Hba1c levels measure long term blood glucose concentration and is not affected by acute changes in blood glucose.
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Treating a newly diagnosed Type 2 Diabetic can be overwhelming for patients and family members. Having a teenager need to manage their own health along with the assistance from providers and parents can be even more overwhelming. Obtaining subjective data about diet and exercise pattern outside of soccer can create awareness to lifestyle habits to be adjusted for improvement in health status. Objective data includes early detection tests, weight, BMI, and vital signs. Early detection of diabetes can be done through plasma glucose, HbA1c level, or oral glucose tolerance test. HbA1c levels measure long term blood glucose concentration and is not affected by acute changes in blood glucose. Oral glucose test is normally done while fasting and is taken in the morning due to fasting over night. Blood glucose concentration is then taken 2 hours after ingestion to see if glucose levels are within normal range. Proper management of care through lifestyle changes can decrease progression of diabetes. Lifestyle changes include goals to lose weight, increase physical activity, and improvement in diet. The patient can continue her physical activity as her high school goalie and if she is able to further increase her activity, then maybe she can also play other positions on the team to improve her weight loss. According to the Center of Disease Control, a BMI 30 or higher is considered obese, therefore we can focus part of the plan of care to decrease her BMI to below 25 which is a healthy weight range (Centers for Disease Control and Prevention, 2022). Nutritional adjustments have been shown to improve A1C, achieve and maintain weight loss goals, prevent complication of diabetes. All of this can be achieved by addressing nutritional needs based on person and cultural preferences, health literacy, access to health food choices, willingness and ability to change, and continue to make food options tasteful and enjoyable. Educating the patient and family about the diabetes plate method can help with the transition which include the largest portion of the plate (1/2) should be non starchy vegetables, then 1/4th of the plate be a protein, and another 1/4 of the plate be a carb. This does not require counting, calculating, measuring, or weighing any portion of the meal (American Diabetes Association, 2022). Therefore, parent and teen can use this method while at school, home, or restaurant. Collaboration with a nutritionist, diabetic educators, and endocrinologist can further assist patient and family to manage health to achieve goals met by patient and provider (Szafran, et al., 2019). The nutritionist can help guide and assist family to create meals that better suit the patients new lifestyle. Diabetic educators can assist and inform patient and family on diabetic related concerns when they are unable to reach the primary care provider. The endocrinologist can further assist patient with diabetic management due to teenage hormones being able to influence glucose and therefore diabetic management.
