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Adolescents with Chronic Illness ( D.M.) Dr.Turki ALBatti,MD تركي حمود البطي.د Types of Diabetes Type I – insulin dependent diabetes mellitus (IDDM) 5-10% of cases have IDDM Normally develops in childhood Pancreas not producing insulin so need insulin injections IDDM - continued Ketoacidosis – main acute complication. High levels of fatty acid in blood leads to kidney problems and subsequent toxic build-up of wastes in the blood. Symptoms are: – Chronic thirst, frequent need to urinate, nausea, vomiting, abdominal pain, and difficulty breathing. Can lead to coma and death. Treatment for Diabetes Mellitus Diet Medication Exercise Diabetic Adherence to Regimen 80% of patients administer insulin in an unhygienic manner. 58% administer the wrong dose of insulin. 77% test or interpret the glucose levels incorrectly. 75% don’t eat the prescribed foods. 75% don’t eat with sufficient regularity. Psychosocial Factors Social support (adherence ) Self-efficacy – feel they can handle the regimen and control the disease. Stress – causes less insulin and more glucose production. Objectives Psychological complications of chronic Illness Developmental complications of chronic illness Introduction Early adolescence (age range 11-14 yrs.) Am I normal Mid-adolescence (age 14-16 yrs.) Independence/self image Late adolescence (age 17-older yrs.) Future oriented, intimacy /career goals Psychological Complications of Chronic Illness Chronic disorder Treatment requirements Hospitalization Surgery or other procedures Developmental Complications of Chronic Illness Body image issues Developing independence Relationship with peers Compliance with Medical Treatment Daily lives Mental disorders Challenge Obstacles affecting transition to health care system for the adolescents Dependent behavior Immaturity Severe illness or disability Psychopathology Lack of support systems Lack of trust in caregivers Poor adherence to treatment regiment Parental involvement Obstacles to health care for family or caregivers Excessive need for control Emotional dependency Parenting styles/overprotective Heightened perception of disease severity Lack of trust in caregivers Denial about the severity of the disease Data systems Transition coordinators Risk & protective factors Parents Peer influences Training for paediatric & adult professionals Healthcare systems & training structures Principles of Adolescent Medicine Psychosocial screening T Confidentiality Info and resources Longer appointments Understanding health condition Adherence Selfmanagement Managing of Health chronic condition disease Growing capacity Promoting autonomy for self-care (Kennedy A & Sawyer SM 2008)