Diabetes and Puberty – How Nurses Can Help Teens and Their Parents Manage Blood Glucose

Trenton Jantzi replaces his insulin pump infusion site during a break at school. The high-school senior must change his infusion site every three days. Photo by Mark Ylen / Democrat-Herald. Trenton Jantzi replaces his insulin pump infusion site during a break at school. The high-school senior must change his infusion site every three days. Photo by Mark Ylen / Democrat-Herald.

A new article in AJN gives crucial information on the challenges to managing diabetes, both type 1 and type 2, that are faced by teenagers and their parents during the physical and psychosocial changes of puberty.

Any nurse can tell you that it’s not easy to manage diabetes. I got type 1 diabetes when I was 27 years old and it took me more than ten years to really understand how to balance the effects of diet, exercise, insulin intake, and other factors like illness or stress.

There’s a lot at stake, too, in terms of long-term complications linked to poor blood glucose control, including blindness, heart disease, neuropathy, and a host of other unpleasant complications. In addition, there are serious potential short-term risks of diabetes like hypoglycemia or hyperglycemia that can land you in a coma or […]

AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one […]

Youth with T1 Diabetes Not Meeting A1c Targets: What Can Nurses Do?

By Jeniece Trast, MA, RN, CDE, clinical research nurse manager, certified diabetes educator, Children’s Hospital at Montefiore, Montefiore Medical Center, Bronx, NY

bloodglucosetestingDiabetes Care recently published an article showing that our youth with type 1 diabetes, especially those in adolescence, are not meeting glycosylated hemoglobin (HbA1c) clinical guidelines. The HbA1c is a blood test done every two to three months that shows how well controlled the glucose levels were over that time period. As much as this news is disappointing, I am not shocked by it. Type 1 diabetes is a challenging disease to live with at any age; however, the adolescent years definitely intensify the challenge.

As a nurse and certified diabetes educator (CDE), I take on many roles when caring for a teenager with type 1 diabetes: educator, team member, moderator, blood glucose assessor, advocate, cheerleader, and even role model (yes, I have type 1 diabetes also).

Challenges and responsibilities. When caring for these patients, keep in mind that type 1 diabetes is a difficult disease to live with on a day-to-day basis. People with type 1 have lots of important responsibilities just to stay alive: multiple insulin administrations each day; constant blood glucose checking; understanding the effects of exercise on glucose level both during and after exercise; balancing exercise, stress, food, and […]

Forward or Back? Some Personal Notes on Why the Affordable Care Act Matters

By Jacob Molyneux, senior editor/blog editor

So today the U.S. Supreme Court did something a little surprising in upholding the individual mandate provision in the Affordable Care Act (here’s the text of the full decision). It was the right thing to do, given judicial precedent, but it still comes as a surprise that Chief Justice Roberts was the swing vote rather than Kennedy, or that they actually did this. Justice Roberts must have looked to his conscience and seen how history would judge him. Or it’s nice to think so.

This is good for many reasons: those under 26 on their parents’ plans can now stay there. A bunch of money earmarked for nurse education will not suddenly disappear. Health care exchanges holding insurance companies to minimum standards will be implemented. Accountable care organizations can continue to experiment in an effort to replace the disastrously expensive fee-for-service model with one tied more closely to outcomes. And a great deal more.

But now we should ask ourselves: Do we go forward or back? This is the real question when it comes to the American health care system. Going back isn’t an option, though many are sure to go on pretending it is (the Republicans will make repealing the Affordable Care Act a centerpiece […]

What Nurses Need to Know About Continuous Glucose Monitoring

Case 1. A 27-year-old man has had type 1 diabetes for 19 years. His hemoglobin AIc level prior to starting RT-CGM [real-time continuous glucose monitoring] was 9.4%. . . . Over the 15 months of RT-CGM use, he was able to decrease his hemoglobin AIc level to 7.7% and maintain it at that level for several months. After he stopped using RT-CGM because his insurance didn’t cover sensors, his hemoglobin AIc level rose to 8.5%. When he got a new job and was able to resume use of RT-CGM, after three months his hemoglobin AIc level had once again decreased, this time to 7.9%.

Case 2. A 10-year-old girl has had type 1 diabetes for almost three years. Her hemoglobin AIc level before starting RT-CGM was 9.8%. By five months after starting RT-CGM her hemoglobin AIc level had decreased to 7.2%. After discontinuing sensor use because of the high cost of RT-CGM supplies and a lack of insurance coverage, her hemoglobin AIc level rose to 8.2%.

The above are composite cases of patients with type 1 diabetes who used real-time continuous glucose monitoring devices as a tool to improve their blood sugar control. They’re from an article in the April issue of AJN that gives a balanced overview of this technology, including how it works, its current uses (as a diagnostic tool, a warning system for hypo- and hyperglycemia, and a way to improve long-term glycemic control), its coverage and costs—and its advantages and disadvantages, […]

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