Developing a teaching plan for type 1 diabetes in children

Diabetic Teaching Plan

Teaching Plan

Teaching plan: Patients with diabetes

Although all patients with type I diabetes manifest the same basic biology in terms of the manifestation of the illness, patients of different ages and genders will have different emotional, social, and environmental needs. This can be seen in a comparison of two patients, 'Sarah' and 'David.'

Patient 1: 'Sarah'

Sarah is a ten-year-old Caucasian daughter of a single mother. Sarah has been recently diagnosed with type 1 diabetes. Engaging in dietary modification has been a challenge for Sarah. Sarah has expressed frustration with the fact she cannot eat 'just the same' as her friends and this has been a source of friction between herself and her mother, who says she frequently feels overwhelmed with the demands of managing Sarah's condition.

Developmental learning needs

Sarah must need to understand how to manage her illness. The nurse must communicate this in an age-appropriate fashion. The first step of helping Sarah deal with her illness involves an "explanation of how the diagnosis has been made and reasons for symptoms" in a manner which is comprehensible for Sarah (Swift 2009: 53). Sarah must understand that diabetes is not a punishment for something she did wrong. The nurse must also teach Sarah practical skills, including "insulin injections blood and/or urine testing" and glucose level monitoring, which will also give Sarah a sense of independence and control over her illness (Swift 2009: 53). Sarah and her mother must develop an agreement over how and what Sarah will eat. Sarah's mother will likely want to receive a more complex explanation about the medical basis of type 1 diabetes and a comprehensive treatment plan detailing dietary modifications for her daughter's diet, including a reduction of carbohydrates: "qualitative and quantitative advice on intake of carbohydrate, fat, proteins and fiber; coping with special events and eating out; growth and weight gain; 'diabetic foods'; sweeteners and drinks" (Swift 2009: 53). But Sarah needs to be 'on board' about agreeing to modify her diet in a manner that is acceptable to her yet is also healthy.

Assessment of learning needs

The goal of Sarah's treatment plan is for the girl to move to greater and greater independence regarding her self-care, although she will initially have the support of a parent or nurse. This includes "adapting diabetes to school programs, school meals, exercise and sport" and "monitoring of BG levels and injections in the school setting" (Swift 2009: 53). The child should also be aware of the physical symptoms of hypoglycemia, such as fogginess, double vision, and lethargy (Swift 2009: 53). The child and the parent should understand how to deal with the symptoms of hypoglycemia: to "drink or eat a concentrated amount of sugar (approx. 10 to 15 grams) to raise the blood glucose value to greater than 80 mg/dl" in the form of glucose tablets, candy, juice" etcetera (Manzella 2012).

The parent should be present to be able to step in where the child may not be able to engage in self-care regarding her illness. The parent should also understand the importance of teaching the child about how to test the girl's blood sugar with adequate frequency (depending on the type of insulin the child is using); assembling a glucose-boosting kit of snacks to have; and monitoring the child's diet.

The nurse must deal with Sarah's emotional needs. It may be desirable to discuss with the young girl alone what she regards as her most pressing concerns: the girl may not want to talk about her reluctance to monitor herself in school in front of her friends, for fear it makes her seem 'different' in an embarrassing fashion. Role-playing may be helpful when dealing with a young child to counteract social fears, such as asking the girl to imagine what she would do if she was in a situation when she felt she needed to check her blood sugar during a class trip and needed to ask the teacher to stop at a somewhere to do so, or what type of foods she might select from the typical offerings at her school cafeteria.

Patient 2: 'David'

Introduction

David is a thirty-five-year-old, single, Caucasian male recently diagnosed with type 1 diabetes. He is surprised, angry and confused, given that he has 'always worked out and taken care of himself.' Unlike type 2 diabetes, type 1 diabetes is an autoimmune disorder and not necessarily associated with excess body weight. David must understand the full implications of his diagnosis, including the changes he will need to make in his lifestyle to allow for appropriate monitoring of his blood sugar, insulin injections and dietary modifications. He must also understand that diabetes is not his 'fault.'

Assessment of learning needs

"Type 1 diabetes, also called juvenile diabetes or insulin-dependent diabetes, is a disorder of the body's immune system -- that is, its system for protecting itself from viruses, bacteria or any 'foreign' substances. Type 1 diabetes diagnosed in adults over 30 may be Latent Autoimmune Diabetes in Adults (LADA), sometimes known as Type 1.5 diabetes" (What is type 1 diabetes, 2012). Living with type 1 diabetes is a 'round the clock' challenge, given that sufferers must test their blood glucose frequently (at least six times a day) and carefully monitor the body's level of insulin (Fact sheets: Type 1 diabetes facts, 2012, JDF). This is a radical lifestyle shift from what David is accustomed to. Although David works out regularly, he lives a relatively carefree 'bachelor' lifestyle and freely admits he seldom gives much thought to health issues or to his diet. David is not overweight, but pizza, burgers, and other non-diabetic friendly meals are part of his weekly diet. David needs to change his lifestyle around to accommodate his illness, which includes being more proactive in seeking assistance when he needs it.