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Student one.
Teens go through extreme growth, physiological and hormonal changes as they go through puberty. As a teenager, more insulin is needed due to the prevalent amount of growth hormones and sex hormones that are released during puberty in order for teens to manage blood sugar levels. A teen that has Type I diabetes cannot product the insulin that is needed by the body and the symptoms start to present themselves that indicate the teen has Type I diabetes mellitus (T1DM).
The team that I am going to put together for the teen and her family would include a psychologist to assist the teen with the changes that they are going to experience, the stigma of being diagnosed with a new disease, the changes that they are going to have to go through in their life to accommodate the disease, the importance of their health choices on their individual health and their future and the feelings of being ‘different’ than their peers. I would also include a dietitian to help them plan their menu and explain why the new diet they are about to take on is important to follow as well as the consequences of not following the diet. A diabetic educator is also important to go over the many aspects of diabetes and how the teenager can take control of the disease instead of letting diabetes control their life.
At the age of 16 teens are often experimenting with a variety of different activities in life. It is important for education to revolve around how alcohol affects blood glucose levels as well as providing a diabetes educator that would be able to effectively educate the teen on how to eat healthy foods at drive-through restaurants. New technology may make it easier for some teens to monitor and regulate themselves which carbohydrate exchange apps and insulin dosing monitors. There are apps that can be downloaded onto phones, handheld nutrient calculator’s insulin infusion pumps, carbohydrate counters and continuing education on diabetes care, all of which would be helpful for any new or experienced diabetic.
Family education is important in order to hold the teen accountable for the diet that they eat, encouraging compliance with blood glucose testing, reporting hypo or hyperglycemia and knowing how to not only observe the symptoms but also treat them. Education on proper meals to prepare and what snacks to keep on hand that the teen can have is an important responsibility of the parents of a teen with T1DM.
Athletic teens should be educated on “how blood glucose is managed before, during, and after exercise will depend on several variables including time of day of exercise, duration and intensity of exercise, type of insulin regimen, blood glucose targets, and a teen’s typical response to exercise.” (Schreiner, B., Brow, S., Phillips, M., 2000). Education with teens should focus on recognizing and treating hypoglycemia, carrying glucose-containing foods to practices/ competitions as well as proper carbohydrate and protein consumption in order to avoid the highs and lows that excessive carbohydrates can produce.
Although it is important to provide adults with new diabetic patient education“Adolescence is a critical developmental phase that presents unique challenges and opportunities to individuals with diabetes, their families and their healthcare providers. Successful treatment of T1DM is of particular importance during puberty for the achievement of normal growth and sexual maturation and also to reduce the risk of long term vascular complications.” (Chowdhury, 2015).
Chowdhury, S. (2015). Puberty and type 1 diabetes. Indian journal of endocrinology and metabolism, 19(Suppl 1), S51.
Schreiner, B., Brow, S., Phillips, M. (2000). Management strategies for the adolescent lifestyle. Diabetes Spectrum 13: 83. Retrieved from: http://journal.diabetes.org/diabetesspectrum/00v13n2/pg83.htm
Student two
According to White (n.d.), the teaching plan should include what to teach, when to teach, where to teach, and how teaching will occur. In addition, teaching should take into consideration the patient’s age, literacy level, and education. Family involvement is also vital to an effective teaching plan and will need to be incorporated as well.
For “what” to teach the teenager, I would include the following:

The basics of diabetes (what it is and how you get it)
How to treat diabetes
Complications of diabetes
Signs and symptoms of uncontrolled blood sugars
Treatment for uncontrolled blood sugars
Safe and Effective Use of Medications (what and how much to take, possible side effects, mixing and administering, proper storage, etc.)
Medical Equipment and Supplies (teach what supplies they will need and how to use them such as blood sugar testing)
Diet and Nutrition (foods to avoid & healthier options)
Sports and exercise
Teens and parties
Sick day needs
Coping skills
Support groups and Community Resources

This teaching plan will differ from an adult plan in several ways. First, I would teach at a high level and not get into specific details about diabetes and how the body functions (I would teach her what she “needs” to know). I would also teach her differently because she is at a stage in life where her appearance and friends are usually very important and she may have trouble coping with the diagnosis. At her age, she may be dependent on others (such as family members and school faculty) and they will also need to be included in the teaching plan. Finally, teenagers may need additional help learning to deal with diabetes while still doing normal activities such as attending parties, dating, driving, and playing various sports.
When a child is diagnosed with diabetes, it can affect the entire family, so including them in the plan can help increase their understanding and improve the support they can provide (American Diabetes Association, 2017). Concerns should be addressed with family members that may include medical costs and managing diabetes when the child is away (at school, etc.). This teaching plan for the family would include areas such as:

Short and long-term goals
A list of medicines
Nutritional advice
Blood sugar and urine ketone testing
Symptoms of high and low blood sugars (and how to treat)
A plan to see other practitioners (such as a dentist, eye, and foot doctor)
How to inform school faculty and include them in her care
When to come back for a follow-up appointment
A plan for sick days

Regarding “when” to teach, I would want to educate the patient as soon as possible after her diagnosis. I would want to make sure she is ready to discuss her condition and her family is available to participate after our initial conversation (unless she wants them there sooner). Regarding “where” and “how”, I would teach in my office using a one-on-one approach first and then include her family members when she is ready. I would use various training materials such as pamphlets, brochures, flip charts, videos, CDs, along with demonstration (and return demonstration) of medication and equipment use.
In addition to family members, other professionals that should be included in the plan would consist of the school staff, school nurse, athletic coaches, and other health care providers. According to American Diabetes Association (2017), the other healthcare providers may include primary care provider, nurse educator, certified diabetes educator, endocrinologist, eye doctor, podiatrist, social worker, family therapist, dentist, exercise physiologist, pharmacist, and dietician. The right team of professionals can support this teenager and help her manage her diabetes and reach her goals.
According to American Diabetes Association (2017), exercise and physical activity can help control blood glucose so I would advise her to continue participating on the basketball team if she can plan appropriately. I would make her aware that blood sugar levels can drop during or after exercise. I would also give her some tips to prevent hypoglycemia during exercise such as: checking blood sugars before, during, and after exercise, the possible need for insulin adjustments with exercise, eating a snack if blood sugars are low, avoiding exercise if blood sugars are too high and ketones are present, the need for medical identification, and making sure others (such as the coaches) know of her condition.
American Diabetes Association. (2017). Retrieved April 3,, 2017, from http://www.diabetes.org
White, H. (n.d.). Developing a teaching plan [Elluminate recording].
Student three:
Diabetes mellitus, type 1 (DM1) is a chronic, life-threatening metabolic disorder characterized by severe insulin deficiency as a result of autoimmune destruction of insulin-producing pancreatic β-cells. The destruction of β-cells usually occurs abruptly during childhood, adolescence, or young adulthood, but autoimmune destruction of β-cells can also occur later in life. DM1 is thought to occur in genetically susceptible individuals when they are exposed to environmental factors that trigger a dysfunctional immune response. In some cases DM1 can occur without evidence of autoimmunity.  Juvenile patients with diabetes and their families require education regarding various topics of treatment and management of diabetes.  The following is a rough list of some of the education that would be needed.

Educate patient and parents regarding management of DM1, including nutrition, medication and side effects, exercise, disease progression, complication prevention strategies, blood glucose monitoring techniques, insulin storage, and the necessity of lifetime medical surveillance
Current recommendations advise that carbohydrates should comprise 50–55% of daily caloric intake, while fats and protein should account for 30–35% and 10–15% of calorie intake, respectively (Chiang, Kirkman, Laffel, & Peters, 2014)
Normal activity is usually encouraged; full participation in sports is possible
Discuss the importance of regular clinician visits to monitor weight, height, and sexual maturation; quarterly HbA1C measurement; annual retinal and foot exams; annual UA for detection of microalbuminuria; and lipid profile evaluation every 5 years
Advise adolescents with DM1 about risks of alcohol use specific to people with DM1, including increased risk of DKA; advise wearing a medical bracelet indicating DM1 status (Costa Flora & Goncalves Herriques, 2016)
Request referral to a registered dietitian to receive individualized medical nutrition management, and to a health care educator, mental health clinician, or both, for individual, group, and/or family counseling on coping with a chronic condition

Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care, 37(7), 2034-2054. doi:10.2337/dc14-1140
Costa Flora, M., & Goncalves Henriques Gameiro, M. (2016). Self-care of adolescents with type 1 diabetes: Responsibility for disease management. Revista de Enfermagem Referencia, 4(9), 9-19. doi:10.12707/RIV16010
Student four:
A 16-year-old female, newly diagnosed with diabetes, presents in the clinic today in need of diabetic education. Education will include an explanation of what diabetes is, the types of diabetes, the cause, and how to treat it. Treatment education includes explaining how to control blood glucose through a carbohydrate controlled diet and the use of medications. Type 1 diabetes will require insulin, whereas Type 2 diabetes may require other medications that include pills such as metformin, and / or insulin injections. Medications used for Type 2 include metformin, thiazolidinedione, insulin releasing pills, starch blockers, incretin based therapies, amylin analogs, and insulin.
Insulin may be ordered using a sliding scale and dosages will be determined based on the results of the blood glucose test via finger sticks and using a glucometer. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements (Diabetes Education Online, 2017).
Nutrition education will include defining macronutrients and the effect each has on the level of blood glucose. Identifying to the patient the different types of carbohydrates and their direct effect on blood glucose levels related to her health will help her to understand the need to regulate their intake. “When people eat a food containing carbohydrates, the digestive system breaks down the digestible ones into sugar, which enters the blood. As blood sugar levels rise, the pancreas produces insulin, a hormone that prompts cells to absorb blood sugar for energy or storage” (Harvard, 2017). Education the includes an explanation of the glycemic index will benefit a diabetic by identifying low glycemic foods that help to control diabetes, improve weight loss, and offer anti-inflammatory benefits. Examples of low glycemic foods include bran cereals, apples, oranges, kidney beans, black beans, lentils, wheat tortilla, skim milk, cashew, peanuts, and carrots.
The treatment team will include the primary care provider, dietician, endocrinology, and possibly psychiatry. Considerations to the patient’s daily activities with school, her social activities, and extracurricular activities such as participation on the basketball team. She will want to keep emergency contact information on her at all times, diabetic treatment essentials that include medication and sugar or dextrose tablets. Encouraging her to tell at least one of her friends will also help for support and in case there is an emergency.
University of California. (2017). Sliding scale therapy. Diabetes Education Online. Retrieved from https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/sliding-scale-therapy/
Harvard T.H. Chan School of Public Health. (2017). Carbohydrates and blood sugar. The Nutrition Source. Retrieved from https://www.hsph.harvard.edu/nutritionsource/carbohydrates/carbohydrates-and-blood-sugar/

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