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Response AH

Peer Response

Instructions:

Please respond to at least 2 of your peer’s posts. 

· Does your plan align with your peers’ plan of care?

· Share your thoughts if your plan of care differed from one of your peers and provide a rationale for why your plan differed from your peer.

· Share your thoughts in support of a peers’ plan that aligned with your plan of care. Provide support for those plan elements that were aligned with your peer.

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Reply from Emily Byrd

Treatment Plan: 16-year-old female-newly diagnosed type 2 diabetic 

Diagnostics: Confirm diagnosis with blood tests such as A1C and fasting blood glucose. Evaluate for related conditions like obesity, dyslipidemia, and hypertension. Check for signs of significant hyperglycemia, such as a random plasma glucose level or the presence of ketoacidosis (ElSayed et al., 2022).

Therapeutics: A family-centered approach is crucial, incorporating a healthy diet plan, a focus on increased physical activity, and a plan for blood sugar monitoring and regular follow-up with a healthcare team (ElSayed et al., 2022).

Pharmacological:  Metformin will be started as the first-line medication in conjunction with lifestyle changes

Non-pharmacological: Work with a dietitian to create an individualized meal plan that focuses on carbohydrate monitoring. Develop a structured exercise plan, which is crucial for managing Type 2 diabetes (Stephenson, 2021).

Education: An education plan for this patient should be comprehensive, covering self-management, healthy lifestyle habits, and school accommodations, with a focus on age-appropriateness. Key components include understanding her specific medical management plan, healthy eating principles, physical activity, and how to handle low and high blood sugar episodes by teaching her how to check her blood glucose levels and what the numbers mean. In addition to educating the patient, it is very important to educate her family on how to recognize the signs of both low and high blood sugar and how to treat each condition (ElSayed et al., 2023).

Consultation: Involve a team that may include an endocrinologist, registered dietitian, certified diabetes educator, and mental health professional (Salvia et al., 2022). The patient may consider attending diabetes camps or programs where they can meet other teens with diabetes and learn in a fun environment. 

References:

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R. A. (2022). 14. children and adolescents: Standards of care in diabetes—2023. Diabetes Care, 46(Supplement_1), S230–S253. 

to an external site.

Salvia, M. G., Ritholz, M. D., Craigen, K. L. E., & Quatromoni, P. A. (2022). Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients’ perceptions and lived experiences. Journal of Eating Disorders, 10(1). 

to an external site.

Stephenson, K. (2021). The Yale Children’s Diabetes Program. Contemporary Endocrinology, 217–261. 

to an external site.

 

 

Reply from Whitney Reeves

Discussion 7: Diabetes Treatment

Diagnosis: Type 2 Diabetes Mellitus (new onset, adolescent, BMI 37) 

·
Diagnostics Order: 

HbA1c, fasting plasma glucose, fasting insulin + C-peptide; lipid panel; liver enzymes (AST, ALT); renal panel + urine microalbumin/creatinine; TSH/free T4; baseline ECG; ophthalmology referral for fundoscopic exam; consider continuous glucose monitoring (CGM) during sports. 

·
Therapeutic: 
Begin metformin immediate-release 500 mg PO once daily with dinner, increasing by 500 mg weekly as tolerated toward ~1,500–2,000 mg/day divided (Alfaraidi & Samaan, 2023). If HbA1c ≥ 9% or hyperglycemic symptoms, initiate basal insulin (e.g. glargine ~0.25 U/kg nightly) and plan to taper as control is achieved.

·
Education / Self-Management / Behavioral: 
Teach SMBG (fasting, postprandial, pre/post-exercise), carb counting, hypoglycemia management; refer dietitian for modest calorie reduction and dietary guidance; prescribe combined exercise (aerobic + resistance + HIIT) aiming for ~900–1,200 MET-minutes/week, as the network meta-analysis showed such doses reduce fasting insulin and HOMA-IR (García-Hermoso et al., 2023); support adherence with motivational interviewing and family involvement. 

·
Consultation / Collaboration: 
Refer to pediatric endocrinologist, arrange diabetes educator, dietitian, athletic trainer / exercise physiologist, and mental health support as needed. 

·
Preventive / Health Promotion: 
Ensure immunizations, monitor/manage hypertension, dyslipidemia, NAFLD, sleep apnea; annual screening for diabetic complications; counsel on sleep, stress, tobacco/alcohol avoidance; coordinate safety plan with school/sports. 

·
Follow-Up: 
Return in 1 month, then quarterly. Review labs (A1c, lipids, renal), SMBG logs; adjust therapy; monitor for side effects or barriers; escalate therapy if goals unmet. 

Evidence Strength Commentary 

· The review by Alfaraidi and Samaan (2023) summarizes modern pediatric evidence for metformin, including mechanisms, efficacy, and safety in adolescents with type 2 diabetes. Its strength is in recency and breadth but, being a narrative review, it is lower-level evidence than randomized trials. 

· The systematic review by García-Hermoso et al. (2023) demonstrates that exercise interventions reduce fasting insulin and HOMA-IR, with optimal effect at ~900–1,200 MET-minutes/week. The methodology is strong; evidence certainty is rated moderate. 

References:

Alfaraidi, H., & Samaan, M. C. (2023). Metformin therapy in pediatric type 2 diabetes mellitus and its comorbidities: A review. Frontiers in Endocrinology, 13. 

to an external site.
 

García-Hermoso, A., López-Gil, J. F., Izquierdo, M., Ramírez-Vélez, R., & Ezzatvar, Y. (2023). Exercise and insulin resistance markers in children and adolescents with excess weight. JAMA Pediatrics, 177(12), 1276. 

to an external site.
  

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