Living with a complex, chronic health condition like type 1 diabetes (T1D) is complicated, expensive, and burdensome. Most people live long, happy, healthy, and satisfying lives with T1D, yet there is a large body of evidence that mental health concerns and behavioral challenges are common, and interfere with self-management, quality of life, and health. At the same time, there are not enough professionals who have knowledge of the complex interplays between diabetes and psychosocial factors to meet the needs of the large and growing population of people with T1D, and their families.
To help address this gap, the Type 1 Diabetes Mental Health Workbook was created to provide a concise, practical resource for mental health clinicians and therapists to use in their care of young people with T1D. The workbook is divided into eight sections:
Overview of T1D
Language and communication about T1D
Challenges associated with a new T1D diagnosis
Approaches to addressing T1D self-management challenges
Emotions associated with T1D
Mood concerns and T1D
T1D-related worries and anxiety
Additional considerations
Chapter 8: Additional Considerations Available to Purchase
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Published:2023
"Additional Considerations", Type 1 Diabetes Mental Health Workbook: A Practical Resource for Providing Behavioral and Mental Health Support to Young People with Type 1 Diabetes, and Their Families
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To provide comprehensive care for youth with T1D, the mental health provider must consider the important effects of pain, sleep, and considerations related to siblings.
Research on pain in diabetes primarily focuses on adults with diabetes and the chronic pain that is associated with long-term complications (e.g., diabetic polyneuropathy or nerve pain caused by long-term hyperglycemia). Children and adolescents with T1D also experience general pain that affects their functioning. Intermittent pain is reported during quarterly diabetes clinic visits in ~50% of adolescents with T1D, with the most common types reported being gastrointestinal and central nervous system pain, including stomach pain and migraines. These general pain symptoms are more typically found in girls and are related to increased hospital utilization and decreased physical activity. Helping young people with T1D who experience interim general pain increase their physical activity on a daily basis is recommended.
Young people with T1D also experience pain related to routine medical procedures and blood draws to screen for health concerns (e.g., cholesterol, thyroid function, celiac disease assessment). Borrowing from the literature on pain experiences with venipuncture laboratory draws and immunizations, recommendations include 1) teaching the child to engage in breathing exercises (e.g., party blower, bubbles, deep breaths); 2) child-directed distractions (e.g., music or a story playing in headphones, watching cartoons); 3) nurse-directed distractions (e.g., interacting using age-appropriate toys); and 4) cognitive behavioral interventions (e.g., combining breathing with positive self-statements). Distraction and coaching from the parents are not generally successful. In addition, some types of adult reassurances (e.g., making statements such as “Don’t worry”) during laboratory blood draws often paradoxically increase childrens’ distress because these verbalizations signal the child about the adult’s own fear and anxiety.
