Specialisation: Nursing Plan

Case Study: Type 1 Diabetes

Type 1 diabetes is a complicated condition that requires careful control. It may be more complex for adolescents, and control often deteriorates. Family dynamics and school support as “significant others” in the circumstances where a comprehensive family assessment of health and social needs is recommended to adapt support. This case study aims to show how adolescence may have altered a 14-year-old boy’s diabetes self-management, background, assessment framework, current nursing plan, and recommendations on how to deal with the condition.

Case Study

Felix was 14 when he was diagnosed with type 1 diabetes six months ago. He lives with his single mother and 10-year-old sister. In this case, Felix represents the hardships teenagers with this disease encounter and the issues families and professionals confront.

Common Assessment Framework

Hingle et al. (2019) recommended family-focused therapies for adolescents with diabetes, which CAF then recommends. As a multi-agency document, it allows information sharing and care collaboration with the family and young person. Significantly, it supports a family-focused team and was used to assess Felix and his family’s diabetes management challenges and how to help them.

Background

About 30% of newly diagnosed type 1 diabetic children have diabetic ketoacidosis as a result of weight loss and fatigue being misinterpreted as puberty symptoms. Felix was critically ill and needed intense DKA route care to stabilize as he recovered after 48 hours and started numerous daily subcutaneous insulin injections. He self-managed his insulin injections on day four after a systematic instructional strategy described in the Best Practice Tariff that included a dietitian introduction to carbohydrate counting, exercise, and a balanced diet. Most importantly, follow-up assistance with structured diabetic self-management education from diagnosis is crucial for diabetes management (Holmqvist, 2020). Felix’s mother realized early on that Felix would benefit from learning to deal independently and declined scheduled education visits, believing they were managing themselves. However, Felix was at risk due to his young age and the responsibilities he was given after a life-changing diagnosis.

Current Nursing Plan

Notably, less than 50% attendance has plagued Felix’s education. He missed school due to migraines, stomach pain, and hyperglycemia-related “high blood sugars” after diagnosis. Gazerani (2021) found that high and low blood glucose levels can affect children’s education through poor concentration, mood, and behavior. Due to a lack of diabetes knowledge, school workers may mistake these behaviors as disruptive or accept illness and absence more easily. Felix must evaluate how school absenteeism affects academic performance. Van Duinkerken et al. (2020) found that childhood diabetes lowers cognitive scores in most domains, with executive cognitive aptitude improving problem-solving, planning, organization, and working memory.

Consequently, the CAF assessment revealed Felix’s dyslexia and academic underachievement. A child’s safety, long-term well-being, and academic achievement depend on proper diabetes care in school and daycare. Felix’s school could be a “significant other” and protective factor if the diabetes team works with it to meet his diabetes requirements during school hours. With an emphasis on “duty of care,” new legislation provides advice and guidance for supporting children with medical issues at school. Holmqvist (2020) proposed statutory guidance to oblige English schools to support children with medical illnesses, emphasizing the school’s position as a significant other. Education, health, and care programs for children with invisible needs at school are intended to make their needs more obvious.

Conclusions

Overall, adolescents like Felix and his family confront significant challenges. As a result, structured diabetes education to increase adherence to the regimen cannot be performed without considering family dynamics and the cognitive capacity of the young person and their family. Therefore, it is recommended that CAF documentation as part of a family assessment of children newly diagnosed with type 1 diabetes may alert healthcare professionals working with children like Felix who have high-risk factors and prevent many diabetes care issues.

References

Gazerani, P. (2021). Migraine and mood in children. Behavioral Sciences, 11(4), 52.

Hingle, M. D., Turner, T., Going, S., Ussery, C., Roe, D. J., Saboda, K., … & Stump, C. (2019). Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The EPIC Kids (Encourage, Practice, and Inspire Change) Study. Preventive medicine reports, 14, 100840.

Holmqvist, M. (2020). Medical diagnosis of dyslexia in a Swedish elite school: A case of “consecrating medicalization.” The British Journal of Sociology, 71(2), 366-381.

Van Duinkerken, E., Snoek, F. J., & De Wit, M. (2020). The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diabetic Medicine, 37(4), 555-563.