Nursing Patient Teaching Plan 6 year old diabetic Type 1

Introduction to Type 1 Diabetes

Diabetes type 1 can also be referred to as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. This diabetes increases the amount of blood sugar levels due to absolute or relative insufficiencies of insulin. Insulin is a hormone produced by pancreas. The role of insulin in the body is to regulate the body’s metabolism (Valentine et al., 2002). After a meal, digestion breaks carbohydrates down into sugar molecules and proteins into amino acids. During the process, amino acids and glucose are absorbed directly into the bloodstream, and the blood glucose level rises sharply. Eventually, blood sugar levels rise, thus signaling critical cells in the pancreas called beta cells that secrete insulin. Insulin is poured into the bloodstream, and 20 minutes after a meal, its level in the blood to its peak. The work of insulin is to enable glucose to enter cells in the body, particularly muscle and liver cells. Here, glucose is burnt to release energy or stored for future use by hormones or insulin. An increase in the level of insulin makes the liver stop functioning; hence, produced glucose is stored in other forms till the body needs it again (Valentine et al., 2002). The moment the blood insulin level reaches its peak, the pancreas reduces production of insulin. Approximately 2-4 hours after a meal, both insulin and blood glucose levels are at low levels, with insulin levels slightly higher. Therefore, blood sugar levels can also be referred to as fasting blood glucose concentrations. In type I diabetes, the body does not produce insulin; hence, it mostly occurs during childhood.

Pathophysiology of Type 1 Diabetes

Pathophysiology is a process by which the body is disturbed from its normal function, which is caused by the disease “diabetic type I.” The first thing to be detected in a patient affected by this condition is a thickening of the glomerulus. At this stage, the kidney leaks more plasma protein in urine than usual. As it progresses, it increases the number of glomeruli that are destroyed by progressive nodular glomerulosclerosis. This appears in a decompensated diabetic manner with glycemia, which is higher than 500mg/dL. However, unspecific chronic changes are shown by the interstitium (Fox & Kilvert, 2007)

Symptoms and Diagnosis of Type 1 Diabetes in Children

According to Fox & Kilvert (2007), type 1 diabetes is known for its sudden appearance and the speed with which it progresses in 6-year-old patients. The warning signs and symptoms are frequent urination, extreme hunger, unusual thirst, weakness, weight loss, extreme fatigue, irritability, blurred vision, nausea, and vomiting. Additionally, swelling occurs around the eyes in the morning, and the patient experiences headaches and frequent hiccups.

There are several tests carried out to identify the cause and the nature of the type 1 diabetes. Testing for glucose abnormalities is one of the tests that are normally carried out on patients. This is a simple blood test taken after 8 hours of fasting. It indicates; normal: U100 mg/dL, pre-diabetes: between 100-125 mg/dL, diabetes: 126mg/dL among many other tests.

Complications of Type 1 Diabetes

There are many complications that come as a result of type I diabetes. It has been noted that these complications can reduce the normal lifespan by about 5-8 years. One of these complications is diabetic ketoacidosis, which is caused by insulin deficiency. Diabetic ketoacidosis poses a risk of low blood glucose levels, which results in hypoglycemia (Fox & Kilvert, 2007). Other complications are heart disease and stroke, kidney damage, neuropathy, amputations and foot ulcers, eye complications, respiratory infections, depression, osteoporosis, and hearing loss.

Lifestyle Modification for Managing Type 1 Diabetes

Life style modification is the process of treatment which patients with type I diabetes undergo (Lenz, 2007). It includes regular exercise, smoking cessation and dietary changes which reduces the risk in patients with cardiovascular disease. This is done through motivating the patients; try to negotiate a plan to enable them to do so, and monitoring the way they progress.

There are several barriers that hinder a patient with type I diabetes from following lifestyle modification procedures. Research conducted by diabetes nurses indicates that a lack of education on the importance and the need for screening examinations hinders lifestyle modification (Lenz, 2007). They also found out that there is limited physician knowledge regarding the history of diabetic patients. Another barrier is physical failure to adhere to clinical practice recommended for guideline testing. Lastly, there is a lack of awareness among physicians about the diabetes program and diabetes education network offered by health plans.

Benefits of Lifestyle Modification for Type 1 Diabetes

The benefits of lifestyle modification are the cornerstone of diabetes treatment. The long-term benefit is that the amount of carbohydrates that patients consume helps regulate their blood glucose levels and adjust their insulin doses (Lenz, 2007). AIC, as a short-term benefit, helps patients with diabetes pursue a low glycemic index diet. The introduction of sugar alcohol causes less hyperglycemia than naturally occurring sugars. It also decreases the risk of dental caries. The level of insulin helps to convert amino acids into glucose. Weight loss, nutrition, increased physical activity, and smoking cessation are recommended to improve medical conditions for type 2 diabetes (Feinglos & Bethel, 2008). Weight loss is recommended since it enables one to lower the calorie intake and remain consistent with dietary changes. Eating fewer fats, particularly saturated fats, whole grains, and fiber, which is dietary, can lower the number of lipids in the body, therefore reducing the risk of developing a metabolic syndrome. An increase in physical activity plays a major role in preventing diabetes. Regular exercise, such as walking, decreases the rate of diabetes. Weight loss is also achieved through daily activities such as walking, jogging and running. Smoking cessation decreases the risk of ischemic vascular disease. Those who are smokers should be helped to quit smoking. This can be achieved through group therapy.

Managing Blood Glucose Levels in Type 1 Diabetes

Physical activity and diet are important in the management of the ABCs of patients with Type 1 diabetes since it helps the body to utilize excess glucose reserves (Escott-Stump, 2007). To be able to manage AIC and achieve stable blood sugar control, it is important to figure out how to balance food intake, insulin, and physical activity. Diet is particularly important since it significantly improves blood sugar control and decreases the risk of diabetes-related complications, such as coronary artery disease, nerve damage, and kidney disease. Additionally, a dietitian can help create a food plan that fits a child’s medical needs, lifestyle, and personal preferences. Meal timing is a very fundamental aspect for patients with type 1 diabetes to consider. Those who take long-acting insulin are being encouraged to take meals consistently at the same times daily (Feinglos & Bethel, 2008). However, if a meal is skipped or delayed, the patient will have a high chance of experiencing low levels of blood glucose. Meals with a high content of fats, such as snacks, can be eaten occasionally, but blood glucose levels must be monitored. This is because this food entails high-fat content, hence reducing the blood sugar level shortly after eating and then rising hours later. Patients who use insulin pumps have an alternative of using more insulin and hence are well-positioned to manage their levels of blood sugar after consuming a high-fat meal than their counterparts who do not use that pump (Shafer, 2001).

Dietary Considerations for Type 1 Diabetes

The main energy source in the diet is carbohydrates, which includes starches, fruits, vegetables, sugar, and dairy products. According to Shafer (2001), due to consistent eating of carbohydrates at each meal, blood sugar level is controlled mostly in patients who take long-acting insulin. As time goes by, a patient is supposed to be enrolled in exchange planning, where all foods are categorized as either carbohydrate, meat or meat substitute or even fat. These foods are excellent sources of fiber and high sodium content. Eating a consistent number of calories every day will help to maintain body weight. The recommended calorie intake for men and active women is 15 calories/pound.

Sample Menu for a Patient with Type 1 Diabetes

A sample menu for a patient who needs [1.600] to [2.000] calories on a daily basis (diabetesdietfordiabetic.com, 2011):

Breakfast: ½ cup cooked oatmeal cereal with 1 medium-sized banana {1S.2F}

1 cup of low-fat milk {1M}

Lunch: 1 slice of cheese with 2 slice of bread. 1 strip of bacon {2S.2M&S.1Ft} and 1 slice of turkey

Dinner: 1 small potato {1S}

2{6 inch} tortilla {2S}

3 ounces of cooked, minced lean meat with 1 cup tomato sauce {3 M&S.2V}

½ cup steamed with broccoli {1V}

Snacks: 1 small roll {1S}

1 small ear of corn {1S]

½ cup of unsweetened apple juice {1F}

Patient Teaching Plan Objectives

Patients with Type 1 diabetes are taught how to follow medical prescriptions by undergoing patient teaching plans for the medical condition (Humphrey, 1999). This disease is a lifelong condition that can be controlled through adjustment of lifestyle and medical treatment. There are many types of insulin treatment that can be that can be successfully controlled by the level of blood sugar. Therefore, this will help people with diabetes to live a full life and keep their blood sugar level under control when they take insulin. The information you are conveying to the patient is that his/her pancreas produces very little insulin, leading to Type 1 diabetes. Insulin eventually is required, and it must be given as a shot. A doctor helps the patient adjust the dose over time; hence, blood sugar levels should be regularly checked per day. According to Humphrey (1999), insulin treatment plans are categorized into two general types: standard insulin treatment and intensive insulin treatment. Intensive insulin treatment is recommended since it is best for keeping blood sugar in a very tight control. 3 shots of insulin per day for the patient with type 1 diabetes and frequently checking the level of blood. As Escott-Stump (2007) notes, this treatment improves blood sugar control in diabetic patients, and this makes it significant for them. It also improves how a patient feels on a daily basis and minimizes the risk of health complications later in life.

Teaching Plan Schedule

The following are the objectives for the teaching plan:

The patient is supposed to be able to describe the diabetic medications that they are on and take medication properly.

The patient should be capable of describing the benefits of regular exercise and how it can improve blood glucose level.

Proper skin and foot care should also be demonstrated well with the patient

Self-monitoring of blood glucose using a blood glucose meter should be performed well by the patient.

Teaching will be carried out in 6 days, and each class will consist 2-3 hours sessions of education.

Day 1 there will be an overview of diabetes, Day 2 monitoring of blood glucose and the role of blood glucose, Day 3 insulin and medication, Day 4 complications from Diabetes, foot care and skin, exercise and diabetes, Day 5 coping with diabetes, diet and diabetes. Day 6 questions and answers so as to gauge if the patient has understood. The last 1 hour is to review any concepts requested by patients.

Conclusion

Diabetes is an alarming disorder of the third world. Through several researches that have been carried out, the prevalence of diabetes in the year 2025 will likely increase by 35%. Diabetes Type 1 is a very complex disease for both patients and the health professions. We believe and have hope in the recommendation presented that will help to fight this Type 1 disease. Through diagnosis, these approaches and strategies have proved to be effective in treating diabetes and its complications.

References

Escott-Stump, S. (2007). Nutrition and diagnosis-related care. Philadelphia : Wolters Kluwer Health.

Feinglos, M. N., & Bethel, M. A. (2008). Type 2 diabetes mellitus: an evidence-based approach to practical management. Totowa, NJ: Humana Press.

Fox, C., & Kilvert, A. (2007). Type 2 diabetes: answers at your fingertips. London: Class Pub.

Humphrey, C. J.  (1999). Home care nursing handbook. Gaithersburg, Md.: Aspen Publishers

Lenz, T. L. (2007). Lifestyle Modifications in Pharmacotherapy. Philadelphia : Wolters Kluwer Health.

Shafer, S. (2001). Diabetes Type 2: Complete Food Management Program. New York: Three Rivers Press

Valentine et al. (2002). Diabetes type 2 and what to do. Los Angeles: Lowell House

Wilson, A. L. (1997). Managing the patient with type I diabetes. Gaithersburg, Md.: Aspen Publisher.

diabetesdietfordiabetic.com. (2011, May). Diabetes Diet Menu: A Few Examples. Retrieved from http://diabetesdietfordiabetic.com/diabetes_diet_menu.htm

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