ABSTRACT
PIP: Insulin-dependent diabetes is the most poorly accepted chronic illness for the following reasons: the customary suddenness and young age at onset of diabetes, the obligatory nature of insulin injections, the incurability of the disease, the need to regulate the diet, and the need for continued surveillance. Among persisting problems of diabetics are frustration at dietary constraints, ambivalence toward insulin, anxiety due to the malfunctioning pancreas, and fear of blindness, amputations, or other complications. The adjustment of a patient to diabetes depends greatly on the age at onset. The disease and its constraints may heighten the usual difficulties of adolescence. The family plays an essential role in adaptation of the diabetic to his condition. The mother of a diabetic child faces 10 principal problems: injections, diet, hypoglycemia, control of diabetic equilibrium, expense, psychological support, time requirements, the need for independence of the child, the feeling that the illness is a punishment, and fears about the future. Renal insufficiency requiring dialysis is another aspect of degraded bodily image for the diabetic. Concerning reproduction, number of pregnancies must be limited because of their potentially unfavorable effects on microangiopathy; maternal health must be monitored even prior to fertilization to avoid fetal malformations. Complications such as these accentuate in the diabetic the usual ambivalence of women toward contraception. Combined oral contraceptives with their vasular risk and IUDs with their risks of infection are not ideal contraceptive methods for diabetics. Tact is needed in couseling diabetics on contraception to avoid stressing once their differences from other women. Tubal ligation, still too frequently practiced, should be avoided so as not to add a further highly sumbolic mutilation. The emotional demands of pregnancy for a diabetic woman are greater than usual, but the desire for pregnancy sometimes increases tolerance of the constraints of the disease. The largescale introduction of portable insulin pumps has met with both positive and negative reactions. The team providing health care to the diabetic should be particularly sensitive in interacting with patient during periods of stress such as immediately after diagnosis, during adolescence, pregnancy, or the appearance of degenerative complications.^ieng
