Increasing insulin requirements during puberty Maintaining parental involvement in insulin and blood glucose management tasks while allowing for independent self-care for special occasionsĬonsolidating self-esteem with respect to the peer groupĬhild learning short- and long-term benefits of optimal controlĬontinuing to educate school and other caregivers Making diabetes regimen flexible to allow for participation in school or peer activities Trusting other caregivers with diabetes managementĭeveloping skills in athletic, cognitive, artistic, and social areas Positively reinforcing cooperation with regimen Reassuring child that diabetes is no one’s faultĬoping with unpredictable appetite and activityĮducating other caregivers about diabetes management Preschooler and early elementary school (3–7 years)ĭeveloping initiative in activities and confidence in self Limit-setting and coping with toddler’s lack of cooperation with regimen Sharing the burden of care to avoid parent burnoutĭeveloping a sense of mastery and autonomyĪvoiding extreme fluctuations in blood glucose levels due to irregular food intake Pancreatic Autoantibodiesįamily issues in type 1 diabetes managementĭeveloping a trusting relationship or bond with primary caregiver(s)Īvoiding extreme fluctuations in blood glucose levels
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If hyperglycemia persists after treatment with noninsulin agents, which is unusual in the treatment of newly diagnosed type 2 diabetes, then type 1 diabetes should be considered. Thus, although leaner individuals are more likely to be diagnosed as having type 1 diabetes, the potential for type 1 diabetes exists in those who phenotypically appear to have type 2 diabetes.
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In young patients aged 10–17 years with phenotypic type 2 diabetes, 10% have evidence of islet autoimmunity suggesting that type 1 diabetes was the likely diagnosis ( 9).
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Obesity does not preclude that autoimmunity and hyperglycemia will occur even amid the relatively higher levels of endogenous insulin secretion observed in obesity. An overweight individual (of any age) with metabolic syndrome and a strong family history of type 2 diabetes may be assessed only for the development of type 2 diabetes, even though type 1 diabetes is on the differential diagnosis. A lean individual presenting with clinical symptoms without a first-degree relative with diabetes (but often with a history of distant relatives with type 1 diabetes or other autoimmune disease) is generally suggestive of type 1 diabetes. Much of the diagnosis will depend on clinical clues, but the rising incidence of overweight/obesity has also confounded the diagnosis of type 1 diabetes.