A Focus on Diabetes Technology for Families (Continued)
Setting Reasonable Expectations
Ms. Bellini and Dr. Weissberg-Benchell explained that it's crucial to work together, and it can begin with setting reasonable expectations for blood glucose control. Teenagers are in a developmental stage with many physiological changes that affect their insulin sensitivity, and so their blood glucose levels can be in constant flux. The speakers advised setting fair expectations, such as checking blood sugars before eating, taking an insulin bolus when they eat (bolusing before meals is even better), and always, always having something on them that can treat hypoglycemia. A key expectation missing from this list is a target blood glucose number; both speakers emphasized that parents should focus on behaviors and not numbers because numbers are rarely stable for teens.
Teens and Continuous Glucose Monitors
These changing blood glucose numbers make it difficult for teens to wear CGMs, but the CGM's trends and the information about the rate of change (shown by the arrows) can be very helpful. If teens respond to these trends by counteracting with the appropriate measures (e.g., taking insulin or eating something with carbs), they can prevent very high or low blood sugars. This approach, instead of constantly examining the CGM for fluctuations, might help teens see the tool in a more positive light and perhaps wear it longer too.
Delivery is Key
Finally, parents can be supportive when they respond to their teen's diabetes care. They can praise their teen every time he or she does a blood glucose check to encourage the practice because every check is information that can be used well. And as difficult as it is to see an extremely high or low blood glucose level, parents can try to be measured in their response. Their child knows what good blood sugars are and what levels they want to avoid; it does not help to further frustrate the teen by expressing anger or disappointment immediately. Deal with the moment practically, and return to it later once everyone has calmed down and can think clearly. When parents work with teens as a team, it makes problem solving that much easier.
Teen Session on Counting Carbohydrates and Fats
In one session with Ms. Bellini, teens were asked to estimate the grams of carbohydrates and fats in pizza, nachos, potato skins, breaded chicken, burritos, and the like; all foods that are widely available. Many of the astute participants, both teens with type 1 diabetes and their siblings, were highly skilled at calculating these quantities, but no one was right every time. When the teens were done estimating, it was time to reveal the carbohydrate and fat content of each plate.
Ms. Bellini had a hands-on approach to counting: she pulled apart each meal and scooped out each third cup of rice or potatoes, asking the teens to count each 15g of carbohydrates with her. She emphasized that no one is able to avoid these foods all the time, especially when they are eating out, and that no one can count correctly every time. It's unhelpful to dwell too long on any glycemic excursion, and it's better to consider it a lesson on how to adjust for next time. However, it is important to try to count the carbohydrates, bolus before meals, and make corrections if needed. Many of the teens appreciated this lesson.
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NOTE: This information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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