Managing Diabetes on the Autism Journey: Guidance through the McGill Nursing Model

Sevgim Küçük Ulak1, Didar Zümrüt Başbakkal2

1Tepecik Training And Research Hospital, Child Health And Diseases Clinic, Izmir, Türkiye
2Ege University, Pediatric Nursing, Izmir, Türkiye

Keywords: mcgill nursing model, type 1 diabetes, autism spectrum disorder.

Abstract

This study presents the case of a 14-year-old diagnosed with autism spectrum disorder (ASD) following a new diagnosis of Type 1 diabetes, focusing on the nursing care and support provided during this transition. Autism is a neurodevelopmental disorder, typically beginning in the pre-school years, characterized by challenges in social communication and interaction, as well as repetitive behaviors. Type 1 diabetes, on the other hand, is a chronic condition commonly seen in children, characterized by the autoimmune destruction of pancreatic beta cells. Managing these two coexisting conditions poses unique challenges, adding complexity to healthcare management for both the individual and their parents. In this context, the McGill Model of Nursing, which emphasizes leveraging the strengths of both the individual and their parents, is applied to promote their health potential and well-being. The McGill Model of Nursing assumes that all families have inherent health potential, and their capacity to overcome health-related challenges is central to promoting overall family well-being. The model seeks to enhance, empower, and sustain the health and resilience of individuals and families. It prioritizes developing, supporting, and complementing their abilities to manage current health conditions, diseases, challenges, and obstacles effectively. This study thoroughly examined the patient's hospitalization and treatment process, focusing on diabetes management, education, the discharge period, and post-discharge follow-up. The findings revealed that theory-based care significantly supported the adaptation process for both the child and the family.

Introduction

Autism spectrum disorder (ASD) is a collection of neurodevelopmental disorders that usually emerge during the pre-school years, characterized by challenges in social communication and interaction, as well as restricted and repetitive behaviors. According to the American Psychiatric Association, the severity and nature of symptoms in individuals with ASD can vary considerably. These challenges often lead to significant difficulties in daily life and are managed through various therapeutic and educational interventions [1]. According to the Centers for Disease Control and Prevention (CDC), the prevalence of ASD has increased from 1 in 44 children two years ago to 1 in 36 in 2023 [2]. The American Academy of Pediatrics recommends screening children for ASD at 18 and 24 months of age [3]. Although comprehensive studies on the prevalence of ASD in Türkiye are limited, the trend seems to follow global patterns [4]. It is estimated that approximately 1,142,586 individuals with autism, aged 0 to 14, live in Türkiye [5].

Type 1 diabetes is characterized by elevated blood sugar levels, hyperglycemia, due to insulin deficiency caused by the loss of pancreatic beta cells. It is a prevalent chronic condition among children and adolescents [6-8]. Both Type 1 diabetes and neurodevelopmental disorders are prevalent chronic conditions in childhood and adolescence, with the presence of one potentially increasing the risk of developing the other [7]. The global prevalence of diabetes continues to rise steadily. As of 2017, there were 451 million adults living with diabetes worldwide, and this number is expected to increase to 693 million by 2045 [9].

Adjusting to a new diagnosis of Type 1 diabetes can be especially difficult for both the child and the family, particularly when ASD is also present. Therefore, effective health management, family education, and comprehensive disease management are essential for supporting the child and family during this challenging time.

In this process, care delivered through a theory-based model of nursing can facilitate adaptation for both the child and the family. Nursing provides a structured framework for addressing individual health needs, managing treatment, and enhancing quality of life [10].

The McGill Nursing Model

The McGill Model of Nursing (MMN) was developed in the 1970s under the guidance of Dr. Moyra Allen and Mona Kravitz at the McGill School of Nursing in Canada. Originally referred to as "Responsive Nursing," "Allen's Model of Nursing," or "Complementary Nursing," the model was eventually refined and became recognized as the "Developmental Model of Health and Nursing" [11,12].

The McGill Model of Nursing is a holistic nursing model that places the individual and their parents at the center of care. It encourages individuals and families to take an active role in managing and improving their health. The model promotes a collaborative, empowering approach that enhances the overall well-being of both patients and their families [11,13,14].

The model defines the four key concepts of person, health, environment, and nursing, with nursing being viewed as an essential part of the environment [10,11,15].

Person: In the McGill Model of Nursing (MMN), the individual is viewed as a dynamic being who undergoes continuous changes from birth to death, adapting to these changes along the way. The individual, along with their significant relationships, is seen as a whole and as an open system that constantly interacts with and responds to its environment [16].

Health: Health is seen as a dynamic and multidimensional process. It is influenced by the daily life experiences of the individual and their parents, with a deep connection to developmental stages and the changes that occur over time. [12,17].

Environment: The environment plays a crucial role in helping the individual learn and adopt healthy behaviors. The nurse is responsible for creating supportive learning environments or adapting the existing environment to facilitate this process [12].

Nursing: Nursing is conceptualized as a science focused on promoting health and fostering positive interactions. The nurse's role involves helping individuals and families realize their potential, thereby contributing to overall health promotion [18,19].

In the MMN, nursing is described as a practice focused on collaborative and health-promoting interactions. Such interactions enable nurses to actively participate in the ongoing processes of change and learning experienced by individuals and their families. The nurse takes on a collaborative, facilitative, and motivating role, working alongside individuals and their families to support the development of healthy living habits. This process utilizes various techniques, including observation and knowledge sharing, asking awareness-raising questions, effective communication and active listening, information collection and dissemination, setting goals, decision-making, planning, testing out ideas, and collaboratively evaluating outcomes over time [17].

The most important concept in MMN is the 'Empowerment of the Family.' Some nursing models adopt a deficit-based approach, whereas others, including certain theorists, emphasize the concept of 'empowerment.' Newer frameworks like the MMN place empowerment at their core. In the MMN, nurses are encouraged to focus on the strengths of individuals and families, helping them recognize and utilize their own resources [13,20].

Assumptions of the Model:

1. Every family has inherent health potentials, including strengths, motivation, and resources, which serve as the foundation for health-promoting behaviors.

2. A family's ability to address health-related challenges and accomplish its goals demonstrates its progress in the health promotion process.

3. The outcomes of effective health promotion include enhanced competence in health-related behaviors and an overall improvement in health status [21,22].

This model seeks to improve the well-being of individuals and families by fostering active family involvement in nursing care. It views health as a dynamic process, with nurses supporting individuals and families in addressing and enhancing their health-related challenges [23].

It is widely recognized that various nursing models are used to manage chronic diseases. In pediatric patients with chronic conditions, family-centered care, self-management, and efficient resource utilization are essential for both the child and their family. Hence, we opted for the McGill Model of Nursing, which emphasizes empowering patients and their families and enhancing their capacity to deliver care.

Case Report

A 14-year-old male patient was diagnosed with ASD at the age of two. He has no known additional medical conditions and was born at term after an uneventful pregnancy. His medical history has been otherwise unremarkable until the age of two. The patient attends a special education school twice a week and participates in inclusive education at a state high school five days a week. Additionally, he takes computer and music courses at a private center twice a week after school. The patient's mother is a housewife, and the father is retired. The patient has no siblings and lives near downtown, with relatives nearby.

The patient had two episodes of nocturnal enuresis the week prior to hospitalization and was taken to the Family Health Center (FHC) by his mother. Blood tests at the FHC revealed a fasting blood glucose level of 170 mg/dL. Following episodes of nausea and vomiting, the patient was taken to the pediatric emergency department. Urinalysis showed 3+ ketones, and a blood glucose was 378 mg/dL. The HbA1c level was 12.4% (normal range: 4-6%).

The patient was evaluated at the pediatric endocrinology clinic. Following fasting and postprandial blood sugar monitoring, subcutaneous insulin therapy was initiated, consisting of bolus insulin administered three times daily and basal insulin once daily. During their hospital stay, the parents received education on managing type 1 diabetes. Blood glucose levels were monitored four times a day, and the patient was transitioned to a basal-bolus insulin regimen. Upon discharge, the patient and his parents were equipped with diabetes self-management skills and given instructions for follow-up appointments. Tables 1 and 2 present the implementation of the McGill Model of Nursing practice.

Table 1. Strategies to Identify the Individual's Strengths Using the McGill Model of Nursing

Table 1. Strategies to Identify the Individual's Strengths Using the McGill Model of Nursing

Table 3. Strategies to Mobilize the Individual's Resources Using the McGill Model of Nursing

Informed written consent was obtained from the parents, who were informed that the case would be used exclusively for scientific purposes.

Discussion

This case report discusses the care of a child with ASD and newly diagnosed Type 1 diabetes, using the McGill Model of Nursing (MMN). The MMN focuses on identifying both individual and family strengths and encourages the effective use of these resources to provide holistic care.

A theory-based care model was applied to the case, with parents receiving education on diabetes management skills. The patient was discharged after five days, during which insulin dose adjustments, blood glucose measurement, and management approaches for hypoglycemia and hyperglycemia were reviewed. Nutritional education additionally reinforced diabetes management. On the second day at home, the patient experienced hypoglycemia (blood glucose was 64 mg/dl) and contacted us by phone. The insulin dose was adjusted accordingly, and blood glucose levels remained within target ranges throughout follow-up. The primary challenge for the parents involved coordinating insulin administration and blood glucose monitoring with the child's school schedule. Adjustments were made to align insulin administration and blood glucose monitoring times with school breaks, and an additional snack was introduced on school days. One week later, during a follow-up visit, it was noted that both the child and the parents had successfully adapted to managing diabetes.

This approach fosters collaboration and holistic care in disease management. Diabetes self-management education, parental guidance, and regular use of resources significantly contributed to enhancing the child's quality of life. Structuring nursing care using theory-based models is essential for protecting and improving individual health. The application of evidence-based models, such as the McGill Model of Nursing (MMN), empowers patients and families, and promotes healthier lifestyles. This case report suggests valuable strategies for supporting children with chronic health needs and their parents, providing practical guidance for effective disease management and care.

Cite this article as: Kucuk Ulak S, Basbakkal DZ. Managing Diabetes on the Autism Journey: Guidance through the McGill Nursing Model. Pediatr Acad Case Rep. 2026;5(1):19-24.

Conflict of Interest

The authors declared no conflicts of interest with respect to authorship and/or publication of the article.

Financial Disclosure

The authors received no financial support for the research and/or publication of this article.

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