Young people with diabetes need training that is tailored to their needs. In the new second edition of the Behandlungs- und Schulungsprogramm für Jugendliche (Treatment and Training Programme for Teenagers), all themes pertinent to this age group are dealt with. Here, Professor Karin Lange introduces the programme.

“Diabetes? Now what?” This question is asked by many young people when confronted for the first time with the statement, “You have type 1 diabetes.” It is not easy for teenagers to find the appropriate answers to the many questions that race through their heads during this time. Who knows of other young people with the same problems? 

Six Teenagers Form Team of Competent Advisors 
Lena (13), Emre (14), Sophie (15), Jan (16), Laura (18) and Lukas (19) know from their own experience what it means to have diabetes. These six teenagers feature in the revised and updated second edition of the ‘Diabetesprogramm für Jugendliche’, issued by the Paediatric Diabetology Society (AGPD) with the support of Roche Diagnostics GmbH.

The six young people tell diabetes beginners of the first steps to self-treatment and give practical tips as to how to live normally despite injections, pumps and blood sugar monitoring. Their positive attitudes, their hands-on experience and knowledge of daily tricks in almost all situations are meant to transmit confidence and to motivate the readers to take diabetes treatment into their own hands and adapt it to their own lives.

Topics Especially Useful for Teenagers
The principle of intensified insulin therapy has proven itself, not only for teenagers, but for nearly all people with type 1 diabetes. But the lives of teenagers is much different from those of older people. To this end, the programme concentrates on topics especially relevant to young people, for example, blood sugar swings and appropriate insulin dosaging in puberty, insulin treatment during physical exertion and athletics, on journeys, and during exams.

The programme also deals with questions regarding bodily and sexual maturity, putting on and losing weight, high and low self-esteem, how to work together with parents without conflict, how to enjoy and be flexible with food at home and away, and on how to handle alchoholic beverages. All these topics have been collated by the young people, who tell their stories with all their highs and lows.

The Future is Yours!
This title covers the topics that pertain to all young people: Which profession shall I enter into? Which courses should I take? Can I travel the world or am I limited to this effect? Can I obtain a driver’s licence with diabetes? Will I be able to find a partner who will accept me for what I am? Will I ever be able to have children?

However, one topic is of particular importance for young people: the chances of remaining healthy and fit in the future, and how to prevent diabetes complications. Dramatized images and documentaries portrayed in certain media can give some young people the impression that they themselves will soon be confronted with crippling complications.

Facts vs. Resignation
Some young people resign themselves to the future, “What does it matter anyhow?” The new programme attempts to present information in a matter-of-fact way minus dramatic images, but also without trivializing. Special weight is placed on information regarding future opportunities that are open to people with diabetes, even when the HbA1c levels are in double digits for months at a time. Laura (18) and Lena (13) talk about what helped them keep their cool when their blood sugar swung, and how to cope with the guilt feelings of high readings. Jan (16) has experienced many a conflict with his parents concerning blood sugar monitoring and insulin injections. This has been hard for the whole family, but Jan and his parents have since managed to find a solution with which all can live easier.

Four Training Modules for All Life Situations 
The new programme has been designed for all young people with diabetes: for absolute beginners; for the more experienced who want to gradually become independent from their parents; and for the really experienced who want to take over their treatment once and for all. For those who want to switch from injections to a pump, for example, there is the module ‘Pump Therapy’. 
The package contains a set of four spiral books: the yellow ‘Diabetes Basics’ for the newly diagnosed; the orange ‘Insulin Therapy for the Advanced’ for fine-tuning and tricks to do with insulin dosing; the green ‘Diabetes Specials’ for living with diabetes; and the blue book ‘Pump Therapy’, for those wanting to make the switch to the pump. All the material is contained in a slipcase. 

Learning by Experience
The four books impart information needed to manage diabetes and gives examples of the kinds of treatments available. They also aim to motivate the readers to observe their own metabolism and to improve their insulin therapy. Many practical tasks have been included to give the readers a sense of success. 

The six featuring characters tell of their daily hurdles that diabetes places before them, for example, how Lena's (13) insulin pump managed to survive a fall from a horse unscathed, and how Emre (14) decided to continue with his football career after finding out how to prevent hypos during tournaments. Jan (15) tells of risky situations that can crop up when there is not enough insulin in the pump, or when the catheter slips out of its position unawares. 

Schooling and Training 
It goes without saying that everyone diagnosed with diabetes are offered a thorough diabetes training. This training programme can be used as text material for this purpose. At home, it can be used for the whole family as a reference book. For those who have had diabetes since childhood, many follow-up courses are offered at diabetes centres on how to tailor the required dosages of insulin, and how to begin independency in terms of diabetes treatment. For such courses, the module ‘Insulin Therapy for the Advanced’ would be suitable. 

The ‘Pump Therapy’ module is suitable as text material for courses for those wanting to begin insulin pump therapy. Those interested can ask themselves whether this form of therapy is really for them. Here they can learn the basics, and then move on to have an individually tailored treatment programme developed by their diabetes team.

The follow-up courses for young people with diabetes are about to be placed within the category of long-term treatment in the Disease Management Programme, and will be covered by the health insurance. This includes a once-only cover for the cost of the training materials.  

Interested?
This programme was launched at the 2009 DDG congress. It is designed to replace the previous programme of 1995, and will be implemented in training centres. The programme can be ordered at Kirchheim Publishers (Mainz). 

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Professor Karin Lange (Dip. Psych.)
Director 
Medical Psychology
Hannover Medical Institute 
Hannover
E-Mail: Lange.Karin(at)MH-Hannover(dot)de