supporting the young adult with diabetes

Supporting the young adult with diabetes: Understanding the unique needs of this population and resources available to both students and providers.

PRESENTERS

• Christina Roth• CEO and Founder, College Diabetes Network

• Danielle Petrunich• CDN Student Leader at Bentley College

• Dr. Jake Kushner, MD. • Chief, Pediatric Diabetes and Endocrinology, McNair Medical

Institute Scholar, Baylor College of Medicine, Texas Children's Hospital

• President, Society for Pediatric Research• College Diabetes Network Board Member; Board Liaison to CDN

Clinical Advisory Committee

PURPOSE & LEARNING OBJECTIVES

Purpose: The purpose of this presentation is to provide insights into the unique needs of the young adult with diabetes, from both clinical and student perspectives, and to arm providers with resources available to better support this vulnerable population.

Learning Objectives:

1. Describe the unique needs associated with young adults living with diabetes on campus.

2. Explain considerations when interacting with young adults with diabetes in a clinical setting.

3. Identify resources available to both providers working with young adults with diabetes on campus, and to students themselves.

4. Describe effective ways in which to interact with and support young adults with diabetes.

THE CDN MODEL

Resources and information on how to navigate diabetes in college

Campus communities that connect you with other young adults with diabetes

Making your environment and supporters better prepared to support you

NetworkToolsEcosystem

Clinicians

Parents

Campus FacultyFriends

Campus Health YOUN

G ADULT

A DAY IN THE LIFE

TAKEAWAYS

• Diabetes is hard and a full-time job, and we are trying our best at it

• We struggle every day to find the right balance between attention to our diabetes and living a “normal” college life

• Individualized care

• We don’t need scolding or lecturing from you- that’s what our parents are for!

• The best thing you can do for us is give us empathy and support

• Peer mentoring—having a friend to talk to is huge!

THE CDN MODEL

Resources and information on how to navigate diabetes in college

Campus communities that connect you with other young adults with diabetes

Making your environment and supporters better prepared to support you

NetworkToolsEcosystem

Clinicians

Parents

Campus FacultyFriends

Campus Health YOUN

G ADULT

RED FLAGS: DIABETES IN THE CLINICAL ENVIRONMENT

A 19 year old student is brought in by friends on a Sunday morning with a “stomach bug”.

Was with his pledge class on a “road trip” and must have eaten “some bad food”.

Diabetes since age 7. Otherwise in good health.

Usual insulin regimen is a combination of long-acting (30 units of insulin glargine a.k.a. Lantus) and short acting insulin (10 units of insulin aspart a.k.a. Humalog).

Checks blood sugars before breakfast, lunch, dinner, and at bed. In “good control”.

Pulse is 170, with a respiratory rate of 55 breaths/minute and blood pressure of 150/60.

He looks thin, a bit somnolent, and smells of vomit and alcohol.

Physical exam: notable for deep, forceful breaths and a small bruised lump on his left abdomen.

Blood sugar is “high” and his urine reads “large” ketones.

Transferred via ambulance to the local emergency room.

Initial blood chemistries: Venus blood gas: ph 7.03. Blood glucose: 851. HbA1: 12%.

SCENARIO: DIABETIC KETOACIDOSIS

YOUNG ADULTS WITH DIABETES: AVERAGE HBA1C SIGNIFICANTLY HIGHER THAN ADA GUIDELINES & INCREASING (T1D EXCHANGE DATA, 2014)

<6 6-<13 13-<18 18-<26 26-<50 ≥507.0%

7.5%

8.0%

8.5%

9.0%

8.2%8.3%

8.7%

8.4%

7.7%7.6%

8.3%8.4%

9.0%

8.7%

7.7%7.6%

Enrollment CurrentAge (years)

Mean H

bA

1c

(%)

3-month Frequency of Severe Hypoglycemia* According to Age

<6 6-<13 13-<18 18-<26 26-<50 50-<65 ≥650%

10%

20%

30%

40%

50%

5% 6%8% 8%

11% 12% 13%

Age (years)

* Seizure or LOC: 1 or more events in 3m

Copyright of Unitio

xxx00.#####.ppt 04/13/2023 08:36:22 PMPediatrics Pediatrics

“People with diabetes should receive medical care from a team that may include physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes.”

“The management plan should be formulated as a collaborative therapeutic alliance among the patient and family, the physician, and other members of the health care team.”

Goal: Best possible outcomes in type 1 diabetes patients with highest quality and safety of care

leveraging patient-centered collaboration

Goal: Peer-to-peer support of type 1 diabetes patients


A 22 year old student is seen for an acute respiratory illness.

She is wearing multiple layers of clothing.

Diabetes since age 10 Otherwise in good health.

Usual insulin regimen is short acting insulin via a pump.

Checks blood sugars before breakfast, lunch, dinner, and at bed. In “good control”.

Pulse is 52, with a respiratory rate of 20breaths/minute and blood pressure of 90/50.

Physical exam: extremely thin with a BMI of 15 kg/m2.

Blood sugar is “312” and his urine “moderate” ketones.

At your urging she submits to lab testing.

HbA1: 14%.

SCENARIO: DISORDERED EATING


Goal: Inter-disciplinary research to optimize psychological and health outcomes in type 1 diabetes

Barbara Anderson, PhDMarisa Hilliard, PhD


A 18 year old student is seen for routine vaccination.

He has had diabetes since age 2. Otherwise in good health.


Checks blood sugars 6-8 times a day. Reports his diabetes is in OK control but he has lots of highs and lows.

Physical exam: unremarkable except for multiple bruises near pump insertion site on abdomen.

Blood glucose and insulin administration history via the insulin pump reveals large swings in blood glucose values (from 50 to 500) with large carbohydrate content in meals (up to 150 grams per meal).

HbA1c is 9.5%

SCENARIO: “BRITTLE DIABETES”“NON-COMPLIANT”“NON-ADHERENT”, “LAZY”, “BAD”


Goal: Inter-disciplinary care and research to optimize health outcomes in young adults with type 1 diabetes

Kelley Cerasuolo, NPSarah Lyons, MD


A 25 year old graduate student is seen for a pregnancy test.

Last menstrual period was “about 2 or 3 months ago”

She has had diabetes since age 12. Otherwise in good health.


Checks blood sugars 2-10 times a day. Reports her diabetes is in “OK” control.

Physical exam: unremarkable.

HbA1c is 10%

SCENARIO: “DIABETIC PREGNANCY”

xxx00.#####.ppt 04/13/2023 08:36:24 PMPediatrics

Bell et al, Diabetologia 2012

Peri-conception HbA1c strongly influences risk of congenital anomalies in infants of diabetic mothers


Goal: Prevent unplanned pregnancies in mothers with type 1 diabetes


Goal: Prevent unplanned pregnancies in mothers with type 1 diabetes

Jaden Schupp

RESOURCES FOR PROVIDERS OF YOUNG ADULT PATIENTS

1. Online resources1.CDN Website

1. New section for Campus Providers and Administrators 2. Hub of resources and information for college students with

diabetes (upcoming local events, scholarships, new expert FAQs, etc)

2.The Endocrine Society Directory of Endocrinologists

2. College Diabetes Network’s Interest DatabaseI. Semester Clinical Update (Being launched in August 2014!)II. Visit CDN’s Booth (#503) in the Exhibit Hall to sign up, or

email Christina ([email protected])

Chapters provide: A safety net of people to call A way to meet other students juggling school and

diabetes A place to share tips and get acquainted with local

resources A chance to take a leadership role An opportunity for community outreach Access to the latest diabetes technology Invitations to events on campus

CHAPTERSSupport networks on campus created and run by students

We provide chapters with:

Chapter Webpage

Chapter Email Address

Personal support from CDN’s Program Director

Student Advisory Committee (SAC)

Materials

o Chapter Toolkit – instructions on how to create and run a sustainable chapter

o Includes templates, instructions, documents, brochures, flyers, forms

CHAPTER RESOURCES

W W W . C O L L E G E D I A B E T E S N E T W O R K . O R G

Stay in Touch!

Christina [email protected]

Dr. Jake [email protected]

Dani Petrunich [email protected]

supporting the young adult with diabetes

Health & Medicine