Phase 1 A 5 year old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also the legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to the urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state no matter how much she eats she cannot gain weight and is hungry all of the time. Phase 2 The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500mg/dl with blood, leukocytes, and ketones. The results are shared with the grandparents along with the potential diagnosis and complications. The child’s grandparents are visibly upset and start asking the nurse questions about their grandchild. Which of the following responses by the nurse are appropriate? (Select all that apply)

A. “It will be hard for you to continue taking dance and gymnastics now that you have been diagnosed with diabetes mellitus type 1.” This is discouraging and incorrect. Children with T1DM can participate in physical activities, which are actually encouraged as part of a healthy lifestyle—with careful glucose monitoring. B. “You may have a hard time making friends who understand your diagnosis.” This is nontherapeutic and pessimistic. It can lead to feelings of isolation and is not supportive or solution-focused. Social support and inclusion are vital for emotional health. C. “You will always have diabetes mellitus type 1, but this does not mean that you cannot be a normal child.” This is a realistic yet hopeful response. It acknowledges the chronic nature of T1DM while affirming that the child can still live a fulfilling life. It promotes emotional well-being and resilience. D. “You will need to monitor your blood sugar and carbohydrate intake, but you can still participate in your favorite activities.” This reinforces the concept of normalcy and independence while emphasizing the importance of disease management. Children with T1DM are encouraged to stay active and engaged in activities, with appropriate planning and monitoring.