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Today, type one diabetes, also known as insulin-dependent diabetes mellitus (IDDM) or

juvenile diabetes is an epidemic around the world and a burden for our youth. Type one diabetes

is a chronic disease of the immune system. The immune system attacks the pancreas and fights

the insulin-producing beta cells of the pancreas. Eventually, the pancreas will make little or no

insulin. In fact, “approximately 1.25 million American children and adults have type one diabetes

and 30.3 million Americans, or nine point four percent of the population, had diabetes”

(“Statistics About Diabetes”). Within these statistics every year more people are being diagnosed

with type one diabetes including other types as well. Some examples of different types of

diabetes comprised under that umbrella are type two diabetes, gestational diabetes, and

prediabetes. Within each of these types of diabetes, there has been an increasing rate of people

being diagnosed and/or showing symptoms of this disease. More than ninety percent of the

people in the United States have type two diabetes. Type two diabetes is known as adult-onset

diabetes or non-insulin-dependent diabetes mellitus and is not a disease of the immune system.

Type two diabetes problem is the insufficient production of insulin for the amount of glucose in

the bloodstream. An estimated ten percent of women develop gestational diabetes during

pregnancy. Gestational diabetes or diabetes during pregnancy develops and affects women

during pregnancy. One report shows, “an estimated thirty-three point nine percent of U.S. adults

aged eighteen years or older (84.1 million people) has prediabetes” (“Prevalence of

Prediabetes”). Prediabetes also is known as impaired glucose tolerance is high glucose levels, but

not considered to be type two diabetes. These statistics are just baseline from the types of

diabetes mentioned above. Type one diabetes is an epidemic concerning all across the globe

affecting every individual in its way. Additionally, “an estimated 40,000 people are diagnosed
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with type one diabetes each year” (“Type 1 Diabetes Statistics”). There are certain social issues

provoking consequences and burdens affecting the health of type one diabetes in the lives of

juveniles. Many ask, ‘What causes it?’, ‘Are we doing enough?’ or ‘What issues could worsen

this chronic disease in youths?’.

There are several social issues that keep worsening the health of juveniles living with

type one diabetes and the progress made. Social issues can be classified as social environmental

factors. Such as transportation and housing, socioeconomic status, social support,

unemployment, among others. One contributor is access to health care. In my research on

juvenile type one diabetes, I met with Palestine Mahmoud. Mahmoud is an executive assistant at

John Muir Medical Center in Walnut Creek. She previously worked as a Cardiac Tell Tech and

holds thirteen years of experience in the healthcare industry. Even though Mahmoud is not an

expert in the medical field, she has been capable of helping me with this project. In the interview

I had with Palestine I ask her about the access to healthcare available for all people living with

diabetes, She stated, “Access to healthcare is based on age and income level for government

funded programs such as Medi-Cal and Medicare. For people who do not have employer

sponsored healthcare but make too much money to qualify for Medi-Cal would need to purchase

their own insurance”. She added that this can be very costly and would be a large barrier to

accessing healthcare. Given this response, all youth must have adult supervision in regards to

managing their chronic condition. For instance, “an estimated 16.0% of known diabetic adults

were uninsured. Diabetes control profiles were worse among uninsured than among insured

persons” (Chiang 2). Providing, a transition plan including a continuing dialogue between the

youth and the family about insurance, obtainment of supplies, an adult care provider, among

others. Despite the age, “the patient’s needs are the same: an individualized care plan with
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ongoing education and support, ongoing assessment for acute and chronic complications, and

access to medical providers with type 1 diabetes expertise” (Chiang 4). Procuring a healthy

management and care plan is vital for the health of juveniles sustaining a chronic illness.

Furthermore, the gap of access to healthcare is not the only cause jeopardizing the health of

youths, access to healthy foods is another issue contributing to the cause. In minority

neighborhoods, low-income youths living with type one diabetes are facing challenges in regard

to healthy eating. Moreover, “East Harlem residents have poor access to stores that sell healthy

foods, and among those with diabetes, 40% report being unable to afford a healthy diet, and 39%

report being unable to shop or cook healthfully” (Breland 1). For juveniles with type one

diabetes living in minority communities are more likely to have access to unhealthy foods rather

than healthy foods experiencing food insecurity. As income drops, so does the food budget which

is necessary that “healthcare professionals should be aware that the inability to pay for food,

medications and other aspects of diabetes care can pose a barrier to optimal self-management”

(Ross and Patti 7). Healthcare professionals should be familiar with the patient’s financial

concerns and guide them in the meal plan changes more suitable for their monetary pocket.

Another area of social issues concerning the health of juveniles with type one diabetes is

socioeconomic status and self-management. I also interviewed Carrie Kojima. Kojima is a

current school nurse for MDUSD and works at three schools; one high school and two

elementary schools. She’s been a nurse for almost three years and worked in an acute care

hospital for the previous ten years. As a nurse in the hospital, she has cared for people with type

one and type two diabetes. Also, as a school nurse she has seven students at three schools she

serves with type one diabetes and manages their care while they are at school. In the interview I

had with Carrie I ask her a similar question that I had asked Palestine. That being, what were
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some socio-economic issues concerning type one diabetes youth. Kojima stated If a student does

not have health insurance coverage. Medi-Cal insurance is available for children whose parents

may not be able to afford insurance and it is just a matter of linking people to the correct

resources and assistance to apply for this type of insurance. Another impact is access to their

healthcare providers if they do not have transportation. If a student lives in an area where they do

not have access to affordable, fresh food this may impact their diet and health (Kojima).

Juveniles with type one diabetes must have support to improve the living conditions and

complications affecting their health.

As a society, we have affected the health of self-management in the lives of individuals

and youths with type one diabetes. Several studies of individuals with diabetes depending on a

low income suggest the struggles to survive and management of their diabetes. One study shows,

“One young female described it as quite a frustrating experience due to the complexity of her

housing situations. Due to financial difficulties, she was unable to afford a new home on a

mortgage or live in rented accommodation. In this situation, managing diabetes became a lower

priority (compared to her housing needs). She realized that the situation affected her diabetes

self-management” (Akhter 3). This different, but common ignition point may result because of

the days-off taken from work due to the complications caused by the chronic disease. It disables

people since the amounts are insufficient and cannot pay bills creating mental struggles such as

stress or frustration. Such circumstances, affect the management of type one diabetes. Also,

another point not mentioned above affecting not only individuals but juveniles with type one

diabetes is a social stigma. Additionally, “a team at the Research Institute of the McGill

University Health Centre (RI-MUHC) report that teen and young adult (aged 14-24 years) type 1

diabetes sufferers often experience stigma, which leads them to neglect treatment and tread
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dangerously close to suffering medical emergencies” (“Living with the Stigma of Diabetes”).

Type one diabetes requires care and attention and feeling stigmatized can jeopardize the health of

juveniles which can lead to sugars levels swinging wildly causing brittle diabetes. Including

changes in symptoms such as confusion, seizures, chills, headache, among others. In fact,

“seventy-six percent of people with type 1 said they felt stigmatized, compared to fifty-two

percent of people with type 2” (Wolf and Liu 5). Having type one diabetes and living with a

burden like a stigma which is hard to control and carry. Increasing public knowledge about the

causes of diabetes can reduce social stigma. Indicating that, “living with type 1 diabetes is a full-

time job which you are not allowed to quit or take a vacation from. It requires 24/7 monitoring of

insulin and blood sugar levels, which can become very overwhelming” (Gordon 1). The lack of

income and support for juveniles with type one diabetes in a majority of our counties youth

further deteriorates both the physical and mental health, setting in motion more issues to seep in.

There are social issues affecting the progress of type one diabetes, but it can not stop the

future outlook that is the progress towards a cure. Improving the future outlook for juvenile type

one diabetes through the development of technologies for further control of glucose. In

particular, “Experimental glucose monitors can do accurate readings on glucose within the body

without drawing a single drop of blood. One such monitor is worn like a wristwatch and uses

tiny electrical current to draw body fluid into a tiny pad attached to the watch where the

calculations are made” (Steward 73). Such a glucose monitor is not the only advanced

technology for diabetics. Also, the bionic pancreas will ease the management of diabetes by

measuring the glucose levels and sending the information to a smartphone. Progress is not made

only in glucose monitors, but to cure the disease. Indeed, “another major goal of NIH-supported

type 1 diabetes research is to identify ways to replace lost beta cells and thereby restore insulin
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production - a biological cure for the disease. One way to restore the ability to produce insulin in

response to glucose levels is to replace beta cells through islet transplantation” (Rodgers 4). The

development of a possible cure will give hopeful insights to youths that remain anxious for a

future antidote against this chronic condition. Also, there is progress in the area of transplants,

“some patients with type 1 diabetes have experienced positive results from pancreas transplants”

(“Pancreas Transplantation”). However, finding a cure is not only seen in our country. Certainly,

“around the world, researchers and doctors are working to find a cure for diabetes. Some are

studying blood and tissues. They hope this will help them predict if a person will develop type

one diabetes. If doctors know a patient may become diabetic, they can prescribe medicine to

protect the cells that make insulin. This might slow the disease or even keep it from happening”

(Peterson 28). Because more children and adults are diagnosed with type one diabetes, it is

becoming a concern and it can be a burden to manage. Especially, if not treated it can inhibit

individuals from being active, working and having healthy lives. With the progress being made,

it shows a future promise of cure and less struggle for our youth living with type one diabetes.

In addition, type one diabetes can affect adolescents' living conditions as well as

influence their quality of life. One report shows, "Having diabetes had changed the lives of

68.5% of the participants. When replying to how it had changed, patients gave replies like the

following. I have a lot of restrictions [Patient code I36, 20 years of diabetes, male], more worries

and limitations [I33, 37 years of diabetes, female], having to inject, control food, etc [I38, 6 years

of diabetes, female], and having to program everything in my life, changing my habits [I44, 2

years of diabetes, female]" (Alvarado and Wägner 6). The management of type one diabetes has

and is still affecting juveniles' ability to function because diabetes is a demanding chronic disease

in which adolescents can suffer from Diabetes burnout. As revealed by Rubin, "almost every
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person with diabetes I have ever met feels that diabetes powerfully affects their lives, and most

feel burdened by the manifold demands of their disease. I call this experience "diabetes

overwhelmus," since so many people feel overwhelmed by the continuous burden of their

disease and its management" (5). Emotional, social burdens, and the complications of diabetes

are an obstacle in increasing the poor quality of life of adolescents with type one diabetes. Most

adolescents living with type one diabetes are able to improve their quality of life from coping

skills because it decreases the complications enhancing their mental and physical health.

My research for the paper was a real eye-opener because it evolves my understanding of

type one diabetes and not only that but the bumpy path juveniles have to walk through. I knew

most of the facts about type one diabetes, from the experience of my sister. The research itself

shows me all the struggles and burdens juveniles living with type one diabetes have to go

through. Having diabetes is overwhelming because individuals not only carry a chronic illness

but the social issues pressuring them affecting the management of diabetes. I understood type

one diabetes had social issues, but it never crossed through my mind how bad it has become. I

never imagine the percentage of people living with diabetes and not being able to receive proper

health care, fresh healthy foods, on top of that tolerate the social stigma, and other social issues.

Also, I became aware of how the influences of social issues jeopardize the health of juveniles

with type one diabetes and not just that, but the progress made to stop the affection of diabetes in

the lives of youth. Through the research, I realize that the progress made to improve and ease the

lives of individuals with diabetes through advanced technologies has been disturbed by the

burdens of social environmental factors because it deprives people to priorities their self-

management in order to control diabetes. Even though progress has been somewhat affected, the

possibility of a cure is still untouched by social issues. I comprehend that doctors and
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researchers' will not stop because of the affection of their progress. Actually, all the doctors and

researchers interest is in finding a cure to decrease the population increase rate of diabetes in

both children and adults. I learned that with a cure every individual, including children with

diabetes can relieve themselves from burdens that may affect them while living with diabetes.

My sister at age 22 has gone through most of the social issues mentioned above because carrying

this chronic disease is a load only oneself can carry. My sister suffered diabetes burnout because

she got tired of having to do the same routine every day and not being able to eat the cravings

desired. My sister was able to control and tolerate her disease like many juveniles living with

type one diabetes but it was not an easy obstacle for her to accomplish. Today, because of the

incredible amount of support giving to her she was able to improve her health and this is exactly

what many juveniles living with type one diabetes need. From the researched I have done, I have

learned a lot and appreciate all the help I was able to get. Diabetes an ancient puzzle not yet

being solved can affect but not discourage juveniles as long as we as individuals can provide

even a small amount of support to our youth which can spark their lives with hope and happiness

just like it did to my sister.

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Works Cited

Akhter, Kalsoom. “Influences of Social Issues on Type 1 Diabetes Self-Management : Are We

Doing Enough ?” Semantic Scholar, 1 Jan. 1970, www.semanticscholar.org/paper/

Influences-of-social-issues-on-type-1-diabetes-%3A-we-Akhter-

Turnbull/217b19366611866941217122a1627de0f69d75f1.

Alvarado, Dácil and Wägner Ana. “Quality of Life and Type 1 Diabetes: a Study Assessing

Patients' Perceptions and Self-Management Needs.” Patient Preference and Adherence,

Dove Medical Press, 14 Sept. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4576890/.

Breland, Jessica Y. “Challenges to Healthy Eating for People with Diabetes in a Low-Income,

Minority Neighborhood.” Current Neurology and Neuroscience Reports., U.S. National

Library of Medicine, Oct. 2013, www.ncbi.nlm.nih.gov/pubmed/23877980/.

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Chiang, Jane L. “Type 1 Diabetes Through the Life Span: A Position Statement of the American

Diabetes Association.” Diabetes Care, American Diabetes Association, 1 July 2014,

care.diabetesjournals.org/content/37/7/2034.

Gordon, Serena. "Stigma Adds to Burden of Type 1 Diabetes." Consumer Health News, 19 June

2018. Student Resources In Context , http://link.gale group.com/apps/ doc

/A543583154/SUIC?u=wal55317&sid=SUIC&xid=2d96bda3. Accessed 9 Mar. 2019.

Kojima, Carrie. School Nurse. Personal Interview. 5 March, 2019.

"Living with the Stigma of Diabetes.” NewsRx Health, 1 July 2018, p. 162. Student Resources In

Context, http://link.galegroup.com/ apps/doc/A544125648/SUIC?u =wal55317&sid

=SUIC&xid=7e42f8d9. Accessed 9 Mar, 2019.

Mahmoud, Palestine. Executive Assistant. 2 March, 2019.

“Pancreas Transplantation.” American Diabetes Association, www.diabetes.org /living -with

-diabetes/treatment-and-care/transplantation/pancreas-transplantation.html.

Peterson, Amanda. “What You Need to Know about Diabetes”. Capstone Press, 2016.

“Prevalence of Prediabetes | Data & Statistics | Diabetes | CDC.” Centers for Disease Control

and Prevention, Centers for Disease Control and Prevention, 19 Feb. 2018,

www.cdc.gov/diabetes/data/statistics-report/prevalence.html.

Rodgers, Griffin P. “Progress Toward a Cure for Type I Diabetes: Research and the Artificial

Pancreas 2017.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S.

Department of Health and Human Services, 26 July 2017, www.niddk.nih .gov/about-

niddk/budget-legislative-information/progress-toward-cure-type-i-diabetes-research-

artificial-pancreas-2017.

Ross, Tami A, and Patti Geil. “Healthy Eating on a Lean Budget: Diabetes Meals for Less.”
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Diabetes Spectrum, American Diabetes Association, 20 Mar. 2010, spectrum.diabetes

journals.org/content/23/2/120.

Rubin, Richard R. “Diabetes and Quality of Life.” Diabetes and Quality of Life,

American Diabetes Association, 2000,

journal.diabetes.org/diabetesspectrum/00v13n1/pg21.htm.

“Statistics About Diabetes.” American Diabetes Association, 22 Mar. 2018, www.diabetes.org

/diabetes-basics/statistics/.

Stewart, Gail B. “Diabetes”. Lucent Books, 1999.

“Type 1 Diabetes Statistics.” Beyond Type 1, 2017, beyondtype1.org/type-1-diabetes-statistics/.

Wolf, Alexander, and Liu Nancy. “The Numbers of Shame and Blame: How Stigma Affects

Patients and Diabetes Management.” DiaTribe, 13 May 2015, diatribe.org /issues /67/lea

rning-curve.