Diabetes Type 1 Sara MartinezChamberlain College of Nursing.docx

Diabetes Type 1
Sara Martinez
Chamberlain College of Nursing
NR 507 Advanced Pathophysiology
2018
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1
What is Diabetes
Body Does not make or properly use insulin: (ADA,2005)
No insulin production
Insufficient insulin production
Resistance to insulin’s effects
No insulin to move glucose from blood into cells
High blood glucose means:
Fuel loss, cells starve
Short and long term complications
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Diabetes is a chronic disease in which the body does not make
or properly

use insulin, a hormone that is needed to convert sugar, starches,
and other
food into energy by moving glucose from blood into the cells (
American Diabetes Association, 2005).
People with diabetes have increased blood glucose (sugar)
levels for one or
more of the following three reasons: Either
No insulin is being produced,
Insulin production is insufficient, and/or
The body is resistant to the effects of insulin.
As a result, high levels of glucose build up in the blood, and
spill into the
urine and out of the body. The body loses its main source of
fuel and cells
are deprived of glucose, a needed source of energy. High blood
glucose
levels may result in short and long term complications over
time ( Centers for Disease Control and Prevention, 2017).
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Understanding Diabetes Type 1
Auto immune disorder
Insulin – producing cells destroyed
Daily insulin replacement necessary
Age of onset: usually childhood, young adults
Most prevalent type of diabetes in children and adolescent’s
(CDC,2017)
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Diabetes mellitus (DM) is a group of diseases characterized by
high levels of blood glucose resulting from defects in insulin
production, insulin action, or both (CDC,2017).
The term diabetes mellitus describes a metabolic disorder of
multiple aetiology characterized by chronic hyperglycaemia
with disturbances of carbohydrate, fat and protein metabolism
resulting from defects in insulin secretion, insulin action, or
both.
The effects of diabetes mellitus include long–term damage,
dysfunction and failure of various organs.
Diabetes is a condition where the body fails to utilize the
ingested glucose properly. This could be due to lack of the
hormone insulin or because the insulin that is available is not
working effectively. Diabetes is the fastest growing long term
disease that affects millions of people worldwide (CDC,2017).
According to the charity Diabetes UK, more than two million
people in the UK have the condition and up to 750,000 more are
unaware of having the condition. In the United States 25.8
million people or 8.3% of the population have diabetes. Of
these, 7.0 million have undiagnosed diabetes. In 2010, about 1.9
million new cases of diabetes were diagnosed in population over
20 years. It is said that if this trend continues, 1 in 3 Americans
would be diabetic by 2050 (Mayo Clinic, 2017).
Type 1 diabetes is a disease of the immune system, which is the
body’s system for fighting infection.
In people with type 1 diabetes, the immune system attacks the
beta cells, the insulin-producing cells of the pancreas, and
destroys them.

The pancreas can no longer produce insulin, so people with type
1 diabetes need to take insulin daily to live.
Type 1 diabetes can occur at any age, but the disease develops
most often in children and young adults.
Type 1 diabetes accounts for about 5 to 10 percent of diagnosed
diabetes in the United States (ADA,2005).
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Risk factors and Etiology Diabetes Type 1
The exact cause of type 1 diabetes is unknown. Usually, the
body's own immune system — which normally fights harmful
bacteria and viruses mistakenly destroys the insulin-producing
(islet, or islets of Langerhans) cells in the pancreas. Other
possible causes include: (CDC,2017)
Genetics
Exposure to viruses and other environmental factors
Family history
Age
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Family history. Anyone with a parent or sibling with type 1
diabetes has a slightly increased risk of developing the
condition. Family history may be important in some cases of
type 1 diabetes. If you have a family member with type 1
diabetes, your risk of developing increases (CDC,2017).

However, not everyone who is at risk for type 1 diabetes
develops the condition.
Genetics. The presence of certain genes indicates an increased
risk of developing type 1 diabetes. Several genes have been
tentatively linked to this condition,
Geography. The incidence of type 1 diabetes tends to increase
as you travel away from the equator.
Age. Although type 1 diabetes can appear at any age, it appears
at two noticeable peaks(CDC,2017). The first peak occurs in
children between 4 and 7 years old, and the second is in
children between 10 and 14 years old.
Though scientists have made much progress in predicting who is
at risk for developing type 1 diabetes, they do not know exactly
what triggers the immune system’s attack on beta
cells.(autoimmunity) They believe that type 1 diabetes is due to
a combination of genetic and environmental factors.
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Healthcare provider implications of prevention
Currently, there is no established means by which to prevent the
onset of DM1, but research is ongoing (Schub & Parks, 2017).
There are some possible preventions are:
Vitamin Supplementation
Probiotic use in infancy
Identification of DM1
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Vitamin D supplementation in early childhood might offer some
degree of protection against DM1 Investigators who conducted a
meta-analysis of four case-control studies including a total of
6,455 participants concluded that vitamin D supplementation in
early childhood is associated with a 29% reduction in risk of
DM1- However, researchers in Sweden found that maternal use
of a multivitamin supplement containing vitamin D during
pregnancy had no effect on risk of developing DM in their
children–The American Diabetes Association (ADA,2005),
makes no nutritional recommendations for preventing DM1
Probiotic use in infancy may be associated with reduced risk of
DM1–Researchers in a study of 7,473 children who were
genetically predisposed to DM1 (due to carriage of HLA-DR-
DQ alleles) in Finland, Germany, Sweden, and the United States
found that probiotic supplementation during the first27 days of
life was associated with a 34% decreased risk of islet
autoimmunity. This overall decrease was almost entirely
accounted for by children with the DR3/4 genotype, in whom
early probiotic exposure decreased risk of islet autoimmunity by
60%; children with other genotypes did not benefit from
probiotic use(CDC,2017).
Identification of a DM1-causing virus and the autoantibodies
associated with pancreatic beta cell destruction could make the
development of a preventive vaccine possible(6)–
Autoantibodies against the antigen glutamic acid decarboxylase-
65 (GAD65), which are frequently found in patients withDM1
of recent onset, may be a target of specific immunotherapy
using recombinant human GAD65; although this is a feasible
and promising approach, it is in early stages of development
(CDC,2017).
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Health Care provider implications for prevention of Type 1

Diabetes
Become knowledgeable about Type 1 Diabetes
Educate parents/patients, Especially those with a family history
of Type 1 Diabetes
Educate parents/patients about possible protective factors
against Type 1 Diabetes
Encourage parents/patients to dee a diabetes specialist for risk
evaluation
(CDC, 2017)
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Become knowledgeable about DM1, including risk factors for
the disease and potential prevention strategies, so you can
accurately assess your patients’ personal characteristics and
health education needs; share this information with your
colleagues› Education is best provided with sensitivity to the
age and developmental stage of the child, with regard to both
the educational approach and the content of the material
delivered. For the preschooler, education likely will be directed
toward the parents and primary caregivers, whereas for most
adolescents (after consideration of their emotional and cognitive
development), education should be directed primarily toward
the patient, with parents included. Since small, albeit often
insignificant inconsistencies in information can be confusing to
a distraught family, education should be provided to all
caregivers simultaneously if possible.
Educate parents/patients, especially those with a family history
of DM1, about factors that might increase the risk for DM1in
children, including- enterovirus infection reduced exposure to

UVB light and subsequent low vitamin D levels- consumption
of nitrates (i.e., substances that are used as food additives in
meat products and are also found in potatoes, cabbage, carrots,
and beet root), nitrites (i.e., substances that are used as food
additives in sausage), and N-nitroso compounds (i.e., substances
that are found in bacon, smoked fish, and smoked sausage)•
consumption of cow’s milk in infancy• increased weight for
height› (CDC,2017).
Educate parents/patients about possible protective factors
against DM1, including• breastfeeding for a longer period of
time• vitamin D and/or probiotic supplementation in infancy
and early childhood›
Encourage your patients and the parents of your pediatric
patients to ask their primary clinician for a referral to a diabetes
specialist to evaluate risk for DM1, if suspected
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Complications of Diabetes Type 1
Heart and blood vessel disease(ADA, 2005)
Nerve damage (neuropathy)
Kidney damage (nephropathy)
Eye damage
Foot damage
Skin and mouth conditions
Pregnancy complications
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Over time, type 1 diabetes complications can affect major
organs in your body, including heart, blood vessels, nerves,
eyes and kidneys. Maintaining a normal blood sugar level can
dramatically reduce the risk of many complications.
Eventually, diabetes complications may be disabling or even
life-threatening (ADA,2005).
Heart and blood vessel disease. Diabetes dramatically increases
your risk of various cardiovascular problems, including
coronary artery disease with chest pain (angina), heart attack,
stroke, narrowing of the arteries (atherosclerosis) and high
blood pressure.
Nerve damage (neuropathy). Excess sugar can injure the walls
of the tiny blood vessels (capillaries) that nourish your nerves,
especially in the legs. This can cause tingling, numbness,
burning or pain that usually begins at the tips of the toes or
fingers and gradually spreads upward. Poorly controlled blood
sugar could cause you to eventually lose all sense of feeling in
the affected limbs.
Damage to the nerves that affect the gastrointestinal tract can
cause problems with nausea, vomiting, diarrhea or constipation.
For men, erectile dysfunction may be an issue.
Kidney damage (nephropathy). The kidneys contain millions of
tiny blood vessel clusters that filter waste from your blood.
Diabetes can damage this delicate filtering system. Severe
damage can lead to kidney failure or irreversible end-stage
kidney disease, which requires dialysis or a kidney transplant.
Eye damage. Diabetes can damage the blood vessels of the
retina (diabetic retinopathy), potentially causing blindness.
Diabetes also increases the risk of other serious vision
conditions, such as cataracts and glaucoma.
Foot damage. Nerve damage in the feet or poor blood flow to
the feet increases the risk of various foot complications. Left

untreated, cuts and blisters can become serious infections that
may ultimately require toe, foot or leg amputation.
Skin and mouth conditions. Diabetes may leave you more
susceptible to infections of the skin and mouth, including
bacterial and fungal infections. Gum disease and dry mouth also
are more likely.
Pregnancy complications. High blood sugar levels can be
dangerous for both the mother and the baby. The risk of
miscarriage, stillbirth and birth defects increases when diabetes
isn't well-controlled. For the mother, diabetes increases the risk
of diabetic ketoacidosis, diabetic eye problems (retinopathy),
pregnancy-induced high blood pressure and preeclampsia.
Sexual Dysfunction - loss of libido and erectile dysfunction
In its most severe forms, ketoacidosis or a non–ketotic
hyperosmolar state may develop and lead to stupor, coma and,
in absence of effective treatment, death (CDC,2017).
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(AMSL, 2017)
The symptoms of type 1 diabetes usually develop over a short
period of time. They include increased thirst and urination,
constant hunger, weight loss, and blurred vision ( AMSL,2017).
Children may also feel very tired all the time. If not diagnosed
and treated with insulin, the person with type 1 diabetes will
eventually lapse into a life-threatening condition known as
diabetic ketoacidosis or DKA
regardless of excreting some of the glucose through waste, the
blood levels continue to be elevated. When this is occurring,
fluids are pulled outside the intercellular space into general

blood circulation causing frequent urination called polyuria.
Due to large volumes of urine, the body becomes dehydrated
and the natural sense of thirst occurs to coach the body into
consuming more fluids, identified as polydipsia (AMSL,2017).
Also, since glucose or sugar is unable to enter the cell and
provide it the energy it needs the body triggers you to eat to
consume sugars and provide it energy. Since the body doesn’t
create insulin to allow the sugars in hyperglycemia continues.
The state that triggers your body to see nutrition is called
polyphagia (AMSL,2017).
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Diagnosis of Diabetes Type 1
Glycated hemoglobin (A1C) test
Random blood sugar
Fasting blood sugar
Glucose Tolerance Test
Urine Test
(Mayo Clinic, 2017)
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Glycated hemoglobin (A1C) test. This blood test indicates your
average blood sugar level for the past two to three months. It
measures the percentage of blood sugar attached to the oxygen-
carrying protein in red blood cells (hemoglobin). The higher
your blood sugar levels, the more hemoglobin you'll have with
sugar attached. An A1C level of 6.5 percent or higher on two
separate tests indicates diabetes.

If the A1C test isn't available, or if you have certain conditions
that can make the A1C test inaccurate — such as pregnancy or
an uncommon form of hemoglobin (hemoglobin variant)
Random blood sugar test. A blood sample will be taken at a
random time and may be confirmed by repeat testing. Blood
sugar values are expressed in milligrams per deciliter (mg/dL)
or millimoles per liter (mmol/L). Regardless of when you last
ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or
higher suggests diabetes, especially when coupled with any of
the signs and symptoms of diabetes, such as frequent urination
and extreme thirst.
Fasting blood sugar test. A blood sample will be taken after an
overnight fast. A fasting blood sugar level less than 100 mg/dL
(5.6 mmol/L) is normal. A fasting blood sugar level from 100 to
125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's
126 mg/dL (7 mmol/L) or higher on two separate tests, you have
diabetes.
If you're diagnosed with diabetes, your doctor may also run
blood tests to check for autoantibodies that are common in type
1 diabetes.
Glucose Tolerance Test- This measures your blood sugar before
and after you drink a liquid that contains glucose. You’ll fast
(not eat) overnight before the test and have your blood drawn to
determine your fasting blood sugar level. Then you’ll drink the
liquid and have your blood sugar level checked 1 hour, 2 hours,
and possibly 3 hours afterward. At 2 hours, a blood sugar level
of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL
indicates you have prediabetes, and 200 mg/dL or higher
indicates you have diabetes.
Urine- random urine will be tested for the presence of ketones (
produced when your body burns fat for energy)

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Managing and Treatment of Diabetes Type 1
NO cure at this time!
Treatment for type 1 diabetes includes:
Taking insulin
Carbohydrate, fat and protein counting
Frequent blood sugar monitoring
Eating healthy foods
Exercising regularly and maintaining a healthy weight.
(Mayo Clinic, 2017)
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The following principles are recommended as dietary guidelines
for people with diabetes:
Dietary fat should provide 25-35% of total intake of calories but
saturated fat intake should not exceed 10% of total energy.
Cholesterol consumption should be restricted and limited to 300
mg or less daily(CDC,2017).
Protein intake can range between 10-15% total energy (0.8-1

g/kg of desirable body weight). Requirements increase for
children and during pregnancy. Protein should be derived from
both animal and vegetable sources.
Carbohydrates provide 50-60% of total caloric content of the
diet. Carbohydrates should be complex and high in fibre.
Excessive salt intake is to be avoided. It should be particularly
restricted in people with hypertension and those with
nephropathy (CDC,2017).
Making diabetes a part of life, such as maintain blood glucose
control is a juggling act, 24 hours a day , 7 days a week
The key to optimal diabetes control is a careful balance or
balancing of food, physical activity, and insulin and/or oral
medication.
As a general rule:
Insulin medication and physical activity makes blood glucose
levels go down.
Food makes blood glucose levels go up.
Several other factors, such as stress, illness or injury, also can
affect blood glucose levels
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Pharmacological Interventions for Diabetes Type 1
Treatment and Management
Insulin
Short acting insulin
Rapid- acting Insulin
Intermediate- acting insulin (NPH)
Long-Acting insulin

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(Mayo Clinic, 2017)
Examples of short-acting (regular) insulin include Humulin R
and Novolin R.
Rapid-acting insulin examples are insulin glulisine (Apidra),
insulin lispro (Humalog) and insulin aspart (Novolog).
Long-acting insulins include insulin glargine (Lantus, Toujeo
Solostar), insulin detemir (Levemir) and insulin degludec
(Tresiba).
Intermediate-acting insulins include insulin NPH (Novolin N,
Humulin N) (Mayo Clinic, 2017).
The majority of patients will require more than one daily
injection if good glycaemic control is to be achieved. However,
a once-daily injection of an intermediate acting preparation may
be effectively used in some patients.
Twice-daily mixtures of short- and intermediate-acting insulin
is a commonly used regimen.
In some cases, a mixture of short- and intermediate-acting
insulin may be given in the morning. Further doses of short-
acting insulin are given before lunch and the evening meal and
an evening dose of intermediate-acting insulin is given at
bedtime.
Other regimens based on the same principles may be used.
A regimen of multiple injections of short-acting insulin before
the main meals, with an appropriate dose of an intermediate-
acting insulin given at bedtime, may be used, particularly when
strict glycaemic control is mandatory (Mayo Clinic, 2017).

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Overview of Insulin and Action
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(AMSL,2017)
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Types of Insulin
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(AMSL,2017)
Hypoglycemia (low blood sugar) can happen quickly and needs
to be treated immediately. It’s most often caused by too much
insulin, waiting too long for a meal or snack, not eating enough,
or getting extra physical activity. Hypoglycemia symptoms are
different from person to person; make sure you know your
specific symptoms, which could include:
Shakiness
Nervousness or anxiety
Sweating, chills, or clamminess
Irritability or impatience
Dizziness and difficulty concentrating
Hunger or nausea
Blurred vision
Weakness or fatigue
Anger, stubbornness, or sadness
If you have hypoglycemia several times a week, talk to your
doctor to see if your treatment needs to be adjusted.

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Frequent blood sugar monitoring
Frequency of monitoring dependent on type of insulin therapy
Checking your blood sugar
Recording your blood sugar in a log
Latest way to monitor blood sugar continuously
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(CDC,2017)
Depending on what type of insulin therapy you select or require,
you may need to check and record your blood sugar level at
least four times a day.
Blood glucose monitoring shows your current blood glucose
(sugar) level. High bloodsugar over a long time may cause
problems with your heart, eyes, kidneys, nerves, orfeet. When
you don’t monitor blood sugar, it’s like driving down the street
with yourwindshield covered up. You can’t see where you’re
going, and you’re likely to have anaccident and get
hurt.Monitoring shows how food, medicine, exercise, and stress
affect your blood sugar. Askyour medical team how often to
check your blood sugar level. They will also help youdecide the
target range in which most of your blood sugar readings should
fall.Your medical team will help you see patterns in your blood
sugar levels. If a reading at acertain time of day is often out of
the target range, you can figure out how to control it.
The American Diabetes Association recommends testing blood
sugar levels before meals and snacks, before bed, before
exercising or driving, and if you suspect you have low blood
sugar. Careful monitoring is the only way to make sure that

your blood sugar level remains within your target range — and
more frequent monitoring can lower A1C levels (ADA,2005).
Even if you take insulin and eat on a rigid schedule, blood sugar
levels can change unpredictably. You'll learn how your blood
sugar level changes in response to food, activity, illness,
medications, stress, hormonal changes and alcohol.
Continuous glucose monitoring (CGM) is the newest way to
monitor blood sugar levels, and may be especially helpful for
preventing hypoglycemia. When used by people older than 25,
the devices have been shown to lower A1C.
Continuous glucose monitors attach to the body using a fine
needle just under the skin that checks blood glucose level every
few minutes. CGM isn't yet considered as accurate as standard
blood sugar monitoring, so at this time it's still important to
check your blood sugar levels manually.
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Diet- Carbohydrate, fat and protein counting
Dietary treatment should aim at: (Gottlieb,2015)
Making healthily food choices
Ensuing weight control
Providing nutritional requirements
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Diet is a basic part of management in every case. Treatment
cannot be effective unless adequate attention is given to
ensuring appropriate nutrition.

center your diet on nutritious, low-fat, high-fiber foods such as:
Fruits
Vegetables
Whole grains
Your dietitian will recommend that you eat fewer animal
products and refined carbohydrates, such as white bread and
sweets. This healthy-eating plan is recommended even for
people without diabetes (Gottlieb,2015).
You'll need to learn how to count the amount of carbohydrates
in the foods you eat so that you can give yourself enough
insulin to properly metabolize those carbohydrates. A registered
dietitian can help you create a meal plan that fits your needs.
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Exercise
Physical activity
Minimum of 30 to 60 min of moderate physical exercise daily
Example- Walking, running, aerobic exercise
Any sort of physical activity
Before exercise it is suggested to intake 15 g of carbohydrate
Example- sports drink , juice or glucose tablet
Physical exercise should be encouraged and sedentary life style
should be discouraged
(Mayo Clinic, 2017)
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Physical activity promotes weight reduction and improves
insulin sensitivity, thus lowering blood glucose levels.

Together with dietary treatment, a programme of regular
physical activity and exercise should be considered for each
person. Such a programme must be tailored to the individual’s
health status and fitness (Mayo Clinic, 2017).
People should, however, be educated about the potential risk of
hypoglycaemia and how to avoid it.
Everyone needs regular aerobic exercise, and people who have
type 1 diabetes are no exception. First, get your doctor's OK to
exercise. Then choose activities you enjoy, such as walking or
swimming, and make them part of your daily routine. Aim for at
least 150 minutes of aerobic exercise a week, with no more than
two days without any exercise (Mayo Clinic, 2017). The goal
for children is at least an hour of activity a day.
Remember that physical activity lowers blood sugar. If you
begin a new activity, check your blood sugar level more often
than usual until you know how that activity affects your blood
sugar levels. You might need to adjust your meal plan or insulin
doses to compensate for the increased activity.
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Self-Care of Diabetes
Patients should be educated to practice self-care. This allows
the patient to assume responsibility and control of his / her own
diabetes management. Self-care should include: (ADA, 2005)
Blood glucose monitoring
Body weight monitoring
Foot-care
Personal hygiene

Healthy lifestyle/diet or physical activity
Identify targets for control
Stopping smoking
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Blood glucose monitoring - Your doctor will advise you how
often you should check your blood sugar level.
Body Weight Monitoring - Many factors affect how well
diabetes is controlled. Many of these factors are controlled by
the person with diabetes, including how much and what is eaten,
how frequently the blood sugar is monitored, physical activity
levels, and accuracy and consistency of medication dosing.
Even small changes can affect blood sugar control.
Eating a consistent amount of food every day and taking
medications as directed can greatly improve blood sugar control
and decrease the risk of diabetes-related complications, such as
coronary artery disease, kidney disease, and nerve damage. In
addition, these measures impact weight control. A dietitian can
help to create a food plan that is tailored to your medical needs,
lifestyle, and personal preferences( ADA, 2005).
Foot Care- inspect your feet every day, and seek care early if
you do get a foot injury. Make sure your health care provider
checks your feet at least once a year - more often if you have
foot problems.
Personal Hygiene- in the diabetic patient refers primarily to
cleanliness. Careful and frequent cleansing of the skin should
be emphasized. Immediate attention to all skin abrasions will

often prevent serious problems.
Healthy lifestyle/Physical Activity -Exercising regularly can
help to lose weight and keep it off. The recommended amount of
exercise is 30 minutes per day most days of the week. People
who take insulin should check their blood sugar level before
and after exercising. If exercise is vigorous and prolonged
(more than thirty minutes), check your blood sugar every 15
minutes (if the exercise regimen is new and will be used again).
Frequent monitoring can help to get a sense of what effect
exercise has on your blood sugar level.
Identify targets for control- Your doctor will advise you what
your targets for control are
Stop smoking - Smokers also have a harder time controlling
their blood glucose levels, because insulin resistance is
increased by smoking. Plus its bad for you.
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Conclusion of Diabetes Type 1
What is diabetes type 1
Cause of Type 1 Diabetes
Symptoms of Type 1 Diabetes
Possible long term complications
Treatment and Management of Type 1 Diabetes
(Gottieb, 2015)
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What is diabetes and what causes Type 1 diabetes?

Diabetes occurs when the level of glucose (sugar) in the blood
becomes too high. Normally, after we eat, various foods are
broken down in the gut into sugars which are then absorbed into
the body. The main sugar is called glucose. To remain healthy,
your blood glucose level should not go too high or too low. A
hormone called insulin helps to take glucose from the
bloodstream into various cells of the body. This helps to keep
the blood sugar normal. Insulin is made by special cells in the
pancreas. In Type 1 diabetes the pancreas stops making insulin,
and so the blood glucose remains high. This occurs because the
immune system makes antibodies which destroy the insulin-
making cells in the pancreas. It is not known why the immune
system does this. Type 1 diabetes usually first develops in
children or young adults (Gottieb, 2015).
What are the symptoms of Type 1 diabetes?
Symptoms tend to develop quite quickly, over a few days or
weeks. They include: excess thirst, passing large amounts of
urine, tiredness, weight loss, and feeling generally unwell. After
treatment is started these symptoms soon go. But, without
treatment, the blood glucose level will go very high which can
cause you to become very ill, lapse into a coma, and die.
Possible long term complications which may develop?
Even a mildly raised glucose level which does not cause any
symptoms in the short-term can affect the blood vessels in the
long-term. This may lead to some complications (often years
after diabetes is first diagnosed). These include: an increased
risk of heart disease, stroke and poor circulation; eye and vision
problems; kidney damage; nerve damage; serious foot problems;
impotence. In general, the risk of developing complications is
reduced if the blood glucose level is well controlled, and other
risk factors such as high blood pressure are dealt with.
What is the treatment for Type 1 diabetes?
Treatment to keep your blood glucose level as near normal as
possible. You will need insulin injections for the rest of your
life. Most people take 2-4 injections each day. There are various
types of insulin and the one advised will be tailored to your

needs. You should aim to eat a low fat, high fiber diet with
plenty of starchy foods, fruit and vegetables. But, you will need
to know how to balance the right amount of insulin for the
amount of food that you eat. So, you will normally be given a
lot of instruction and advice from a dietician and diabetes nurse
(Gottieb, 2015). To reduce your risk of future complications
your blood pressure should be well controlled. Medication may
be needed for this. In addition you are strongly advised: not to
smoke, to exercise regularly, and to lose weight if you are
overweight. Some of these lifestyle issues may not seem to be
relevant at first to young children with diabetes. But, as
children grow, a healthy lifestyle should be greatly encouraged
to reduce the risk of developing complications in the long-term.
Most people with Type 1 diabetes attend a diabetes clinic where
doctors, nurses, dieticians, podiatrists, etc., advise on treatment,
and aim to detect any complications as early as possible.
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Implication for Nurse Practitioner
Begins with Trust
Relationship Building for Behavioral Change
Communication and Teamwork
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Begins with Trust -Perhaps our most important skill is the
ability to build a trust-based relationship with the patient and
the patient’s defined support system. Once we understand the
importance of trust, it shifts how we think about intervening.
Sensitive, nonjudgmental empathy is crucial, because the
patient’s process is often fraught with self-judgment as he or
she struggles to achieve desired glucose, weight loss, exercise

and other goals. There is often the sense among patients that
they could be doing better. Sometimes this self-judgment
manifests as defensive behavior; sometimes it borders on self-
loathing; but there is often shame and blame in trying to manage
their illness.
Relationship Building for Behavioral Change - What does all
this mean, specifically, in practice? From the outset, not only
must we take a good medical, family and social history and
discern the current treatment plan (including current
medications and frequency of glucose monitoring), but it is also
of utmost importance to know:
How the patient and family have coped with other major
stressors in their lives
Their experience with diabetes before they or their child was
diagnosed with it (e.g., did they have a family member who died
secondary to diabetes complications)
Their level of confidence in their ability to manage diabetes
Their greatest current challenge with diabetes
Communication and Team Work - Last but not least,
communication extends to working effectively at the center of
team-based care. Sometimes this can mean ensuring that
everyone involved is clear on the patient’s status and next steps,
but it can also mean understanding when we need – and how
best – to consult with a physician on difficult medical cases,
such as when a child requires excess insulin, which may
indicate other metabolic disorders or something esoteric on the
medical side. How often to consult with a physician depends on
experience, but a beginning NP will likely ask for consultation
frequently.
The point is that each role is important – from the medical
assistant triaging a child, to the RN or dietitian trying to teach a
family about diabetes, to the endocrinologist or NP fine-tuning
the insulin regimen. It is our responsibility to use our intimate
understanding of all these roles to maximize the efficacy of the
entire team so that we help patients and families live the full

and rewarding lives they deserve.
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References
American Diabetes Association. ( 2005). Diabetes Care.
Retrieved from:
http://care.diabetesjournals.org/content/diacare/28/1/186.full.pd
f
AMSL. (2017). Diabetes. Retrieved from:
http://amsldiabetes.com.au/
Centers for Disease Control and Prevention. (2017). Type 1
Diabetes. Retrieved from:
https://www.cdc.gov/diabetes/basics/type1.html
Gottlieb, P. A. (2015). What defines disease in an age of
genetics and biomarkers?. Current Opinion in Endocrinology,
Diabetes and Obesity, 22(4), 296-299.
Mayo Clinic. (2017). Type 1 Diabetes. Retrieved from
https://www.mayoclinic.org/diseases-conditions/type-1-
diabetes/symptoms-causes/syc-20353011
Schub, T. B.,& Parks, J. B. (2017). Diabetes Mellitus, Type 1:
Risk Factors and Prevention. CINAHL Nursing Guide,
20
20

Business Communication Today
Fourteenth Edition
Chapter 12
Writing Persuasive Messages
Copyright © 2018, 2015, 2012 Pearson Education, Inc. All
Rights Reserved.
Rights Reserved.
Learning Objectives
12.1 Apply the three-step writing process to persuasive
messages.
12.2 Describe an effective strategy for developing persuasive
business messages, and identify the three most common
categories of persuasive business messages.
12.3 Describe an effective strategy for developing marketing
and sales messages, and explain how to modify your
approach when writing promotional messages for social

media.
12.4 Identify steps you can take to avoid ethical lapses in
marketing and sales messages.
Rights Reserved.
Using the Three-Step Writing Process for
Persuasive Messages
• LO 12.1 Apply the three-step writing process to persuasive
messages.
Rights Reserved.
Step 1: Planning Persuasive Messages
• Analyze the Situation
• Gather the Information
• Select the Right Media and Channels
• Organize the Information

Rights Reserved.
Analyzing the Situation
• What Are the Audience’s Desires, Needs, and Culture?
• Refer to
– Demographics
– Psychographics
– Motivation
Rights Reserved.
Gathering Information
• Persuasive Business Messages
• Marketing Messages
• Sales Messages
Rights Reserved.
Selecting the Right Media and Channels
• Analyze Options

• Select Cost-Effective Combination
• Employ Multiple Media and Channels
Rights Reserved.
Organizing Your Information
• Audience-Centered “You” Attitude
• Limited Scope
• Explain reason
• Build Interest
• Ask for a Decision or Action
• Choose Approach
Rights Reserved.
Step 2: Writing Persuasive Messages
• Encourage a Positive Response By:
– Using Positive and Polite Language
– Respecting Cultural Differences

– Being Sensitive to Organizational Cultures
– Establishing Your Credibility
Rights Reserved.
Building Your Credibility (1 of 2)
• Use Simple Language
• Provide Objective Evidence
• Identify Information Sources
• Establish Common Ground
• Emphasize Common Beliefs, Attitudes, and Experiences
Rights Reserved.
Building Your Credibility (2 of 2)
• Be Objective
• Present Fair and Logical Arguments
• Focus on Audience’s Best Interests
• Persuade with Logic

• Build Credibility Before Presenting Proposal
Rights Reserved.
Developing Persuasive Business
Messages (1 of 2)
• LO 12.2 Describe an effective strategy for developing
persuasive business messages, and identify the three
most common categories of persuasive business
messages.
Rights Reserved.
Strategies for Persuasive Business Messages
• Four Essential Strategies:
– Framing Your Arguments
– Balancing Emotional and Logical Appeals
– Reinforcing Your Position
– Anticipating Objections

Rights Reserved.
Framing Your Arguments
• AIDA Model
– Attention
– Interest
– Desire
– Action
Rights Reserved.
Balancing Emotional and Logical Appeals
• Consider Four Factors:
– Actions you hope to motivate
– Readers’ expectations
– Degree of resistance
– Position in the power structure of the organization

Rights Reserved.
Selecting Emotional or Logical Appeals
Emotional Logical
Feelings Analogy
Emotions Induction
Sympathies Deductive
Rights Reserved.
Avoiding Faulty Logic
• Avoid These Mistakes:
– Hasty Generalizations
– Circular Reasoning
– Attacking an Opponent
– Oversimplifying a Complex Issue
– Mistaken Assumptions of Cause and Effect
– Faulty Analogies
– Illogical Support

Rights Reserved.
Reinforcing Your Position
• Believable Evidence
• Examine Your Language
• Use Metaphors and Analogies
• Audience Benefits
Rights Reserved.
Anticipating Objections
• Identify Areas of Potential Resistance
• Find
Solution
s to Potential Objections
• Present All Sides of the Story

• Explain the Pros and Cons
Rights Reserved.
Avoiding Common Mistakes in Persuasive
Communication
• Avoid Using a Hard Sell
• Don’t Resist Compromise
• Avoid Relying Solely on Great Arguments
• Don’t Use a “One-Shot” Approach
Rights Reserved.

Common Examples of Persuasive Business
Messages
• Requests for Action
• Presentations of Ideas
• Claims and Requests for Adjustment
Rights Reserved.
Persuasive Requests for Action
• Use the Direct Approach for Anticipated Requests
• Use the Indirect Approach or AIDA for Unanticipated
Requests
• Open with an Attention-Getting Device

• Goals:
– Gain Credibility
– Convince Your Readers You Will Help Solve a Problem
Rights Reserved.
Persuasive Presentations of Ideas
• Change Attitudes or Beliefs About a Topic
– Consider a New Idea
– Reexamine Options
– Reconsider Ways of Thinking
Rights Reserved.

Persuasive Claims and Requests for
Adjustment
• Review the Facts in a Positive Tone
– Outline the Problem and Status
– Be Specific About the Resolution Sought
– Provide a Good Reason for Granting the Claim
– Close on a Respectful Note
Rights Reserved.
Developing Persuasive Business
Messages (2 of 2)
• LO 12.3 Describe an effective strategy for developing

marketing and sales messages, and explain how to modify
your approach when writing promotional messages for
social media.
Rights Reserved.
Contrasting Marketing and Sales Messages
Marketing Sales
Don’t Ask for an Immediate
Decision
Ask Prospect to Make
Immediate Decision
Introduce New Products

Request to Buy Specific
Product or Service
Rights Reserved.
Planning Marketing and Sales Messages
• Assessing Audience Needs
• Analyzing Your Competition
• Determining Key Selling Points and Benefits
• Anticipating Purchase Options
Rights Reserved.
Writing Conventional Sales and Marketing

Messages
• Using the AIDA Model
– Getting the Reader’s Attention
– Building Interest
– Increasing Desire
– Motivating Action
Rights Reserved.
Writing Promotional Messages for Social
Media
• Facilitate Community Building
• Listen at Least as Much as You Talk

• Initiate and Respond to Community Conversations
• Provide Information that People Want
• Identify and Support Your Champions
• Be Real
• Integrate Conventional Marketing and Sales Strategies
Rights Reserved.
Creating Promotional Messages for Mobile
Devices
Mobile Advertising Mobile Commerce
Short, Simple Text Ads
Searching for Product

Reviews and Stores
Mobile-Optimized Video
Finding Coupons and Other
Promotions
Fast and Straightforward Making Purchases
Rights Reserved.
Maintaining High Standards of Ethics,
Legal Compliance, and Etiquette
• LO 12.4 Identify steps you can take to avoid ethical lapses
in marketing and sales messages.

Rights Reserved.
Promotional Messages
• Federal Laws and Regulations
• State Laws and Regulations
• International Laws and Regulations
Rights Reserved.
Legal Ramifications of Marketing and Sales
Efforts
• Messages Must Be Truthful and Non-Deceptive
• Claims Must Be Backed By Evidence
• “Bait-and-Switch” Advertising is Illegal

• Children’s Messages Subject to Special Rules
• Can Be Binding Contracts in Many States
• Must Have Permission to Use Person’s Identity
Rights Reserved.
Maintaining Etiquette
• Audience-Centered Approach
• Use Technology to Demonstrate
• Sensitivity to User Needs
• Opt-In Email Newsletters
Rights Reserved.

Copyright
Business Communication Today
Fourteenth Edition
Chapter 11
Writing Negative Messages
Rights Reserved.
Rights Reserved.
Learning Objectives (1 of 2)
11.1 Apply the three-step writing process to negative

messages.
11.2 Explain how to effectively use the direct approach when
conveying negative news.
11.3 Explain how to effectively use the indirect approach when
conveying negative news.
11.4 Explain the importance of maintaining high standards of
ethics and etiquette when delivering negative messages.
Rights Reserved.
Learning Objectives (2 of 2)
11.5 Describe successful strategies for sending negative
messages on routine business matters.

11.6 List the important points to consider when conveying
negative organizational news.
11.7 Describe successful strategies for sending negative
employment-related messages.
Rights Reserved.
Using the Three-Step Writing Process for
Negative Messages
• LO 11.1 Apply the three-step writing process to negative
messages.

Rights Reserved.
Five Goals of Negative Communication
• Convey the Bad News
• Gain Acceptance of the Bad News
• Maintain Audience’s Goodwill
• Maintain Good Image for Organization
• Reduce the Need for Future Correspondence
Rights Reserved.
Step 1: Planning a Negative Message
• Consider Your Audience and Purpose
• Select the Right

• Medium and Channel
• Define Your Main Idea
• Choose the Best Approach
Rights Reserved.
Choosing the Direct or Indirect Approach
Direct Indirect
Do You Need to Get the
Reader’s Attention?
How Important
is the News to the Reader?
What is the Audience’s

Preference?
Will the Bad News Come as
a Shock?
Rights Reserved.
Step 2: Writing a Negative Message
• Write Clearly and Sensitively
• Clarify Your Qualifications
• Convey Respect
• Observe Communication Etiquette
• Choose Positive Words

Rights Reserved.
Step 3: Completing a Negative Message
• Revise Your Content
• Produce Professional Documents
• Proofread Carefully
• Deliver Messages Promptly
Rights Reserved.
Using the Direct Approach for Negative
Messages
• LO 11.2 Explain how to effectively use the direct approach
when conveying negative news.

Rights Reserved.
Opening With a Clear Statement of the Bad
News
• State the Bad News at the Beginning
• Maintain a Calm, Professional Tone
• Focus on the News Not on Individuals
• Explain or Remind the Reader Why You’re Writing
Rights Reserved.
Providing Reasons and Additional

Information
• Explain Why the News Is Negative
• Consider the Nature of the News
• Assess Your Relationship with the Reader
• Determine Whether to Apologize
Rights Reserved.
Factors for Determining Whether to
Apologize
• Deliver the Apology from the Right Person in the
Organization
• Only Apologize if it is Sincere

• Deliver the Apology Quickly
Rights Reserved.
Close on a Respectful Note (1 of 2)
• Consider Alternatives
• Include Positive Statements
• Communicate How Future Mistakes Will Be Avoided
Rights Reserved.
Using the Indirect Approach for Negative
Messages
• LO 11.3 Explain how to effectively use the indirect

approach when conveying negative news.
Rights Reserved.
Opening With a Buffer
• Open With a Neutral Statement
• Establish Common Ground
• Express Appreciation
• Assure the Readers You Understand Their Needs
• Be Relevant and Sincere
Rights Reserved.

Continuing With a Clear Statement of the
Bad News (1 of 2)
• To Handle Bad News Carefully:
– De-emphasize the Bad News
– Use a Conditional Statement
– Tell What You DID, Not What You Didn’t
Rights Reserved.
Continuing With a Clear Statement of the
Bad News (2 of 2)
• To Handle Bad News Carefully:
– De-emphasize the Bad News

– Use a Conditional Statement
– Emphasize What You DID, Not What You Didn’t Do
Rights Reserved.
Close on a Respectful Note (2 of 2)
• Find a Positive Angle
• Avoid an Uncertain Conclusion
• Manage Future Correspondence
• Express Optimism
• Be Sincere
Rights Reserved.

Maintaining High Standards of Ethics and
Etiquette
• LO 11.4 Explain the importance of maintaining high
standards of ethics and etiquette when delivering negative
messages.
Rights Reserved.
Challenges of Sending and Receiving
Negative Messages
• Legal Compliance
• Impact of Negative Message on Recipient
• Managing Emotions of Both Sender and Recipient

• Appropriately Timing the Message
Rights Reserved.
Effectively Sharing Bad News
Employees Managers Whistleblowers
Sending Negative
News
Open
Communication
Internal and
External Reporting
Mechanisms

Timely
Communication
Active
Listening
Internal and
External
Protection
Rights Reserved.
Sending Negative Messages on Routine
Business Matters
• LO 11.5 Describe successful strategies for sending

negative messages on routine business matters.
Rights Reserved.
Making Negative Announcements on
Routine Business Matters
• Open with a Buffer
• Advance Your Reasoning
• Announce the Change
• Close on a Positive Note
Rights Reserved.

Rejecting Suggestions and Proposals
• Choose Your Approach Based on the Following Factors:
– Is the Proposal Solicited or Unsolicited?
– Is the Proposal from an Internal or External Source?
– What is the Nature of Your Relationship With the
Sender?
Rights Reserved.
Refusing Routine Requests
• Choose Your Approach
• Focus on the Most Important Relationships and Requests
• Don’t Leave a Closed Matter Open-Ended

• Offer Alternatives
• Only Offer Other Assistance If Available
Rights Reserved.
Handling Bad News About Transactions
• Three Goals
– Modify Customer’s Expectations
– Explain How You Plan To Resolve
– Repair Damage to Business Relationship
Rights Reserved.
Refusing Claims and Requests for

Adjustment
DO DON’T
Provide Accurate Information Use Abusive Language
Consult Legal Advisers Allow Anger or Malice to
Motivate You
Communicate Honestly Use Negative Tone
Emphasize Good
Future Relationship
Use Accusations
Rights Reserved.
Sending Negative Organizational News

• LO 11.6 List the important points to consider when
conveying negative organizational news.
Rights Reserved.
Communicating Under Normal
Circumstances
• Match the Approach to the Situation
• Consider the Unique Needs of Each Group
• Give Each Audience Time to React
• Plan and Manage a Response
• Look For Positive Angles
• Seek Expert Advice

Rights Reserved.
Responding to Negative Information In a
Social Media Environment
• Responding to Online Rumors
• Countering False Information
• Defending Attacks on a Company’s Reputation
Rights Reserved.
Responding to Rumors and Countering
Negative Information

• Engage Early, Engage Often
• Monitor the Conversation
• Evaluate Negative Messages
• Respond Appropriately
Rights Reserved.
Communicating in a Crisis
• Develop a Crisis Management Plan
– Define Operational Procedures
– Outline Communication Tasks and Responsibilities
– List News and Social Media Outlets for Disseminating
Information

Rights Reserved.
Sending Negative Employment Messages
• LO 11.7 Describe successful strategies for sending
negative employment-related messages.
Rights Reserved.
Refusing Requests for Employee References
and Recommendation Letters
Employees Applicants
Be Concise Prepare Carefully
Be Direct Use Tact and Diplomacy

Rights Reserved.
Refusing Social Networking
Recommendation Requests
• Three Options
– Ignore or Delete the Request
– Refrain From Making Any Recommendations
– Responding to the Request
Rights Reserved.
Rejecting Job Applications

• Personalize with the Recipient's Name
• Open with Appreciation
• Convey the News Politely and Concisely
• Avoid Explanations
• Don’t Imply the Application Will Be Reviewed Later
• Close With Positive Wishes
Rights Reserved.
Giving Negative Performance Reviews
• Document Performance Problems
• Evaluate All Employees Consistently
• Write in a Calm, Objective Voice

• Focus on Opportunities for Improvement
• Keep Job Descriptions Up to Date
Rights Reserved.
Terminating Employment
• Clearly Present the Reasons
• Present Reasons in a Neutral Manner
• Follow Company Policy and Applicable Laws
• Avoid Personal Attacks or Insults
• Have a Colleague Review the Letter
• Deliver the Letter in Person

Rights Reserved.
Copyright
Chamberlain College of NursingWEEK 6 Recorded Disease
Process PRESENTATION GUIDELINES and Grading Rubric
Purpose
The purpose of the Disease Process Presentation is for learners
to:
· Develop professional presentation/communication skills.
· Demonstrate an advancing understanding of
pathophysiological processes of body systems that result in the
diagnosis and treatment of patients who present with these
disorders in these systems.
· Demonstrate the ability to analyze the literature to obtain the
most current, evidence-based resources on the assigned disease
process.
· Demonstrate and practice professional communication and
leadership, while advancing the education of peers.

Course Outcomes
1. Analyze pathophysiological mechanisms associated with
select disease states.
5. Relate research findings to the management of patients with
complex pathophysiologic dysfunction.
Total Points Possible: 200 Points
Due Date: upload your presentation to the discussion by
Tuesday, 11:59 p.m. MT of Week 6
Requirements
For Week 6 of the course, there is no case study given to you by
the faculty. Instead you will be creating a recorded presentation
that demonstrates your understanding of a selected disease
process. This presentation will be uploaded into the course via
Kaltura (see course resource for directions).
Address the following Criteria:
1. Introduce the disease with a brief definition and description.
2. Discuss the Risk Factorsand the connection to theEtiology of
the initial injury to the cell/tissue/organ.
3. Discuss health care provider implications for prevention of
the disease.
4. Show the progression from the initial injury to the defect in

the tissue, organ and system functioning.
5. Link changes in the tissue, organ, and system functioning to
the initial presenting signs and symptoms seen in primary care
of the disease.
6. Provide a brief description of how the disease is diagnosed.
7. Provide a brief description of the pharmacological and non-
pharmacological interventions used to treat and manage the
disease.
8. Summarizes the disease on final slide with concluding
remarks; includes implication for nurse practitioner practice.
9. Utilizes at least two current (within 5 years), peer-review
scholarly sources to support presentation content.
10. Reference slide and in-text citations depict references
correctly cited according to APA.
Presentation Guidelines:
· The presentation should include a PowerPoint presentation
which will be recorded using the instructions located in the
Course Resource section.
· The presentation should be no more than 15-20 minutes in
recorded length.
· The presentation should contain appropriate evidence to
support the information presented per APA format.
· Slides should be used as cues to topics and key concepts
without lengthy sentences and paragraphs- reading information

from slides is not professional and therefore not acceptable.
· Students need to demonstrate understanding and mastery of
content by discussion style presentation.
Technology Requirements
The instructions for using Kaltura are located in the Course
Resource section.Directions and Grading Criteria
Criterion
Exceptional
Outstanding or highest level of performance
Exceeds
Very good or high level of performance
Meets
Satisfactory level of performance
NeedsImprovement
Poor or failing level of performance
Developing
Unsatisfactory level of performance
Total Points Possible = 200
Application of Course Knowledge
70 Points

61 Points
57 Points
28 Points
0 Points
The recorded presentation includes clear presentation of all
required concepts:
-Introduction of disease with brief definition and description.
-Risk factors with link to etiology provided.
-Implications of health care provider in disease prevention.
-Shows progression from the initial injury to the defect in the
tissue, organ, and system functioning.
- Links changes in the tissue, organ, and system functioning to
the initial presenting signs and symptoms seen in primary care
of the disease.
- Provides a brief description of how the disease is diagnosed.
- Provide a brief description of the pharmacological and non-
pharmacological interventions used to treat and manage the
disease.
All concepts are presented with logical thought process.
The recorded presentation includes clear presentation of all
required concepts and linkages, but may lack some applicability
to topic or misses one criteria in some way.

The recorded presentation has limited perspective, unclear
linkages, insights and/or applicability to topic or does not meet
one or more of the criteria of the assignment.
The recorded presentation contains inaccurate information and
is not consistent with current practice. No clear linkages
provided. Analysis is minimal.
The recorded presentation offers no insight or application to the
assignment or course content.
Support from Evidence-Based Practice (EBP)
60 Points
52 Points
49 Points
24 Points
0 Points
Scholarly literature is present throughout the presentation.
Guidelines regarding disease prevention and pharmacological
and non-pharmacological interventions are addressed and
clearly analyzed.
Where applicable in the recorded presentation, analysis is

partially supported by evidence from appropriate sources
published within the last 5 years.
In-text citations and full references are provided.
Evidence-based, peer reviewed journal article cited but may not
fully support disease prevention and pharmacological and non-
pharmacological interventions.
Where applicable in the recorded presentation, analysis is
partially supported by evidence.
Sources may not be scholarly in nature or may be older than 5
years. Guidelines are not used.
In-text citations and/or full references may be incomplete or
missing.
Citations to non-scholarly websites given as rationale to support
disease prevention and pharmacological and non-
pharmacological interventions.
Presentation contains no evidence-based practice reference or
citation.
50 Points
44 Points
41 Points
20 Points
0 Points

Summary of Disease Process
Summarizes the disease using concise statements that reflect all
content covered in the presentation.
Implications for practice addressed.
Summarizes the disease using concise statements that reflect all
content covered in the presentation.
Implications for practice not clearly evident.
Summarizes the disease using concise statements with some
content not reflected in the summary.
Implications for practice not clearly evident or missing.
Summary of the disease process is lacking concise statements
and all content not reflected in the summary.
Implications for practice not addressed or not clearly evident.
No summary of the disease process provided.
Implications for practice not addressed.
Professionalism/ Organization
10 Points
9 Points
8 Points
4 Points
0 Points
The recorded presentation has clear audio/video. The content
flows in a logical, smooth manner. Verbal pauses are limited or
absent. Student speaks in a clear cadence and speed.

The recorded presentation is lacking 1-2 components from the
50 point criteria.
The recorded presentation is lacking 3-4 components from the
50 point criteria.
Presentation presents findings that are sometimes unclear to
follow and may not always be relevant to topic and concepts are
difficult to follow.
The audio/video are hard to hear/see. Slides contain lengthy
content (student reading from slides). Presentation style lacks
flow of ideas and thoughts.
Grammar, Syntax, APA
10 points
9 points
8 points
4 point
0 points
APA format, grammar, spelling, and/or punctuation are
accurate, or with zero to one errors.
Two to four errors in APA format, grammar, spelling, and
syntax noted.
Five to seven errors in APA format, grammar, spelling, and
syntax noted.

Eight to nine errors in APA format, grammar, spelling, and
syntax noted.
Post contains ten or greater errors in APA format, grammar,
spelling, and/or punctuation.
Total Points Possible= 200
NR507 W6 March 2018

Diabetes Type 1 Sara MartinezChamberlain College of Nursing.docx

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