Patient discussions
Patients must be educated regarding the benefits of self-monitoring of blood glucose, to identify inadequate glycemic control and to proactively make dosage adjustments.[1]
Patients need to be taught how to promptly identify the signs and symptoms of hypoglycemia (i.e., shakiness, irritability, hunger, sweating, tachycardia, mood changes, confusion, dizziness). Advise patients and caregivers that when blood glucose levels fall to <70 mg/dL (<3.9 mmol/L), the patient should ingest approximately 15-20g of pure glucose (i.e. glucose tablets) or, if this is unavailable, that they should eat any form of carbohydrate-containing food containing glucose.[1] Fifteen minutes after treatment, they should recheck the blood glucose, and if there is continued hypoglycemia, they should repeat the treatment. Once the blood glucose pattern is trending up, the patient should eat a meal or a snack, to prevent recurrence of hypoglycemia.[1] Insulin-treated patients need to monitor blood glucose more frequently (before meals and before bedtime) than patients on oral medications, and should be educated on the need to adjust insulin dosing according to meal composition.[1]
Patients need to receive advice regarding optimum nutrition and exercise counseling from a registered dietitian. All older children and adolescents should be advised not to smoke; note that this includes not using electronic cigarettes.[1] Smoking cessation counseling should be included as a routine component of diabetes care.
Patients also need to be educated on the monitoring for and treatment of other common complications (i.e., hypertension, dyslipidemia, increased urinary albumin excretion).
Transition to adult health care services is a critical period for young people with diabetes, and often comes at a time when they are becoming increasingly responsible for their own care. This is typically a period associated with reduced glycemic stability, and may be associated with worsening diabetes outcomes. It is therefore important that interprofessional adult and pediatric diabetes teams begin to prepare young people for transition to adult health care in early adolescence, and, at the latest, at least 1 year before the transition, including offering support and resources for transitioning young adults and their families.[1] Pediatric diabetes specialists should partner with youth with diabetes and their caregivers to decide on the timing of transfer to an adult diabetes specialist.
The Endocrine Society, in collaboration with the ADA and other organizations, has developed transition tools for clinicians and for adolescents and their families. Endocrine Society: Transitions of care: managing pediatric to adult transitions of care Opens in new window
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