Reasons for missed meal-time insulin boluses from the perspective of adolescents using insulin pumps: 'lost focus'.
OBJECTIVE
To investigate the reasons for missed bolus doses and strategies for avoiding this among adolescents using insulin pumps.


METHODS
The grounded theory method was chosen as a model for the collection and analysis of data. Data were collected through interviews with 12 adolescents treated with an insulin pump (5 males and 7 females, mean age 14.4 yr) from different Swedish pediatric diabetes clinics. All interviews were tape-recorded and immediately transcribed.


RESULTS
The core category 'lost focus' emerged as representing the main reason for missed bolus doses. Identified subcategories were delayed lost focus, directly lost focus, and totally lost focus. There was a risk of delayed lost focus when the adolescent used postprandial bolusing. Focus could also be lost directly in connection with the start of the meal. Totally lost focus could occur when the adolescent perceived the impact of diabetes as too high or tried to neglect that he or she had it. The category 'agreements about reminders' appeared to be the main strategy for avoiding missed bolus doses; subcategories were personal reminders and technical reminders. The adolescent needed to be involved in these agreements; otherwise, the reminding could be seen as nagging and did not work.


CONCLUSIONS
The results may help diabetes care teams understand the circumstances in which adolescents miss their bolus doses. This understanding may make it easier to discuss missed doses and strategies for avoiding this with adolescents and support negotiations over agreements about reminders between them and their parents.
Sachs' Children's Hospital, Södersjukhuset, SE-118 83 Stockholm, Sweden. olinder@sodersjukhuset.se
Anna Lindholm
AL
Olinder
Kerstin Ternulf
KT
Nyhlin
Bibbi
B
Smide
D000293:Adolescent; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology*; D004435:Eating; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D010290:Parents; D019518:Postprandial Period; D012648:Self Care / Q000379:methods* / Q000523:psychology; D055815:Young Adult
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin