Diabetes Management for the Pediatric and Adolescent Populations

#1 - Type 1 and Type 2 Diabetes in Youth

I. Type 1 diabetes

A. Definition
B. Causes of beta cell destruction
C. Symptoms
D. Prevalence
E. Screening
F. Diagnostic criteria
G. Treatment

II. Type 2 diabetes in youth

A. Definition
B. Potential causes
C. Characteristics
D. Prevalence
E. Screening
F. Diagnosis
G. Treatment

III. Maturity Onset Diabetes of the Young (MODY)

A. Definition
B. Causes
C. Symptoms
D. Prevalence
E. Screening
F. Diagnosis
G. Treatment

Behavioral/Learning Objectives:

1. Describe 3 characteristics of type 2 diabetes in youth.
2. Discuss 2 difficulties of identifying youth with type 2 diabetes.
3. Describe 2 treatment options for preventing and treating type 2 diabetes in youth.

#2 - Acute and Chronic Complications

I. Signs and symptoms of hypoglycemia

II. Treatment of hypoglycemia

III. Prevention

IV. Case Example

A. Chronic Complications

1. Retinopathy
2. Nephropathy
3. Neuropathy
4. Cardiovascular

B. Define ketoacidosis
C. Testing ketones

1. blood sugar levels
2. illness

V. Treatment/prevention

Behavioral/Learning Objectives:

1. State the appropriate hypoglycemia treatment protocol.
2. Identify when an eye exam should be done for a child with type 1 diabetes.
3. State two situations for which it would be appropriate to test ketones.

#3 - Meal Planning for youth with Diabetes

I. Medical Nutrition Therapy Goals for Type 1 Diabetes:

A. Type 1: Match insulin therapy to diet and activity pattern
B .If using rapid-acting insulin by injection or an insulin pump, adjust meal and snack insulin doses based on the carbohydrate content of the meals and snacks.
C. If using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount.
D. For planned exercise, insulin doses can be adjusted. For unplanned exercise, extra carbohydrate may be needed.

II Medical Nutrition Therapy goals for type 2 diabetes

A. Implement lifestyle changes to reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure.
B. BG monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication(s) needs to be combined with MNT

III. Carbohydrate (Carb) Counting

A. Definition B. Role of carb, protein and fat on blood glucose
C. Carbohydrate: types and serving sizes
D. Determining carbs per meal and snack
E. Factors that influence glycemic response
F. Demonstration of carb counting

IV. Advanced Carb Counting

A. Definition of a carb to insulin ratio

1. 500 rule for calculating carb to insulin ratios

B. Determining accuracy of carb to insulin ratios

1. Pre/post meal blood glucose testing

Behavioral/Learning Objectives:

1. Differentiate Medical Nutrition Therapy (MNT) goals for type 1 and type 2 diabetes.
2. Define carbohydrate (carb) counting.
3. Calculate a carb to insulin ratio.

#4 - Pattern Management

I. Insulin

A. Long acting
B. Fast acting
C. Calculating initiation doses

II. Insulin/carb ratios

A. Calculations
B. Evaluations and adjusting ratio's

III. Insulin Sensitivity

A. Calculations
B. Evaluations and adjusting insulin

IV. Insulin sensitivity

A. Calculations
B. Evaluations
C. Making adjustments

Behavioral/Learning Objectives:

1. Identify the role of basal insulin for type 1 diabetes.
2. Define how to calculate an insulin/carb ratio for dosing meal insulin.
3. State two uses of continuous glucose monitoring.

#5 - New Diabetes Technologies for Youth

I. New diabetes technologies/research

A. BG Monitoring
B. Ketone testing

II. New diabetes technologies/research

A. Insulin delivery
B. Insulin pumps

Behavioral/Learning Objectives:

1. Describe two new technologies currently investigated to control diabetes.
2. Describe two new technologies for managing diabetes.

#6 - Adolescents: Sports, Physical Activity and Psychosocial Issues

I. Sports and physical activity

A. benefits
B. risks

II. Planning

A. Blood glucose patterns

1. insulin adjustments
2. food adjustments

III. Teens

A. Psychological issues
B. Family involvement
C. Goal setting

Behavioral/Learning Objectives:

1. State two benefits of physical activity for youth with diabetes.
2. Identify two ways to prevent hypoglycemia after exercising.
3. List two ways to engage teens in their diabetes care.

Accreditation Information

Nurses – Academy Medical Systems is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

Academy Medical Systems (AMS) is also a provider approved by the California Board of Registered Nursing, provider #CEP14413.

AMS is also a provider approved by the Florida Board of Nursing, provider #50-19.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Certified Diabetes Educators – Academy Medical Systems' approved Provider Status with the ANCC (nurses) and the CDR (dietitians) is recognized by the National Certification Board of Diabetes Educators (NCBDE).

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.  This course is an intermediate education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs and PTAs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, AL, AZ, CA, CO, CT, GA (Class 1), HI, IA, ID, IN, KS (Cat 2), KY,  MA, ME, MI, MN (Cat 2), MO, MS, MT, NE, NM, ND, OK (Cat 2), OR, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WI, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10.  The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, OK (Cat 2), WI.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.  See The Federation of State Boards of Physical Therapy website for more information.

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