From New York City, New York, USA:
What complications of uncontrolled juvenile diabetes occur during puberty?
Broadly the problems are in two categories: present and future.
During puberty the body needs much more insulin anyway. Badly controlled blood sugars can become even worse at times of infection, etc., and there is a very real risk of diabetic ketoacidosis (the effect of acute insulin lack) where the body breaks down fat for fuel and makes ketones. This is associated with vomiting and abdominal pain and can be very serious without prompt and skilled management. Bad control is also associated with hypoglycaemia if there's no attention paid to eating properly at the right times.
I suspect, however, that you really want to know about the long term risks. The peak incidence of first evidence of diabetic eye and kidney disease is in the late teens. This is much commoner in those with poor blood sugar control. Nonetheless, these complications are usually very early and mild and can be managed provided they are picked up quickly. This underlines the importance of teenagers continuing to attend a clinic regularly no matter how carefully - or carelessly - they look after their diabetes. It is a disaster when a young person defaults from clinics during the teenage years then returns later with established eye or kidney disease.
Original posting 28 Dec 96
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