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Long-term Complications from Diabetes – They Occur in Teens Too

Sep 20, 2017

A recent article in Diabetes Care caught my eye: “Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy (DPN) in Youth with Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study.” The article, written by Jaiswal et al, reviews the incidence of DPN and the statistics are sad. Seven percent of youth with type 1 diabetes and 22 percent of youth with type 2 diabetes have some DPN. This adds to the literature supporting a reduction in VO2 max (maximum volume of oxygen used during a high level of activity) in teens with type 1 diabetes, and reduction in left ventricular systolic and diastolic function in adolescents with type 1 diabetes. In my inpatient clinical practice, I have patients with diabetes who have striking complications in their late twenties and early thirties – all of whom have had significant hyperglycemia for multiple years, including during adolescence.

I can remember early in my practice where there was a question of whether hyperglycemia related to long term complications when it occurred in childhood and adolescents. There is no longer a question in this regard.


The evidence is in: diabetes management cannot be ignored and should not be minimized.


The challenge is not recognizing the problem- it is getting at the answer. Teens nationally are one of the most challenging age groups in regard to diabetes management and achieving recommended A1C goals. Their lives are full of activities (sports, debate teams, music) which consume hours of their time and generally bring fulfillment to their lives. In addition, for many it is a time of experimenting with alcohol, drugs and sex. The evidence is in: diabetes management cannot be ignored and should not be minimized.

One additional twist to the story is that other aspects of the life of the teen may also help to reduce the impact of the chronic hyperglycemia. In our busy lives, we can get caught up in the numbers and forget the other aspects of diabetes care.

  • Regular exercise: The teen may be willing to ride a bike or walk with a friend. According to the CDC, only one-quarter of U.S. youth aged 12 to 15 years engaged in moderate-to-vigorous physical activity for at least 60 minutes daily (2012 data)
  • NOT smoking: If children and teens are living in a smoke-filled environment or have started smoking, working to eliminate this risk is so important!
  • Eating healthfully: Lots of vegetables, lean meats, whole grains, healthy fats – working with a dietitian to change the menu or make better fast food choices
  • And oh – if they would just bolus for their food!

Diabetes management is always a challenge – but in children and teens it is even more so. Complications from hyperglycemia as well as other lifestyle choices do happen in youth. We need to continue to address the “numbers,” but in addition, remember the other aspects of diabetes care that perhaps may be easier to tackle, more agreeable to the child/adolescent, let the child/teen know we care about all of their choices, and help to lessen (not eliminate) the impact of the elevated A1C.


Carla Cox

About the Author:

Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.

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4 comments

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  1. Oct 11, 2017

    I was diagnosed with high blood sugar 7 years ago. I was able to get it down with exercise and diet to remain a pre diabetic. I was definitely addicted to high fructose corn sweetener.

    I was just craving more and more. I switch to water, fruits and veggies. And after time a carrot was so amazing sweet where before the diet it was not. The good news is I lost 40 pound but the bad news it I gained a lot of it back. It was much easier to have a diet set goal to lose weight.

    The problem after you succeed whats the plan. HBO recently had an excellent mini series on weight gain and health. Its seems doctors do not want people to go on diets because they are temporary. They want an eating lifestyle change. that is gradual, easier to maintain and you eat things you like but just lower you calorie count.

    The idea is to lose weight over years slowly so you maintain it. They found that a small amount of calorie loss can go a long way to reduce diabetes and your blood sugar levels (<a href="https://healthiack.com/health/what-is-normal-blood-sugar-level">blood sugar levels chart</a>). Diets are great business for companies and an eating lifestyle change is not. So now I am doing moderate exercising and cutting out HFCS. A slower easier way. Its working.

    J.

  2. Oct 11, 2017

    I was diagnosed with high blood sugar 7 years ago. I was able to get it down with exercise and diet to remain a pre diabetic. I was definitely addicted to high fructose corn sweetener.

    I was just craving more and more. I switch to water, fruits and veggies. And after time a carrot was so amazing sweet where before the diet it was not. The good news is I lost 40 pound but the bad news it I gained a lot of it back. It was much easier to have a diet set goal to lose weight.

    The problem after you succeed whats the plan. HBO recently had an excellent mini series on weight gain and health. Its seems doctors do not want people to go on diets because they are temporary. They want an eating lifestyle change. that is gradual, easier to maintain and you eat things you like but just lower you calorie count.

    The idea is to lose weight over years slowly so you maintain it. They found that a small amount of calorie loss can go a long way to reduce diabetes and your blood sugar levels (<a hred="https://healthiack.com/health/what-is-normal-blood-sugar-level">blood sugar levels chart</a>). Diets are great business for companies and an eating lifestyle change is not. So now I am doing moderate exercising and cutting out HFCS. A slower easier way. Its working.

    J.

  3. Sep 21, 2017

    Hubs and I began to eat ketogenic when he was dxd w T2 in 2014. His A1c is 5.4 and he was recently taken off metformin.

    Initially, I ate that way to support him, but recently discovered I have diabetic retinopathy and never dxd w diabetes! As far as i can gather, it began years ago before we dropped carbs from our diet. My annual blood panels showed fasting blood sugar always in the 80s. Diabetes was not suspected nor investigated.

    A new doctor began checking my A1c in 2015 and it was 5.7. Now is 5.4. Studies show that eye damage can begin at a blood sugar of 108. Whole grains would raise my blood sugar well beyond that! 

    Complications are real and result from high blood sugar. As a former nursing professional, I am disappointed that the medical community chooses to run diabetics high to avoid lows when dropping carbs prevents the roller coaster lows! I have a granddaughter who is T1 and i worry about her getting complications constantly. 

  4. Sep 21, 2017

    What helped me was to cut out grains and sugar entirely from my diet. This helped me lower my blood sugar which helped ease my depression so that I could finally feel good enough to exercise, give insulin appropriately, and test as necessary. High blood sugar feels so awful you can't do what you need to do to manage your diabetes! So getting that down is an important first step and the only way to do that is to avoid or sharply limit grains. 

    When my blood sugars were super high for years, experts tried to tell me "just bolus for your food!" they didn't understand that high blood sugar feels HORRIBLE and over time can make you unable to do simple and easy things as well as feel utterly hopeless.

    Find a person with type 1 diabetes who has a really low A1c and interrogate them on what they do to achieve that low A1c--then consider that information when you're helping others. You can't go off of theory but real results and outcomes. There are people out there who are doing remarkably well with type 1 diabetes and I promise you they aren't taking your advice.

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