Self-management of food intake in type 1 diabetes mellitus

Dawn Marie Fexete, Purdue University

Abstract

The current study assessed how adolescents and young adults self-manage type 1 diabetes in relation to eating episodes that exceed a self-defined, upper limit blood glucose value (i.e., the value at which subjects would perform a compensatory act). Lazarus and Folkman's (1984) theory of stress and coping was used as a framework to guide the study. Daily self-monitoring forms were completed over a 10-day period by subjects (N = 41) to assess food intake, coping with the above-mentioned eating episodes, feedback mechanisms, and mood. The mean blood glucose value defined as the upper limit (stressful) was 250 mg/dl (range 135–500 mg/dl). There was a significant, positive correlation between glycosylated hemoglobin (HbA1c) and subjects' upper limit blood glucose values. On average, subjects reported 4.7 eating episodes per day. Two-thirds of the sample indicated they believed at least one of their eating episodes would exceed (or did exceed) their upper limit glucose level; these subjects averaged 0.4 such eating episodes per day. These eating episodes were most likely to be defined as stressful due to “too much sugar” (37%) or eating “more than normal” (28%). Most subjects reported they had been taught to compensate for changes in food intake by adjusting insulin (76%) or exercise (71%). Subjects engaged in compensatory behaviors one-third of the time they perceived an eating episode to exceed their upper limit blood glucose value. Self-monitoring of blood glucose (SMBG) was identified as the predominant means of feedback to determine if compensation was effective; however, SMBG was performed an average of 3.8 hours after the critical (stressful) eating episodes. Subjects were generally in a positive mood throughout the assessment period, and mood was not significantly related to subjects' mean SMBG value (168 mg/dl) across the same time period. Overall, these findings suggest subjects have difficulties with the process of defining stressful blood glucose levels where behavioral coping is warranted and performing compensatory behaviors to cope with stressful eating episodes. In addition, although SMBG was identified as the predominant means of feedback to determine if compensation was effective, the timing of SMBG for this purpose was inappropriate. These deficits should be addressed in a multi-step intervention. Specific self-management tasks should be addressed first, followed by the integration of these tasks that reflect the complete self-management process.

Degree

Ph.D.

Advisors

Guare, Purdue University.

Subject Area

Psychotherapy|Developmental psychology|Nutrition|Behaviorial sciences

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