Stress and Disease Processes

Annette M. La Greca Dante S. Spetter University of Miami

Insulin-dependent diabetes mellitus (IDDM), previously known as juvenileonset diabetes and also referred to as Type I diabetes, is the most common metabolic disorder of childhood. Estimates indicate that approximately 120,000 youngsters in the United States are affected by this disease. For these individuals, survival depends on exogenous insulin administration and a very demanding and complex treatment regimen to balance insulin levels with food intake and energy expenditure, in an effort to approximate normal glucose metabolism.

Among individuals with IDDM, persistently high levels of plasma glucose (hyperglycemia) have been implicated in the development of diabetesrelated health complications ( Klein, Klein, & Moss, 1985; Krolewski et al., 1986; Skyler, 1987). Chronic complications associated with the disease include retinopathy, neuropathy, and renal disease ( Keen & Jarrett, 1982). Diabetic retinopathy, for instance, is the leading cause of adult blindness in the United States ( Klein, 1988). Moreover, virtually all youngsters with IDDM eventually develop at least background diabetic retinopathy, and this typically emerges during early adulthood ( Klein, 1988).

In order to prevent or forestall associated disease complications, medical management of IDDM emphasizes the maintenance of adequate or, if possible, near normal levels of glycemia. This is a very difficult and challenging task for most youngsters with diabetes and their families. Daily management of IDDM requires a complicated, multicomponent treatment regimen that includes: daily insulin administration (typically two shots or more), multiple daily glucose tests, dietary regulation, careful timing of

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