Iatrogenic hypoglycemia is a limiting factor for managing diabetes mellitus and can have severe outcomes such as seizures and coma. Although several studies have investigated the central nervous system consequences of hypoglycemia, the effects of seizures, as well as possible treatment strategies, have yet to be elucidated in juvenile animals. The objective of this thesis was to establish an in vivo model of severe hypoglycemia and seizures in juvenile diabetic and non-diabetic rats. In both groups there existed a similar blood glucose threshold for seizures, and mortality only occurred following severe seizures, particularly with repeated seizures that were unresponsive to treatment. While the administration of anticonvulsants temporarily mitigated seizures, glucose administration was required to prevent mortality. Abnormalities in the hippocampal and brainstem electroencephalograms (EEG) were observed in hypoglycemic animals without a clear correlate to convulsive activity.

Iatrogenic hypoglycemia is a limiting factor for managing diabetes mellitus and can have severe outcomes such as seizures and coma. Although several studies have investigated the central nervous system consequences of hypoglycemia, the effects of seizures, as well as possible treatment strategies, have yet to be elucidated in juvenile animals. The objective of this thesis was to establish an in vivo model of severe hypoglycemia and seizures in juvenile diabetic and non-diabetic rats. In both groups there existed a similar blood glucose threshold for seizures, and mortality only occurred following severe seizures, particularly with repeated seizures that were unresponsive to treatment. While the administration of anticonvulsants temporarily mitigated seizures, glucose administration was required to prevent mortality. Abnormalities in the hippocampal and brainstem electroencephalograms (EEG) were observed in hypoglycemic animals without a clear correlate to convulsive activity.

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Please read the abstract in the section, 00front, of this document / Dissertation (MA)--University of Pretoria, 2008. / Social Work and Criminology / Unrestricted

Objectives: The rate and impact of depressive symptoms were examined with two models based on known effects of depression on variables related to diabetes management, parental involvement and diabetes conflict. The proposed models will measure potential effects high maternal depressive symptoms may have on parental monitoring and involvement and diabetes specific conflict and how these variables may in turn relate to poor regimen adherence. Methods: Participants included 225 mothers and young adolescents (aged 11-14) with T1D. Diabetes self-care behaviors were measured with the 24 Hour Recall Interview, parental involvement and monitoring were measured with the Parent Management of Diabetes Scale, and diabetes specific conflict was measured with the Diabetes Family Conflict Scale. Results: A significant portion of mothers (21%) reported clinically elevated levels of depressive symptoms. These high levels of depressive symptoms were related to low levels of parental involvement with diabetes care (r = -.19, p < .01). Depressive symptoms were indirectly related to lower frequency of blood glucose monitoring (C.95 = -.03, -.002), insulin use (C.95 = -.01, -.0007), and meals (C.95 = -.02, -.002) through low levels of parental involvement. Higher levels of depressive symptoms were also related to higher levels of diabetes specific conflict (r = .16, p < .01), however, this relationship did not have a significant indirect effect on frequency of self-care behaviors. Conclusions: A significant portion of mothers in the current sample reported symptoms of depression above the clinical cutoff. Mothers that reported higher levels of depressive symptoms also reported lower levels of parental involvement in management of disease-care behaviors. Low levels of parental involvement mediated a significant relation between depressive symptoms and less frequent disease-care behaviors. Diabetes conflict did not mediate a relation between depressive symptoms and disease-care behaviors. These findings suggest that the reported high levels of maternal depressive symptoms among mothers of children with T1D may interfere with good diabetes management through low parental involvement. Individual treatment for depressive symptoms and interventions targeted at increasing parental involvement without increasing diabetes conflict could help improve regimen adherence.

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text