Type 1 Diabetes
CONSEQUENCES
Before diagnosis
with type 1 diabetes, a teen with elevated blood glucose levels
will develop symptoms
of increased urination, thirst, and appetite
in addition to weight loss or failure
to grow normally. If not diagnosed
soon enough, life-threatening ketoacidosis may result.
After diagnosis
with type 1 diabetes, the teen must follow a daily management regimen that includes regularly scheduled
insulin injections, blood
glucose monitoring, and attention to food intake (especially carbohydrates) that adds stress
to many families. Families must receive
comprehensive education, diabetes
self-management training, frequent
follow-up, and social
support on an on-going basis. The burden
of living with a chronic
illness is a consequence that is often
overlooked.
Consequences occur with administration of too much or not enough insulin.
Too much insulin
or inadequate food intake
may lead to low blood glucose levels
(hypoglycemia) and potentially, loss of
consciousness and seizures.
Chronic hyperglycemia, a reflection of insufficient insulin,
results in eye disease, kidney
disease, nerve damage,
and an increased risk of cardiovascular disease
that may appear 10-15 years after diagnosis.
Type 2 Diabetes
Before diagnosis
with type 2 diabetes, a teen with elevated blood glucose levels
may present with no
symptoms or have mild glucosuria and/or ketosis with or without
weight loss.
After diagnosis
with type 2 diabetes, the teen must follow a daily management regimen that includes attention to food intake
(carbohydrates, as well as fats and total
energy intake), exercise,
and blood glucose monitoring. Administration of medication (insulin
or oral medications) may also be required. This new regimen
may add stress to families.
Families must receive
comprehensive education, diabetes
self-management training, frequent
follow-up, and social
support on an on-going basis.
The burden of living with a chronic
illness is a consequence that is often
overlooked.
Acute consequences will depend on the medication prescribed. Those teens treated with insulin or sulfonylureas are at risk for low blood glucose
levels.
Long term consequences are similar to those resulting from poor control
of type 1 diabetes– eye disease, kidney
disease, nerve damage
and an increased risk of cardiovascular disease.
SCREENING
Early Warning
Signs for Type 1 and Type 2 Diabetes
A blood glucose level
should be checked
if one or more of these symptoms
is present:
•
Increased urination
•
Increased thirst
•
Increased appetite
•
Unexplained weight loss
Screening for Type 1 Diabetes
•
No screening recommendations for the diagnosis of type 1 diabetes in adolescents have been established.
Screening for Type 2 Diabetes
The screening recommendations listed in Table 2 are from the American
Diabetes Association.
Criteria*
TABLE 2
Testing for Type 2 Diabetes
in Children and Adolescents
Overweight (BMI ≥ 85th percentile for age and gender, weight
for height ≥ 85th percentile or weight
≥ 120% of ideal for height).
Plus any two of the following risk factors:
–
Family history
of type 2 diabetes in first- or second degree
relative
–
Race/ethnicity (American Indian, African American, Hispanic, Asian/Pacific Islander)
–
Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome)
Age of initiation: age 10 years or at onset of puberty
if puberty occurs
at a younger age.
Frequency: every 2 years.
Test: fasting plasma glucose
is the preferred method for screening.
*Clinical judgment should
be used to test for diabetes in high-risk patients
who do not meet these
criteria.
Source: © 2002 American
Diabetes Association. From Standards of medical care for patients
with diabetes mellitus. Diabetes Care 2002;25(1):213-229; Table 4, p. 215. Reprinted
with permission from The American
Diabetes Association.
ASSESSMENT
A nutrition
assessment should be done at diagnosis and at least
once a year thereafter by a registered dietitian experienced with diabetes and adolescent nutrition. The assessment includes
an evaluation of typical food intake and eating habits
in addition to identifying the many factors
that influence food intake (Table 3). A 24-hour dietary
recall and an age appropriate nutrition questionnaire are useful tools to obtain
this information (see Chapter 4). Then an initial meal plan can be determined and adjustments in total energy
intake may be made to allow for stage of growth and activity level. Information about family support
and barriers to learning will help the dietitian individualize the educational experience.
TABLE 3
Factors that Influence Adolescent Food Intake
School schedule Work schedule Social activities
Weekday vs. weekend routines
Family culture Family traditions Food likes/dislikes
Places where meals are eaten
Financial resources
Family and/or peer support
•
Use body mass index to assess physical
growth (see Chapter
4). A teen with weight
loss prior to diagnosis often needs additional calories for catch-up
growth. Once healthy
weight gain has occurred, it is important to check the meal plan 3-4 weeks after diagnosis
and decrease total food
intake, if necessary, to prevent
excess caloric intake
and unwanted weight
gain.
•
Total energy and protein requirements can be estimated
by a combination of typical
food intake and the Recommended Dietary Allowances. Adolescent energy and protein
intake is often calculated by height to allow for changes in energy requirements related to growth
during puberty rather than chronological age.
TO BE CONTINEU
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