Children and young people with diabetes: recognition and management

Abstract

Diabetes mellitus (type 1) is an autoimmune condition leading to absolute insulin deficiency resulting in hyperglycaemia and its associated manifestations. It is the most common type of diabetes seen in children, characterised by the 4Ts (toilet, thinner, thirsty, tired). The signs and symptoms can sometimes be non-specific and a delay or missed diagnosis may be catastrophic to the health of the child. Children with an established diagnosis of diabetes often present to the health service with issues such as hypoglycaemia, hyperglycaemia, or diabetic ketoacidosis. The condition requires life-long monitoring and strict control of blood glucose levels with insulin replacement therapy, with the aim of achieving an HbA1c level of 48 mmol/mol. There are often physical and psychosocial issues that arise from the diagnosis leading to poor control. Nurses working in different clinical settings play a vital role in raising suspicions of diabetes leading to timely diagnosis and rapid initiation of treatment. They are best placed to provide essential support in helping children and their families to come to terms with the diagnosis, as well as manage this chronic condition by addressing the common issues that arise in the ongoing management, with a particular emphasis on managing the various day-to-day challenges. Two case studies are included to highlight some of the challenges that nurses may encounter while managing children with diabetes.

Sleep in Parental Caregivers and Children With Type 1 Diabetes

“…School nurses are often called to aide children in checking their blood glucose, administering insulin, and assessing for complications (hypoglycemia and hyperglycemia), as well as providing and reinforcing diabetes education. Including education on the importance of sleep, sleep habits, and asking children how they are sleeping may be first steps in opening up a wider dialogue that also can include parents (Hamilton, Knudsen, Vaina, Smith, & Paul, 2017).…”

Effects of mobile health interventions on improving glycemic stability and quality of life in patients with type 1 diabetes: A meta‐analysis

“…Previous studies found that young adults with T1D reported poor mental health, such as anxiety, depression, and stress (Mellerio et al, 2015; Rathbone & Prescott, 2017). Patients with T1D may suffer difficulties in performing frequent blood glucose monitoring, active insulin‐dose titration tailored to carbohydrate intake, and physical activities, thereby causing psychological distress and a decrease in mental health (Hamilton et al, 2017). Evidence supports reminders of blood glucose monitoring, carbohydrate intake education, and engagement in insulin treatment being beneficial for people with T1D (Baretić et al, 2018; Wangberg et al, 2006).…”

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“…Jis gali varginti įvairaus amžiaus vaikus, netgi kūdikius (American Diabetes Association, 2017). Cukrinis diabetas vaikams nustatomas esant labai aukštam gliukozės kiekiui kraujyje (Dabelea, Stafford, Mayer-Davis, 2017;Hamilton, Knudsen, Vaina, 2017).…”