There is evidence that glycaemic control deteriorates during adolescence and there is an increased risk of admission to hospital with diabetic ketoacidosis. In addition, the early signs of microvascular complications of diabetes may begin to appear in those who have had a significant duration of diabetes.

 

References:

Diabetes UK - Info for teens

Diabetes UK - Type 1 Uncut - Videos and info made by and for young adults with Type 1 diabetes

 

Aims of Diabetes Care during Adolescence

  • Promotion of physical and psychological well being
  • Normal growth and development
  • Avoidance of diabetes related hospitalisation
  • Achievement of glycaemic control to limit the risk of long term microvascular
  • Person centred care with individualised targets aiming for highest achievable time in range
  • Regular screening (annually) for the detection of complications i.e. urinary microalbumin excretion, blood pressure, and retinal examination
  • Integration into the school, social and working life of people in their age group
  • Smooth transition from paediatric to adult diabetes services

 

Insulin Regimens

  • Young people will be supported with their individual insulin regimen: multiple daily injections, pump therapy or hybrid closed loop therapy

 

Monitoring

  • CGMS should be offered according to NICE guidance (ref NG 18)
  • All young people with diabetes should be able to check for ketones using either urine ketone test or blood ketone meter

 

Life-style issues

 

School/College

Young people with diabetes should not have to miss more school than anyone else, apart from visits to the clinic. They can undertake all normal activities and their academic and sporting achievements should not be limited. Diabetes UK provides information material for teachers, which may be obtained from Paediatric Diabetes Specialist Nurses or at https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/schools/diabetes-in-schools-resources

 

Sport

Many young people with diabetes enjoy sport and some participate at a highly competitive level.  With careful planning and monitoring of blood glucose levels, insulin doses and food, sporting performance can be optimized. For further information visit the Digibete app or www.runsweet.com

 

Sexual Health

  • Women with type 1 diabetes are able to conceive and have a pregnancy with a healthy baby
  • Contraception and pregnancy should be routinely discussed because of the adverse effect of poor glycaemic control on foetal development
  • Young people with diabetes run the same risk of sexually transmitted infections
  • It is important to optimize glycaemic control prior to becoming pregnant to ensure the best health outcomes for both mother and baby
  • Unplanned pregnancy can be associated with major problems – including difficulties in controlling diabetes and serious complications in foetal development
  • Counselling and contraceptive advice is available to those attending the Young Adult Clinic. For further information visit- fpa.org.uk

 

Driving

Young people with diabetes who are applying for their provisional licenses will need to give further information to the DVLA about their health. There are clear guidelines for people with diabetes and further information is available at:

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving/driving-licence

 

Alcohol

  • Most young people with diabetes use alcohol to the same extent as their peers and this can have serious consequences
  • Alcohol consumption is also a major contributing factor towards hypoglycaemia
  • Alcohol excess in the longer term can lead to weight gain and deterioration in glycaemic control
  • Alcohol excess is one of the common causes of ketoacidosis in this age group
  • Information about the effects of alcohol on blood glucose levels should be given along with sensible advice regarding moderate and safe consumption

 

Recreational drugs

  • Use of recreational drugs is illegal
  • Use of illicit drugs by young people with diabetes may result in potentially serious adverse metabolic consequences e.g. ketoacidosis, severe hypoglycaemia
  • Ecstasy has been associated with severe dehydration and the development of ketoacidosis
  • Illicit drugs with unknown content can be fatal
  • For further useful information visit: talktofrank.com

 

Other Activities

Many young people with diabetes respond well to the opportunity to meet socially to develop their own support structures. Opportunities include:

 

Circle D

Tay Teens

Diabetes Scotland Type 1 Together

Patient Diabetes Information Resource Leaflet

 

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Transition from Children’s to Adult Diabetes Services

 

Recommendations for the transition of care from paediatrics to adult care are found in NICE guideline “Diabetes (type 1 and type 2) in children and young people; diagnosis and management”.  Published Aug 2015 and updated in May 2023.

 

  • Give young people with diabetes enough time to understand how transition from paediatric to adult services will work, because this improves clinic attendance [2004, amended 2015]
  • Agree specific local protocols for transferring young people with diabetes from paediatric to adult services [2004, amended 2015]
  • Base the decision on when a young person should transfer to the adult service on their physical development and emotional maturity, and on local circumstances [2004, amended 2015]
  • Ensure that transition from the paediatric service occurs at a time of relative stability in the young person's health, and that it is coordinated with other life transitions [2004, amended 2015]
  • Explain to young people with type 1 diabetes who are preparing for transition to adult services that some aspects of diabetes care will change [2004, amended 2015]

 

Transition Services in Tayside

Clinic services for young people with diabetes are organized slightly differently across Tayside. The age of transfer between services will depend on the individual’s physical development, emotional maturity and local circumstances.

 

  • This will be completed by 18 years of age
  • Each patient will require to be assessed on an individual basis to consider their readiness to transfer from one service to another
  • The patient’s views should be sought and taken into account when making a decision
  • Prior to transferring to the Young Adult Clinic patients should be given the Patient Type 1 Diabetes Information and Resource leaflet
  • The importance of maintaining contact with this group of vulnerable young people with diabetes cannot be underestimated – the need for all staff involved in their care to take a flexible approach is important and maintaining close links between paediatric and adult services essential

 

Age Range Clinic Staff Ongoing Responsibility
0-18*

Children’s

  • Annual review clinic -Tuesday morning, Ninewells Hospital
  • 1st Wednesday of the month in the morning Perth Royal Infirmary
  • 1st Wednesday of the month in the morning, Ninewells Hospital
  • 4th Thursday of month in the morning, Arbroath Infirmary
  • Wednesday and Thursday mornings via Near Me
 Paediatrics Paediatrics
16-18*

Teenager Clinic – Dundee Only

  • Wednesday afternoons, Near Me
 Paediatrics / adult Paediatrics
18-25*

Young Adults – Dundee and Perth Only

  • 3rd Thursday of the month 1-5pm, Ninewells Hospital
  • Thursday (two-monthly) 4-6pm, Perth Royal Infirmary
  • Patients who prefer to be seen more locally could be seen in adult diabetes clinics in Angus:
    • Mondays twice per month Arbroath Infirmary
    • 1st and 3rd Wednesdays of the month 9am-12pm, Forfar
    • 2nd Tuesday of the month 9am-12pm, Montrose Royal Infirmary
    • 1st Wednesdays of the month, 9am-12pm, Stratcathro Hospital

Adult with Paediatric input at transition** for discussion

 

 Adult
25***

General Adult Diabetes Clinic

 Adult Adult

*   Newly diagnosed patients aged 16 -18 years should go directly to the Young Adult Clinic (Dundee and Perth) or General Adult Diabetes Clinics). Note that those newly diagnosed, who present in diabetic ketoacdisosis under age of 18 years should be sent in to paediatrics for emergency management.  Communication between the Adult and Paediatric service is essential to ensure appropriate care is provided according to the needs of each individual patient.

 

**  Paediatric staff (medical and nursing) will be in attendance during the transition clinic which will also be attended by the Young Adult Diabetes team and therefore facilitate “hand over” and ensure a smooth transition.

  

*** Flexible

  • In Dundee this will be approximately every 3 or 4 months at the Young Adult Clinic
  • In Perth with the smaller numbers transferring the timing will need to be agreed but will be within the Young Adult Clinic

 

In Ninewells, the teenage clinic (for those aged 15-18yrs) is staffed by the paediatric diabetes team – medical nursing and dietetic and includes access to clinical psychology services.  In Ninewells and PRI there is a young adult clinic (staffed by the adult diabetes teams). Transfer to these clinics is at the discretion of the paediatric diabetes team based on the physical and emotional maturity of the individual, along with their life circumstances.

 

In other areas (Angus, North East Fife) transfer is to the adult diabetes service in that area. Joint clinic appointments (with staff form both paediatric and adult services) are arranged in all areas to facilitate transition.

 

Inpatient Care

Cases of DKA in the age-group < 18 should be admitted and managed in the Paediatric Unit.  Ref BSPED guideline 2015

Medical admissions to Paediatric ward is up to 16th birthday. 

 

Resource Leaflets

 

HCP Diabetes Information and Resources Leaflet

Patient Diabetes Information and Resources Leaflet

 

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