Manuel is a 12-year-old boy who was sent to his school office because of lethargy, extreme confusion, and blurred vision. His teacher believed that he was intoxicated and recommended disciplinary action. Manuel lost consciousness when he arrived in the principal’s office and was sent to the emergency department. An evaluation indicated that Manuel was in the 98th percentile for body mass index (BMI; for age and sex) and that both his blood glucose level and his glycated hemoglobin level (HbA1c; a longer-term measure of glycemic control) were elevated. He was referred to the endocrinology department for further evaluation and was subsequently diagnosed with type 2 diabetes mellitus. His endocrinologist recommended monitoring of blood sugar levels twice daily, decreasing his weight, increasing his physical activity, and altering his diet to manage his blood glucose level.

 

After 6 months on this regimen, Manuel’s weight has remained virtually unchanged, and his blood glucose and HbA1c levels are still higher than expected. Manuel and his mother report that they are having difficulty managing his diet and his physical activity. Manuel’s mother works in the afternoons, leaving Manuel and his younger brother by themselves for much of the time after school. Manuel’s mother reports that his inability to manage his diabetes has put a strain on their relationship. Because of her work schedule, she needs Manuel to take more responsibility for his medical management than he is currently taking.

 

Manuel reports being embarrassed to monitor his blood sugar levels during school, as well as having some confusion about what his blood sugar levels mean. He also reports challenges with regard to his social functioning; specifically, Manuel explained that he is frequently teased because of his weight by his peers and coaches and that he has started avoiding some social activities because of concerns that he will be singled out because of his dietary restrictions.

 

 

DISCUSSION QUESTIONS