as we do with mourning a death. He has not progressed the phases to get to acceptance yet. Give him time &/or get counciling with a person who is knows about what a person with diabetes goes through. 2) Both hyperglycemia & hypoglycemia can affect the brain & cause changes so keep his blood sugars as near normal as possible. I suspect though that his problem is acceptance. He has not accepted that he has to have this disease & all the changes it entails, and he is angry at the world, at his parents who gave it to him and feels sorry for himself. All this usually resolves with time but getting some help from someone who knows grief psychology & diabetes would be a good idea. Getting him with other kids with diabetes so he can see that he is not alone with this disease, would help. Diabetes camp can also be helpful. The councilors are usually older people with diabetes who have gone through the same phases your son is and companionship with other campers with the disease can be very helpful. He can see that he is not different and can cope with the problem as he sees others doing. This is a common problem & can be solved. Good luck in finding the proper people for him to be with & have good counciling.
Yes, usually through hypoglycemia, low blood sugar, caused by the treatment of type 1 diabetes, insulin. It helps to get a continuous blood sugar monitor and pump to help manage the insulin delivery and avoid frequent hypoglycemia.
