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abstract: Type 1 Diabetes Mellitus (T1DM) is a chronic disease that requires maintaining tight metabolic control through complex behavioral and pharmaceutical regimens. Subtle cognitive impairments and stress response dysregulation may partially account for problems negotiating life changes and maintaining treatment adherence among emerging adults. The current study examined whether young adults with T1DM physiologically respond to psychological stress in a dysregulated manner compared to non-diabetic peers, and if such individuals also demonstrated greater cognitive declines following psychological stress. Participants included 23 young adults with T1DM and 52 non-diabetic controls yoked to T1DM participants based on age, gender, ethnicity, participant education, and maternal education. Participants completed a laboratory-based social stressor, pre- and post-stressor neurocognitive testing, provided fingerstick blood spots (for glucose levels) and salivary samples (for cortisol levels) at five points across the protocol, and completed psychosocial questionnaires. Related measures ANOVAs were conducted to assess differences between T1DM participants and the average of yoked controls on cortisol and cognitive outcomes. Results demonstrated that differences in cortisol reactivity were dependent on T1DM participants' use of insulin pump therapy (IPT). T1DM participants not using IPT demonstrated elevated cortisol reactivity compared to matched controls. There was no difference in cortisol reactivity between the T1DM participants on IPT and matched controls. On the Stroop task, performance patterns did not differ between participants with T1DM not on IPT and matched controls. The performance of participants with T1DM on IPT slightly improved following the stressor and matched controls slightly worsened. On the Trail Making Test, the performance of participants with T1DM was not different following the stressor whereas participants without T1DM demonstrated a decline following the stressor. Participants with and without T1DM did not differ in patterns of performance on the Rey Verbal Learning Task, Sustained Attention Allocation Task, Controlled Oral Word Association Task, or overall cortisol output across participation. The results of this study are suggestive of an exaggerated cortisol response to psychological stress in T1DM and indicate potential direct and indirect protective influences of IPT. / Dissertation/Thesis / Ph.D. Psychology 2013

Adolescent athletes with type 1 diabetes (T1DM) face unique challenges when compared to peers with and without diabetes. Continuous subcutaneous insulin infusion (CSII) provides a method of insulin delivery that can enhance flexibility in insulin regimens and lifestyle that may be especially appealing to the adolescent athlete. No studies have explored the impact of athletics in this population. This descriptive qualitative study explored and described the experiences of adolescent athletes using CSII as their primary insulin delivery method, with a focus on athletic participation and performance. The purposeful sample consisted of four adolescent athletes, ages 13 to 15 years with T1DM, using CSII, in excellent diabetes control, and recently participated in organized sports activities. After written informed consent, data were collected through a semi-structured interview with the adolescent and parent. Results were transcribed verbatim and analyzed for emerging themes. Four themes emerged from the transcripts along with multiple subcategories. The main themes included: protecting the pump and infusion site; dealing with highs and lows; maximizing participation and performance; and keeping watch. Information gathered from this study will prepare healthcare professionals to anticipate the needs of adolescent athletes using CSII when prescribing a diabetes management regimen.

This study is about young people (age 11-16) with diabetes. Based on fieldwork in a paediatric diabetes centre in Scotland, it describes the ways diabetes is lived and done by young people, their health carers and insulin pumps. This enactment is contrasted with other ways of doing diabetes, as observed on short fieldwork trips to paediatric centres in Brussels, Gothenburg and Boston. I explore the dynamics of diabetes care on two levels. I consider the interaction between health carers and patients. Comparative data from various paediatric centres make apparent how culturally and socially informed approaches towards adolescence, health and illness shape both care practices and patients' experiences, resulting in different medical outcomes. Concretely in the Scottish centre, a non-hierarchical holistic care approach by health carers emphasizing quality of life over health, informs the young people's perspective on diabetes. Being a free adolescent takes priority over managing diabetes, with the results of ill health and possible future complications. The existing dynamics in this care framework change as a third actor enters the scene: the insulin pump, a pager-sized technological device continuously attached to the body. I explore the balancing act between young people and their pumps. As the adolescents actively engage with their pumps not to search for better health but rather to pursue a better quality of life, the guiding question becomes: how can a technological device for insulin injection double as a tool towards a desired identity and a different illness? This work then, can be read as a concrete case study of how a uniform technological device is embedded and used in a specific cultural and social context. It can also be read as an argument for a re-orientation of paediatric diabetes care in the Scottish centre: care centred on collaboration and inclusion rather than focused on merely containing underlying conflict (between adults and adolescents, diabetes and life, health and quality of life). Centres in Brussels, Gothenburg and Boston, and the insulin pump concretely, show how collaboration can lead to good health and quality of life. To leave us to wonder: is 'doing diabetes differently' synonymous with 'doing a different diabetes'?