Type 1 diabetes needs lifelong self-care such as preset glucose control to prevent complications and optimize wellbeing. Relationships among metabolic control, coping, adjustment, and psychosocial stress influence an individual’s self-care ability, and as a result, affect clinical outcomes. Health and illness transitions include life transitions. Many strategies are employed to manage diabetes during transitions. For women with type I diabetes, transition to motherhood can be stressful because managing levels of blood glucose can be intense and challenging.
- Contraception must be sustained until optimal glycemic control is attained. Choice of contraception technique must be with discussed with health providers. Estrogen and progesterone pills should be avoided at al cost if there are vascular complications.
- Educate women with childbearing age the need for tight glucose control prior to pregnancy and encourage them to take part in effective family planning.
- Women with T1D Women who are considering pregnancy should be assessed and, if found, treated for diabetic neuropathy, retinopathy, nephropathy, cardiac diseases, hypertension, thyroid disease, and dyslipidemia (Kitzmiller, et al., 2008). Right from preconception care, a comprehensive medical assessment should be carried out to review patient’s history of physical activity, psychosocial problems, and eating patterns (Kitzmiller, et al., 2008). Besides apt obstetrical examination, clinicians should perform physical examination such as determination of blood pressure, thyroid palpation, and orthostatic heart rate.
- Physical examination should be conducted to determine blood pressure, thyroid palpation, and orthostatic heart rate.
- Use of medication use must be evaluated prior to conception, given that drugs typically used to diabetes complications can be contraindicated.
- Regular visit follow-up visits are necessary for adjustment in the regimen plan associated with stage of pregnancy, blood pressure and glycemic control, individual patient needs, and weight gain.
- Educate expectant mothers with T1D regarding the lifelong benefits of cardiovascular disease reduction, effective contraception with tight glycemic control prior to the next pregnancy. Pregnancy deeply affects diabetes management because growth factors, placental hormones and cytokines can wreak a progressive elevation in insulin resistance calling for intensive regulated insulin administration and medical nutrition therapy.
Lack of Family Structure and Financial Resources
- Health providers must conduct psychosocial screening that includes attitudes regarding diabetes, resources (social, emotional and financial), expectations for clinical management and outcomes, psychiatric history, and diabetes related quality of life (Kitzmiller, Block, Brown, et al., 2008).
- Emphasize the significance of complying with the prescribed treatment regime. Also health providers should engage family members and discuss with them about the weightiness of the patient’s status.
- Asses the financial status of the patient and discuss future financial cost of treatment. Patients with financial problems need assistance to get access to generic drugs or pharmaceutical companies concerning programs that give prescriptions at lower prices. Such patients can save some money by utilizing generic testing supplies.
- Provide access to appropriate services and relevant, accurate information. Clinicians should pay attention to the attributes of childbearing women with T1D When seeking clarifications for changing blood glucose levels, choosing actions, and evaluating their decision and act appropriately
Suspected Medical Failure
Noncompliant with T1D treatment is caused by existing gap in the disease management in adolescents. Due to lack of knowledge about diabetes, many adolescents do not understand the disease process, related complications. Other challenges stem from the inability to manage T1D independently and health insurance status.
- Discuss and educate young people on the disease process and its complications
- Emphasize the importance of refilling medications regularly and complying with the therapy
- Choices of medical prescription should be made available to enable adolescents make informed decisions about medications that fit their lifestyles. Choosing suitable regimen is desirable because some therapies are known to disrupt the personal and social life
- Adolescents should be advised about the importance of scheduling appointments independently
- Clinicians should reinforce written prescriptions with verbally cues
- Prescription instruction should be a brief word with clear illustrations. Healthcare providers must take additional time to review prescription material, involve family member or friends to reinforce the medical prescription.
Kitzmiller, J. L. Block, J. M., Brown, F. M., et al. (2008). Managing Preexisting Diabetes for Pregnancy: Summary of evidence and consensus recommendations for care. Diabetes Care, 31 (5): 1060-1079