Background
Adolescents with Type 1 Diabetes (T1D) in the inpatient setting struggle with dietary compliance. Understanding factors underlying dietary compliance can improve diabetes management.
Client History
SP is a 16-year-old female with T1D and a history of recurrent DKA admissions. A dietitian referral was dispatched, upon latest admission, to establish insulin regimen.
Assessment
SP was overweight (>85th percentile, BMI-for-Age) with unexplained weight loss (3 kg over 2 months). She had metabolic acidosis, which resolved. Blood glucose levels were persistently elevated (Fasting: 17.2 - 22.3mmol/L; Post-prandial: 10.0 - 15.3mmol/L) despite prescription of a 1800kcal/day meal plan (carbohydrate contributing to 50% energy; carbohydrate distribution: 3#/2#/3#/2#/3#/2#) and a basal-bolus insulin regimen (Basal 30 units ON, Rapid-acting 18 units TDS). Dietary assessment showed that SP’s intake was between 1300 - 2600 kcal/day with inconsistent carbohydrate consumption due to unplanned snacking. Further assessment indicated that SP had situational (loneliness) and behavioral (impulsive eating) factors that drove her lack of value for behavior change.
Nutrition Diagnosis
Limited adherence to nutrition-related recommendations related to lack of value for behavior change as evidenced by food records of inconsistent carbohydrate intake from unplanned carbohydrate-dense snacks.
Objective(s) of Management & Nutrient Prescription
The aim is to improve dietary adherence in order to establish insulin regimen and achieve optimal glycaemic control. Nutrition education on carbohydrate portions for main meals and snacks was reinforced in addition to counselling to promote self-monitoring via the use of daily food records.
Outcome & Follow-up
Despite repeated reinforcement on carbohydrate portions and self-monitoring of dietary intake, adherence was poor till discharge.
Discussion / Learning Points / Take-Home Messages
• In retrospect, identification of possible influences that may affect dietary adherence in regulated conditions is important in planning dietary approaches.
• The impact of physical environments and behaviour on dietary strategies should be evaluated and monitored to ensure improved outcomes in diabetes care of adolescents.
