Type 2 Diabetes Management for Youth and Families

Understanding the Disease

Diabetes is a condition where the body cannot effectively convert food into energy. In Type 2 diabetes, the pancreas may not produce enough insulin or the body’s cells may not use insulin properly, leading to high blood glucose levels. People at risk for Type 2 diabetes often have a higher body weight, are less active, or have a family history of the disease. Specialized terms include Acanthosis Nigricans (AN), which refers to dark skin patches that can signal insulin resistance. Managing blood sugar is critical, as chronic high levels can damage the heart, kidneys, and eyes.

Managing Diabetes with STAR

The STAR framework is used to help patients make better health decisions across daily activities. The steps involve: STOP before making a decision, THINK about how choices affect the diabetes care plan, ACT on the healthier choice for long-term health, and REFLECT on progress while giving credit for positive steps. This method applies to nutrition, exercise, and lifestyle choices such as navigating social pressure during teenage years.

Blood Sugar Monitoring and Health Targets

Checking blood sugar involves a blood glucose meter, lancets, and test strips. Monitoring results should be kept in a logbook. A key indicator of long-term health is the Hemoglobin A1C test, which measures average blood sugar levels over a period of $3$ to $4$ months. Most youth with Type 2 diabetes should aim for an A1C of $7\%$ or less. For example, an A1C of $7.0\%$ corresponds to an average blood sugar of $154\,mg/dl$, while an A1C of $10.0\%$ reflects $240\,mg/dl$.

Medication and Treatment

Management plans may include oral pills, which help the body use its own insulin better or produce more, or insulin shots (injections). Injections replace the insulin the pancreas can no longer make. Care plans are individualized, and it is essential to never stop taking medications without consulting the diabetes care team. Common side effects to report include dizziness, headaches, or blurred vision.

Hypoglycemia and Hyperglycemia

Hypoglycemia (low blood sugar) occurs when there is too much insulin for the amount of sugar in the blood. It is treated with the $15-15$ Rule: consume $15\,g$ of fast-acting carbohydrates (such as $4\,ounces$ of juice) and wait $15$ minutes to recheck. Hyperglycemia (high blood sugar) results from insufficient insulin or excess food. It should be treated by drinking sugar-free liquids to avoid dehydration and contacting a care team if vomiting or fever occurs.

Nutrition and Physical Activity

Healthy eating focuses on portion control and choosing healthy carbohydrates with high fiber. The plate method suggests filling $\frac{1}{2}$ of a $9$-inch plate with non-starchy vegetables, $\frac{1}{4}$ with protein, and $\frac{1}{4}$ with grains or starchy vegetables. Youth are encouraged to avoid sugary drinks and limit fats. Physical activity should include aerobic exercise for $1$ hour daily and strength training $3$ to $4$ times per week.

Adolescent Lifestyle and Challenges

Teens with diabetes face unique challenges, including hormone changes during puberty and the menstrual cycle that can affect blood glucose levels. Lifestyle precautions include avoiding tobacco, drugs, and alcohol, as these substances interfere with diabetes management and narrow blood vessels. The TODAY study (Treatment Options for type 2 Diabetes in Adolescents and Youth) provided the foundation for these educational materials to help families manage the disease through different life stages.

Questions and Discussion

The materials utilize case studies to prompt discussion on social and health choices. In the case of Tony, he felt discouraged by high readings and considered skipping a clinic visit or falsifying logs. The recommended response is honesty with the care team to adjust the treatment plan. In the case of Mikah, she faced a situation involving alcohol while with friends. Using the STAR method, Mikah is encouraged to identify the illegal nature of underage drinking, its high calorie count, and the risk of severe blood sugar fluctuations before deciding to refuse the drink.