Academic journal article The Qualitative Report

"Being in Balance": Self-Management Experiences among Young Women with Type 1 Diabetes

Academic journal article The Qualitative Report

"Being in Balance": Self-Management Experiences among Young Women with Type 1 Diabetes

Article excerpt

Worldwide, 382 million individuals are living with diabetes, and this number is projected to increase to 592 million by 2035 [International Diabetes Federation (IDF, 2013)]. Type 1 (T1) diabetes mellitus is an autoimmune, chronic disease caused by no or very limited pancreatic insulin production, thus daily insulin administration either by pen, syringe or insulin pump is required [Canadian Diabetes Association (CD A, 2013)]. The prevalence of T1 diabetes varies widely by country with the highest rates found in Northern Europe and Canada (Frese & Sandholzer, 2013). Commonly diagnosed in childhood or adolescence, approximately five to 10 percent of individuals with diabetes are living with type 1 diabetes (CDA & Diabetes Quebec, 2012; Centers for Disease Control and Prevention, 2014). Commitment to self-management health behaviors including routine blood glucose monitoring, insulin delivery and exercise, as well as healthy diet choices, are required to achieve and maintain recommended blood glucose and glycated hemoglobin (HbA1c or A1c) values (CDA, 2013).

Multiple daily injections (MDIs) and continuous subcutaneous insulin infusion (CSII or insulin pump therapy) are two intensive insulin regimens used to manage T1 diabetes. MDI therapy involves administration of intermediate- or long-acting insulin by injection once or twice a day, as well as rapid- or short-acting insulin at meal times (CDA, 2013). In contrast, insulin pump therapy is comprised of continuous delivery of small, hourly doses (basal rates (1)) of rapid-acting insulin, through a small cannula that lies in the subcutaneous tissue, typically in the abdomen. For both methods, individuals are required to routinely self-monitor blood glucose levels, and accordingly administer appropriate insulin dosages. Some individuals also manage using an added technology: continuous glucose monitoring (CGM). Users of CGM have a small glucose sensor implanted underneath the skin, which continuously measures glucose levels in the interstitial fluid (CDA, 2013). Users of this technology are still required to self-monitor blood glucose levels using the finger poke and glucometer method, for calibration and quality assurance purposes (CDA, 2013).

Relevant Review of the Literature

In 2013, the IDF estimated that 184 million women are living with diabetes. Using the previously discussed prevalence rate, this equates to roughly 18.4 million women, worldwide, living with T1 diabetes. Women living with T1 diabetes possess characteristics and experiences that differ from men. For example, puberty, menstruation, pregnancy, motherhood, and menopause can all present challenges for self-management (Homko & Trout, 2006). A1c levels in diabetic women have been reported to be elevated during late adolescence (17-19 years) (Bryden et al., 2001), and during adulthood (late 20's to early 30's) (Lloyd et al., 1999; Pound, Sturrock, & Jeffcoate, 1996). Diabetic women have a potential for poorer pregnancy outcomes, which emphasizes the importance of self-management pre-conception and during pregnancy (IDF, 2009, 2013). Excluding hormonal influences, poor glycemic control in women may reflect behavioral and social factors including demands placed on women, such as family planning, juggling family responsibilities and balancing multiple roles (Pound et al., 1996; Rasmussen, O'Connell, Drummond, & Cox, 2007; Rasmussen, Wellard, & Nankervis, 2001).

From a hormonal standpoint, variability in glycemia and insulin sensitivity during the menstrual cycle has been reported in the literature (Trout & Teff, 2004). In comparison to non-diabetic women, the prevalence of menstrual disorders is also increased in women with T1 diabetes (Auryan & Itamar, 2008). There is limited understanding of self-management during this recurring hormonal period, and given the glycemic variability reported in previous literature, it is imperative for health care professionals to understand womens' self-management experiences during this time, from both biomedical (blood glucose monitoring and insulin delivery) and psychosocial (attitudes and behaviors) standpoints, to help inform care plan development. …

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