# A 12-year-old child with newly diagnosed type 1 diabetes mellitus is being prepared for discharge. The child's parents express concern about preventing long-term complications. What is the most appropriate initial nursing intervention to address this concern?

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> subject: Child Health

## 문제

A 12-year-old child with newly diagnosed type 1 diabetes mellitus is being prepared for discharge. The child's parents express concern about preventing long-term complications. What is the most appropriate initial nursing intervention to address this concern?

## 보기

1. Teach the parents to recognize early signs of hypoglycemia and demonstrate proper administration of glucagon injection **✔ 정답**
2. Provide written instructions about when to contact the healthcare provider for blood glucose reading
3. Explain the importance of maintaining strict dietary restrictions to prevent hypoglycemic episodes
4. Schedule frequent follow-up appointments to monitor the child's blood glucose control

**정답: 1**

## 해설

Teaching parents to recognize early hypoglycemia signs and glucagon administration is the priority safety intervention for newly diagnosed pediatric diabetes, addressing immediate emergency concerns. Other options are important but secondary for initial intervention.

## 심화 해설

Understanding the Core Concern

When a child is newly diagnosed with type 1 diabetes mellitus (T1DM), parents often focus on the distant future, worrying about complications like retinopathy or nephropathy. However, the immediate, life-threatening risk in the first days and weeks at home is hypoglycemia. The transition from a monitored hospital setting to home management is a high-risk period. Research indicates that hypoglycemia is a significant and prevalent issue in newly diagnosed children. A study on hospitalized children with new-onset T1DM found a notable incidence of hypoglycemic events, with some experiencing severe episodes (blood glucose

## 임상 시나리오

Clinical Practice Guide: Discharge Teaching for New-Onset Pediatric T1DM

Priority: Hypoglycemia Safety

The immediate post-discharge period carries the highest risk for severe hypoglycemia. The family's ability to recognize and treat low blood glucose is the single most critical survival skill. "Sick day rules" and long-term complication prevention are secondary to this acute safety need.

Essential Discharge Competencies

- **Hypoglycemia Recognition:** Teach physical signs (shakiness, sweating, pallor) and neuroglycopenic symptoms (confusion, lethargy) specific to their child.

- **Glucagon Administration:** Require a return demonstration of the glucagon injection kit. Ensure at least two family members are trained.

- **Rule of 15:** For conscious hypoglycemia, instruct on giving 15 grams of fast-acting carbohydrate, rechecking blood glucose in 15 minutes, and repeating if necessary.

Structuring the Teaching Session

Begin with survival skills (hypoglycemia management, insulin administration) before progressing to advanced topics like carbohydrate counting or exercise adjustments. Provide a clear, written emergency action plan with specific blood glucose thresholds for giving glucagon and calling emergency services.

## 핵심 개념

- **Hypoglycemia** — An acute complication of diabetes management characterized by abnormally low blood glucose, which can lead to seizures, loss of consciousness, and death if not treated promptly.
- **Glucagon** — A hormone administered via injection to rapidly raise blood glucose levels in a person with severe hypoglycemia who is unconscious or unable to swallow safely.
- **Type 1 Diabetes Mellitus** — A chronic autoimmune condition where the pancreas produces little to no insulin, requiring lifelong exogenous insulin therapy for survival.

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