Role of Health Educators in Assisting Youth and Adolescents with Diabetes

By Spiegel, Gail A.; Evert, Alison et al. | American Journal of Health Education, September-October 2009 | Go to article overview

Role of Health Educators in Assisting Youth and Adolescents with Diabetes


Spiegel, Gail A., Evert, Alison, Shea, Laura, American Journal of Health Education


ABSTRACT

Management of diabetes in children requires balancing nutrition, physical activity and medication on a daily basis in order to achieve blood glucose targets. The health educator can assist children and their families in meeting their diabetes management goals by better understanding the current recommendations and tasks involved to achieve them. Whereas children with type 1 diabetes require multiple injections of insulin per day or use of an insulin pump, children with type 2 diabetes may require an oral medication, insulin or both. Nutrition and physical activity recommendations are similar for children with diabetes as they are for all healthy children. Meal planning for children with diabetes usually involves a method of carbohydrate counting, since this is the main nutrient that raises blood glucose. Short term management outcomes for children with diabetes include the prevention of hypo- and hyperglycemia, while long term outcomes include the prevention of micro and macro-vascular complications.

INTRODUCTION

Children with diabetes need to balance food, medication and activity on a daily basis to keep their blood glucose in, or close to, a desired target range. This paper reviews current medication management, nutrition and physical activity recommendations for children with diabetes. Diabetes management outcome recommendations also are reviewed, along with ways that the health educator can assist children and their families to achieve their individualized nutrition, physical activity and diabetes management goals.

MEDICATION MANAGEMENT

All children with type 1 diabetes must take insulin for survival. Children with type 2 diabetes who require medication to control their blood glucose may take either an oral medication, insulin, or both. Today, new types of insulin and new delivery systems help to keep blood glucose levels in the desired range. These options, however, may require more frequent blood glucose monitoring and more assistance for the child with diabetes.

Insulin has three dimensions of importance to the successful management of diabetes: onset, the length of time before insulin reaches the bloodstream and begins lowering blood glucose levels; peak, the time at which insulin is at its maximum strength in terms of lowering blood glucose levels; and, duration, the number of hours that insulin continues to lower blood glucose levels.

Most children with type 1 diabetes require multiple injections, or they receive their insulin through a programmable insulin pump. For children using injections, there are several types of insulin that may be used in combination. The different types of insulin have been formulated to have immediate (rapid-acting or short-acting insulin), intermediate, or long (basal insulin) onset and duration of action. A coordinated combination of different types of insulin is used to allow for adequate treatment of diabetes at meals, snacks, during periods of physical activity and throughout the night. For children using an insulin pump (a computerized device), a small amount of rapid or short-acting insulin is programmed to infuse 24 hours per day (basal rate) and additional doses (boluses) of rapid or short-acting insulin are programmed before eating meals and snacks or when high blood glucose levels are attained. By being aware of how medications play an important role in managing diabetes and the challenges that a child faces everyday, the health educator can help to provide a supportive atmosphere for the child to handle this complicated disease.

DIABETES NUTRITION RECOMMENDATIONS

The American Diabetes Association (ADA) states that nutrition recommendations for children and adolescents with diabetes should focus on achieving blood glucose goals (without excessive hypoglycemia), lipid and blood pressure goals and normal growth and development. (1) Today, meal plans for children with diabetes are individualized to accommodate food preferences, cultural influences, physical activity patterns and family eating patterns and schedules. …

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