Patients with type 1 diabetes are insulin deficient due to the destruction of pancreatic beta cells and are prone to ketosis. Patients need to rely on insulin for life-long blood sugar control. Compared with patients with type 2 diabetes, patients with type 1 diabetes may be more likely to have psychological problems, and psychological problems have certain characteristics.
1. General psychological and behavioral problems
Type 1 diabetes patients and their families will go through a process from denial to acceptance starting from the diagnosis of the disease, that is, experiencing grief, coping with stress and difficulties, and adapting. Because diabetes treatment brings about changes in patients' lifestyle and eating behaviors, patients will show various maladaptive behavioral reactions, such as changes in their overall sense of self-worth, fear, low self-esteem, interpersonal sensitivity, social avoidance, Behavioral responses such as low self-evaluation.
Since there are more children and adolescents among patients with type 1 diabetes, family factors, especially the psychological state of family members, are more important. For example, the emotions and behaviors of parents will affect the emotions and behaviors of children and adolescents. The "China Type 1 Diabetes Guidelines" stated that 24% of mothers and 22% of fathers showed symptoms of post-traumatic stress disorder within 6 weeks of their child being diagnosed with type 1 diabetes. There is a clear relationship between family environment and glucose metabolism control, especially patients who live in closed families and have less communication with family members are more likely to have poor blood glucose control.
2. Anxiety and depression
Anxiety and depression combine physical, cognitive, emotional and other symptoms. Anxiety is common in the early stages of the disease. As the disease progresses, the incidence of depression increases, but it is often ignored. The diagnosis of type 1 diabetes is a major stressful event for patients, and the daily management and care required by the disease puts tremendous pressure on patients and their families, which can easily lead to depression and anxiety in patients. The "China Type 1 Diabetes Guidelines" points out that the incidence of depression and anxiety in diabetic patients is 2 to 3 times that of non-diabetic people. A large-sample study shows that one-third of type 1 diabetes patients are accompanied by anxiety, and one-third are accompanied by depression.
Depression is related to gender, age and disease course of diabetes. The incidence of depression is higher in female patients than in male patients. In addition, patients of all ages can suffer from depression and anxiety, but children and adolescents are the most common age group for depression.
Studies have shown that the proportion of depression among type 1 diabetes patients aged 8 to 16 years can reach 23% to 28%; as the course of the disease increases, the possibility of co-existing depression also increases significantly. A follow-up study reported that the rate of suicidal ideation at the beginning of the study was 29.5% and reached 46% during the follow-up period. Patients with suicidal ideation had significantly reduced compliance with insulin treatment. Poor blood sugar control in patients with type 1 diabetes is significantly related to depression. Compared with patients without depressive symptoms, patients with depressive symptoms have significantly higher glycosylated hemoglobin levels. It can be seen that bad emotions can affect patients' blood sugar control.
In short, children and adolescents with type 1 diabetes are prone to anxiety and depression, especially those with a longer course of disease. They are more likely to develop anxiety and depression when they encounter difficulties in self-management. Moreover, anxiety and depression can be both a cause and a result of poor blood sugar control. Therefore, when children and adolescents with type 1 diabetes show poor blood sugar control for a long time, it is necessary to highly consider whether anxiety and depression are complicated, and to detect depression and anxiety levels.
3. Eating disorders
There are two forms of eating disorders: one is neurotic anorexia, which is clinically characterized by excessive restriction of caloric intake and accompanied by excessive body movements; the other is neurotic bulimia, which is characterized by overeating and often piercing after eating. To induce vomiting in the throat to achieve weight loss. Research results show that the incidence of neuropathic anorexia in patients with type 1 diabetes is not higher than that in the general population, but if accompanied by neurotic anorexia, the mortality rate is significantly increased.
The "China Type 1 Diabetes Guidelines" pointed out that among children, adolescents and adults with type 1 diabetes, the incidence of neuropathic bulimia is significantly higher than that of the general population, especially among female patients, and the impact of insulin treatment is Poor compliance. Eating disorders significantly affect the treatment of diabetes and can cause acute and chronic complications in patients with type 1 diabetes. Patients with eating disorders have a significant increase in missed insulin injections or insufficient insulin dosage, leading to increased blood sugar fluctuations and poor control. It manifests as persistent hyperglycemia and repeated hypoglycemia, which can cause gastroparesis-related symptoms and accelerate and aggravate the occurrence of chronic complications of diabetes, especially retinopathy.
4. Cognitive impairment
Type 1 diabetes can cause cognitive impairment in patients, especially in children and adolescents. It manifests as impairment of cognitive functions such as intelligence, memory, and attention. Impairment of cognitive function is closely related to the age of onset of type 1 diabetes, blood sugar fluctuations, and especially to the history of hypoglycemia. Some research results show that patients with type 1 diabetes whose onset occurs before the age of 5 or who have a history of hypoglycemic seizures may develop mild neurocognitive dysfunction. The academic performance of children and adolescents with type 1 diabetes who have poor control of glucose metabolism is significantly reduced. Hypoglycemia can reduce children's speech, memory and concentration abilities. Early cross-sectional studies have shown that children and adolescents with diabetes whose onset occurs before the age of 7 and whose disease lasts for more than 5 years have significantly lower IQs. Therefore, we should be aware that children and adolescents who have a young age of onset, large fluctuations in blood sugar, and a history of hypoglycemic episodes, especially those who have had hypoglycemic convulsions, are more likely to suffer from impaired cognitive function.
5. Behavioral and conduct disorders
Conduct disorder often manifests as oppositional and defiant behavior, and is far more common in men than women. For patients with type 1 diabetes, the greatest impact of behavioral and conduct disorders may be on compliance with diabetes management. Individuals with conduct disorders have poor compliance with diabetes management, thus affecting blood sugar control. A survey shows that about 5% of children and adolescent patients show clinical conduct disorder, such as behavioral symptoms such as distraction, provocation, and disciplinary violations, and more hospitalized children and adolescents with recurrent diabetic ketoacidosis have Anxiety, affective, and disruptive behavior disorders.
6. Non-compliance
Diabetes management involves many aspects, such as insulin injections, blood sugar monitoring, diet and lifestyle adjustments, etc. The compliance of patients with type 1 diabetes and their family members, especially parents of children and adolescents, to diabetes management will directly affect the effectiveness of diabetes management, and thus affect blood sugar control. Among patients with type 1 diabetes, noncompliance is a common problem, especially in self-monitoring of blood sugar and dietary management, but noncompliance with insulin injections is relatively rare.
The "China Type 1 Diabetes Guidelines" points out that patient compliance is affected by factors such as age, family structure, family functions, education, and personality characteristics. Research results show that family cohesion, education level of parents and patients, and understanding of type 1 diabetes are positively related to compliance with diabetes management. Patients' personality characteristics such as motivation, attitude, and self-efficacy are also important for compliance. influencing factors.
How to deal with psychological issues in people with type 1 diabetes
(1) The psychological problems of children with diabetes are closely related to the psychological state of family members. Therefore, parents of children with diabetes need to correct their mentality, not only not to bring their emotions to their children, but also to establish a positive and optimistic image in front of their children. Provide regular psychological counseling to children to help them realize that as long as they can actively control blood sugar, they can enjoy the same life as everyone else.
(2) Type 1 diabetes patients and their families should be aware that bad emotions will have adverse effects on blood sugar, and correcting bad emotions is a sign of responsibility for one's own body.
(3) Not only diabetic patients, but also their family members should actively learn diabetes knowledge. It is important for parents to provide correct guidance on children's psychology, blood sugar control and other aspects.
(4) The compliance of patients and their families will directly affect blood sugar control. Patients with type 1 diabetes must establish a healthy and positive personal image, maintain an optimistic attitude, communicate more with other diabetes patients, and learn from those who are active in sugar control to reduce the risk of diabetes. Compliance with treatment.
The content of this article is reproduced and adapted from Diabetes World
