Diabetes, Technology and Mental Health
My previous entry discussed the new Minimed pump and Enlite sensor with the hypoglycemia suspend technology- a major advance along the path towards development of the Artificial Pancreas. The insulin dependent diabetes world has been waiting anxiously over the years for a cure; now, at least we are beginning to make further leaps toward improved care and safety with the development of sophisticated technology.
However, advanced technology, new medications, and treatment options do not always meet the expectations of those utilizing the new products. Clearly, despite the advent of new technology, the mind must adapt to these new technologies allowing behavior to change and the body to adjust. This is not a simplistic statement. Chris Feudtner, author of Bitter Sweet (2003) speaks to this concern as a cyclical process. In a talk presented at the Pediatric Arab Health Conference in Dubai, January, 2012, I adapted his theory into a cycle of new advancements and how they relate to behavior:
In the center of the diagram – to relate all the bubbles together- psychosocial intervention is paramount. To put the above schematic representation in perspective, after the discovery of insulin in 1921-22, there was a clamor to obtain the initial insulin as manufactured by Drs. Banting, Best, and McLeod even if it was not easily regulated in terms of units. People survived, yes, but there were other complications and difficulties to resolve including site infections, hypertrophy, atrophy, allergic reactions, and severe hypoglycemic events. Diabetes healthcare teams were called upon to develop responses to the new treatment and side effects.
Enter the availability of glucose meters. With the meters, people with diabetes were asked to test blood sugars more frequently in order to achieve the tighter controlled as indicated by the Diabetes Control and Complications study published in 1993. This led to increased diabetes self-care skills, and additional hypoglycemia as tighter controlled was required.
More recently, the insulin pump and shortly thereafter, the continuous glucose sensor, became the most advanced standard of care. Yet, despite knowing that tight glucose control will decrease the risk of diabetes-related complications in association with the best technology that medicine and research have to offer, people with diabetes must still adjust psychologically to the more complicated self-care skills required that are associated with sophisticated technology.
In my patient population consisting of children, teenagers, and young adults, this is not an easy task due to the different developmental stages of the diverse age groups.
Teenagers, specifically, often have developmentally related issues that lend themselves to the resistance in adapting to more complex tasks and technology due to the fact that they simply want to be like everyone else. Thus, even though adolescents may have the cognitive abilities and dexterity to understand and manipulate the insulin pump and CGM (continuous glucose monitoring) they may not do so either in defiance, ennui, or not wanting to call attention to oneself.
Therefore the need for psychosocial support becomes more necessary as the technology becomes more sophisticated. It is clear, at least to me, that the psychologist must act as a shepherd through the labyrinth of medication and devices and how they interact with the child/adolescent’s day-to-day life. Parents of small children are also intensely affected and stay up nights in order to ensure that their child does not go “low.” Sleep deprivation, guilt, and concern takes a great toll for our parents and caregivers. Thus, psychosocial strategies must be taught and further developed to help our families move toward the “holy grail” of diabetes care: the artificial pancreas OR a true cure.
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