Juvenile Diabetes
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Descriptions, definitions, synonyms, organizer terms, types of
Description of Juvenile Diabetes:
Juvenile Diabetes is a disease of the endocrine system which is the body’s ductless hormone system and is responsible for maintaining homeostasis within the body. This disease of diabetes gets its name from Greek roots and it means to flow through and is resultant from the main symptom of frequent urination but this will be expanded upon later on in this site. Juvenile Diabetes, also known as Type 1 diabetes, is a disease in which the hormone insulin is no longer produced by the Beta Cells of the Islets of Langerhans. The function of insulin is to stimulate the uptake of glucose into the body’s cells by mobilizing glucose receptors to the cell surface. This has the effect of maintaining blood glucose level between the normal fasting levels of 70 to 110 mg of glucose per deciliter of blood. In juvenile diabetes the Beta cells of the pancreas are destroyed so that insulin is no longer produced and the body looses its ability to regulate its blood glucose levels. From the body’s inability to regulate its blood glucose level, a cascade of symptoms occurs.
Symptoms of Juvenile Diabetes:
As a consequence of the loss of the production of insulin, some or all of the symptoms can occur within individuals with Juvenile Diabetes.
1.Hyperglycemia- High Blood Sugar caused by the inability to absorb glucose
2.Glycosuria- Glucose in the urine because levels are too high to be absorbed by the kidneys
3.Polyuria- Water follows glucose by osmosis to increase the amount of urine
4.Polydipsia- Excessive thirst caused by loss of massive amounts of water
5.Hyperphagia- Excessive hunger because on is unable to get the necessary glucose absorbed
6.Ketoacidosis- This symptom is only seen in severe cases in which individuals have little effective treatment. Seen when the body breaks down fats for energy when it unable to absorb glucose. This Breakdown of fats forms Ketone Bodies that are acidic and raise the pH of the blood. This suppresses higher nervous functions and causes coma. Causes ones breath to smell like acetone because this is formed from the ketone bodies and is exhaled from the lungs.
Treatment:
Typically individuals with juvenile diabetes receive insulin injections several times a day to supplement the lack of insulin production in the individual. To coincide with this individuals typically regulate their diet by either monitoring their sugar intake or carbohydrate intake and along with monitoring their blood sugar they can maintain blood glucose levels that are close to normal. Some individuals have pumps that connect to them through a catheter and with monitoring their carbohydrate intake they can administer more effective insulin doses through this device and thus have a better blood glucose level.
Suspected Cause of Juvenile Diabetes:
It has been known since the 1970s that Juvenile Diabetes involved some aspect of the body’s own immune system playing a role in the destruction of the Beta cells of the pancreas. This theory was confirmed in vitro in the 1980s through research in France and once this was confirmed two major theories came about to explain it (Clinical & Exp. Immunology 1983: 571). The two explanations that came forth involved both the role that viruses played in triggering a response and the role that T-Cells played in causing the destruction of the Beta cells (Diabetes: Type I Annual Report: 2-3).
The first of the two prominent theories for the cause of an autoimmune response to the Beta cells involves viral interaction with these cells through modification and interaction with cells in the pancreas (Diabetes: Type I Annual Report: 3). The major aspect of this theory is that the body is exposed to a disease that triggers an immune response by body to target the Beta cells specifically and lead to their destruction. One of the major tenants of this theory is that a virus enters the body and has a similar resemblance to the body’s Beta cell epitopes and this triggers the autoimmune response: “T-cells and antibodies are tricked by this resemblance into attacking the beta protein as well as the virus” (Diabetes: Type I Annual Report: 3). A wide range of studies have been performed in hopes to verify this theory and determine which virus is responsible for triggering this response but no conclusive results have yet to be determined.
The second prominent theory for the cause of an autoimmune response is an invasion of the Islet cells by T-cells and this triggers an overactive response to destroy the Beta cells (Countdown Spring 2006: 8). The central concept to this theory is that when foreign material enters the Islet cells, the T-cells can enter and lead to destruction of the Beta cells in susceptible individuals: “… T-cells in the pancreatic lymph nodes encounter antigens from the intestinal tract, which may contain foreign material. This event instructs the T-cells to recognize and destroy cells bearing the foreign substance” (Countdown Spring 2006: 8). It is this theory that has more conclusive research behind it and tends to be favored by more and more researchers in the field of endocrinology.
Complications of Juvenile Diabetes:
Currently 16 million people diagnosed with diabetes in the United States
Of these 16 million, approximately 2 million have Juvenile Diabetes
Responsible for 200,000 deaths last year in the United States
On average the Life Span of an individual diagnosed with diabetes decreases by 15 years
Costs for treatment and diagnosing Diabetes was $132 Billion in the United States during the year 2000.
Associated Health Problems:
Increases susceptibility to the following diseases:
- Heart Disease (2x) - Blindness (75x) - Non-traumatic lower-limb amputations(5x) -Kidney Disease (7x)
Diabetes in the Classroom
Having a student with Juvenile Diabetes can be a challange if the teacher is not aware of the symptoms and physical and learning problems that it can cause.Having a student who has a chronic illness needs to be addressed by the coperative work with the student,parents,teacher,and class itself.Good communication between the home and school is important.
Application in classrooms
Juvenile Diabetes in the Classroom
Before discussing the instructor’s role in teaching a student that is diagnosed with Juvenile Diabetes one must have a knowledge base of the rights the student has by law. All children with juvenile diabetes are protected by a federal statue known as Section 504 of the Rehabilitation Act of 1973 (JDRF). This law allows parents to develop written agreements with schools to guarantee special services for the student and these agreements are called a Section 504 plan or they can also be known as the common name of an Individualized Education Program or IEP (JDRF). This statue and these plans commonly guarantee several important rights for the student. Of these rights the following are some of the most common:
1. Full-time nursing supervision in the school
2. Eating whenever and wherever necessary
3. Going to the bathroom as needed
4. Participating fully in all activities and fieldtrips
5. Eating lunch at the appropriate time
6. The right to monitor blood glucose levels, administer insulin injections, and wear insulin pumps whenever deemed necessary by the student
With these rights in mind the teachers have certain duties and responsibilities to perform when they have a diabetic student that is within the class room. In order for this to happen the US Department of Health and Human Services recommends that schools distribute informational sheets to all staff members so that they can recognize the signs of trouble within a diabetic student. To aid in this, they also recommend that all the teachers of a student with diabetes have a Quick Reference Emergency Plan which points out the signs of trouble through hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) and what needs to be done to fight this.
Common Symptoms for Teachers to Recognize:
Mild
• Hunger
• Shakiness/Dizziness
• Drowsiness
• Personality Change
• Irritability
• Inability to Concentrate
Moderate
• Headache
• Poor Coordination
• Blurry Vision
• Confusion
• Slurred Speech
Severe
• Loss of Consciousness
• Seizure
• Inability to swallow
Common Symptoms of Hyperglycemia
Mild
• Thirst
• Frequent Urination
• Increased Hunger
• Blurred vision
• Sweet, Fruity Breath
. Tired or lethargic
Moderate
• Mild Symptoms plus the following
• Dry mouth
• Nausea
• Vomiting
Severe
• Mild and Moderate symptoms plus the following
• Heavy Breathing
• Very Weak
• Unconscious
• Confused
When a teacher recognizes these symptoms they must contact the school nurse or their schools trained diabetes personal immediately so that the student can receive the necessary treatment. In order for the teacher to be properly prepared to recognize and identify the symptoms shown earlier there are several important actions that they must undertake (Dept of HHS). First and foremost teachers who have direct contact with the student should be aware of and try to involve themselves in the development of the students 504 Plan (Dept of HHS). Teachers should be aware that a behavioral change could be indicative of symptoms of blood glucose changes (Dept of HHS). They should also be readily able to recognize and respond to the symptoms of hypoglycemia and hyperglycemia. Teachers should also be accommodating to the needs of the student and provide a supportive environment for the student. Teachers should also provide the necessary instruction to the student for any diabetes related absences. Teachers should also learn more about diabetes in general through the informational handouts supplied by the administration (Dept of HHS).
Evidence of effectiveness
Critics and their rationale
Alternative explanations due to Diversity considerations
Signed “life experiences”, testimonies and stories
As a mother of a Juvenile Diabetic and also a teacher ,I have a great concern for the wellbeing of my child and other students when they are at school.My son contracted diabetes at the age of six after a summer cold.Since then his life has been centered around dealing with the effects of the disease.It is important to have a good relationship with the school and make sure that the teachers understand the side effects of diabetes,especially low or high blood sugar levels(possible coma).Many times my son had experienced low sugar and passed out in the classroom.It is important that teachers understand that when the child experiences low blood sugar they do not remember and are unaware of their surroundings.After extreme low blood sugar for three days in a row,my son fell and had to be on crutches for three weeks. The teacher told my son to tell his mom that his sugar was low but, the teacher failed to realize that during an episode of low blood sugar the child won't remember.It is also important not to let the student walk alone to the office when they are feeling a low sugar.My son has adjusted well.He treats his diabetes as a part of his life.His fifth grade science project was about diabetes, titled "5000 Shots and Still Going Strong." I hope all schools treat students with diabetes as normally as possible but be aware of how serious a disease it is.A.H.
My daughter was diagnosed with Juvenile Diabetes at the age of 12. Since this was new to all of us, we weren't quite sure how her school would handle the changes that diabetes brings, such as testing her blood sugar, extra trips to the bathroom, eating snacks in her classroom, etc. Since there was no nurse at the school, she was on her own, with the help of the school secretary. I spoke to each teacher to telling them what the signs and symptoms of both high and low blood sugar were and that she could "feel" when her blood sugar was low.Each year the teachers were given the "Know the Difference"sheet explaining the difference between the two. She always carried glucose tablets with her and a box with food items to provide sugar when she was low was kept in the classroom closet. High school was a bit more challenging. She was further away, and started to become more lax with her eating habits, causing quite a few hypoglycemic episodes, especially upon waking. I've been bit, spit at, screamed at, all by trying to get her to have some sugar and orange juice. Being a teenager is hard enough, but a teen with diabetes was something that she didn't want to deal with, which caused many, many arguments between us. We knew one of the teachers at her school from a support group at the hospital that had a child the same age who also had diabetes. It was comforting to us to know that she was there and that she understood what our daughter was going through. Thankfully, she never missed a day of school due to anything relating to diabetes, only a case of mono kept her home for a few days. She has been hospitalized once for severe hyperglycemia, went on the insulin pump for a few years but had to stop because of skin infections. She is now 25 years old and living on her own. I hope and pray everyday that there will be a cure for this disease in her lifetime. C. Ryan
My son was diagnosed at age 3, and has now had diabetes for nearly 21 years. Much has changed since he was diagnosed, in fact the technological advances have been astonishing. When he started school it was rare to have a child with diabetes, so it was truly a learning experience for ALL involved. The school was wonderful, and very eager to learn, understand and know my son well enough to take good care of him while he was in their hands. Still, as much as one can teach them, much of what we learn as parents is fromthe experience, day in and day out.
As a child growing up with diabetes, my son suffered many, many low blood sugars or hypoglycemia. He was always a very active child, and I didn't want that to change because of his illness. His participation in all kinds of sports and activites kept him from feeling different than other children. Because he grew up with the disease, the shots and testing became routine (if that's possible.)
I kept all my sons supplies in the office at school (though I also kept a box of snacks & juice in his classroom too.) A testing meter, strips, cotton, alchol swabs, and lancets were kept in a box with a locking lid. In addition, there were glucose tablets and gel in the box. In a separate container were snacks that were already the correct amount for him to eat/drink in order to bring up a low blood sugar. I would also keep glucose urine strips, or Keotone strips in his supplies in case his blood sugar was running high, or hyperglycemia (usually tested after a reading of 200-250.) If my sons blood sugar was high, the school would call me at home, or page me (yes, that was before cell phones) and I would call them from the nearest pay phone. I wold find out what his blood sugar was and assess whether or I should run up and give him an additional shot. Most times this was the case, however if he was slightly high, I would have him drink as much water or diet pop as he could handle. The unsweetened fluid help dramatically in bringing down the slightly elevated blood sugar. As years went by, the entire school started getting involved in the learning process (as opposed to just the teachers my son was in contact with, and the office personnel.) This is a great thing, but I feel it is all to easy to forget important things when one is not dealing with the diabetes on a regular basis. Even I could miss a sign of a low or high blood sugar now and then, and I dealt with it 24/7.
One of my sons biggest complaints through out school was the lack of knowledge the nurse/nurses assistant had regarding diabetes. In fact, when my son got to highschool, he started refusing to go to the office to check his blood sugar since they absolutely had no clue as to what he really should or shouldn't be doing, and it frustrated him a great deal. I cannot find much fault in regards to the nursing personnel in our schools since when he was younger they were absolutely great. Also, it is very difficult to be well versed in every condition that the nurses at school encounter. Still, with the prevalence of diabetes now (and as my son started getting older,) there is certainly little excuse for these caretakers not to know the signs, symptoms of highs or lows, and what to do about them.
While my son was young (under the age of 14,) and he would suffer an overnight hypoglycemia episode, I would many times have to hold him like he was in a straight jacket in order to get anything down his throat. My son would be thrashing his arms, kicking his legs, slurring protests at me, while refusing to cooperate in the least. I would literally squeeze a tube of glucose into his mouth (or cheek,) so that it would be absorbed. Of course this takes time to go to work (usually 15 minutes,) so all the while I had to hold him tight until things started improving. There weren't many episodes that I couldn't treat manually (as described, or with a glass of juice,) but there were times when I had to give him a shot in order to bring up his blood sugar. It's not insulin, but is instead named the emergency Glucagon kit, and is kept on hand and stored in the refrigerator. The newest ones are even easier to use then the one I first started out with. Using this shot is always a last resort, since it usually makes them very sick afterwards and often lasting the entire day. Still, I was thankful to have it on hand for those rare occassions when my son was completely untreatable in any other fashion.
Highschool and college are tough, but we made it through with out too many bumps. Of course they want to eat, drink and be merry just like all the kids who don't have diabetes. No matter how or what you attempt to drive home, they are going to experiment with drinking. I stressed to my son before he left that though I wish he wouldn't drink, that I also didn't have any pie in the sky notion that he wouldn't drink with his friends. I stressed moderation, 1 or 2 drinks most. I taught him the importance of checking his blood sugars routinely while drinking, and to make sure he let his friends know to watch him for any unusual behavior since he coulc be experiencing a low blood sugar, and not the effects of the alcohol. In addition, I told my son to be sure he didn't omit eating in order to have his drinks, which is a common but dangerous practice.
We had a scary incident where my son had too much to drink, and started getting sick to his stomach. Luckily he had done what I had asked of him and told his friends about his diabetes and how he might be low. His friends were great, and as soon as he started getting sick, they got a driver who hadn't been drinking and took him over to the nearest ER. My son was placed on an IV for a short time, and was then allowed to go back to his dorm. We picked him up as soon as we learned of his experience (early the following morning,) and brought him home for the week-end. I didn't criticize my son, but instead praised him for letting his friends know the symptoms of a low or high blood sugar, and for them to be on alert. Many of his closest friends knew how to check my sons blood sugar as well, which was a huge benefit. I did speak to my son about having too much to drink, but I didn't lecture him, nor did I need to. What happened was the most powerful lesson he could learn, and one that I could not have taught him simply by educating him. As they say, 'experience is the best teacher', though this was certainly a dangerous one.
Though my son tried switching to an insulin pump before his senior year in highschool (which I insisted on since he'd have a full year of experimentation while still under my supervision.) A month after being on the pump he suffered the only episode he has ever had with ketoacidosis. Ketoacidosis happens when a person with diabetes has such high blood sugar that most or none of the sugar in the blood is able to be absorbed by the red blood cells. This happens because of a severe lack of insulin. Insulin acts as a key in unlocking the doors to the cells so the glucose can be absorbed for energy. When the body can no longer is getting the sugar/glucose it needs for energy (ALL food is broken down into sugar,) then the body resorts to burning body fat for energy. As the body fat is being broken down to be used by the body for energy, it releases an acid (called Keoto-acid) which causes the person with high blood sugar to get dangerously sick (dehyrdated, vomiting, weakness) At this stage, it is a dire emergency to get this treated at a hospital ER. When placed on a pump, one uses fast acting insulin only (in most cases.) If that fast acting insulin isn't being supplied to the blood stream for any reason (i.e. kink in the tubing, pump not working,) the blood sugars rise up to ridiculous levels in a very short time. Even though we recognized something was going on after 2 high blood sugar readings, and started supplementing immediately with insulin injections, we were unable to get the blood sugar down. After hours of attempting to treat it ourselves, my son was so sick that we couldn't even get him to rise out of bed. We of course called the emergency number and let the paramedics get him started on an IV, and transport him to the hospital. My son ended up staying in the hospital for about 4 to 5 hours, during which time he had an IV to replace all the fluids his body was deprived of during the hyperglycemia. My son was also given something to stop him from throwing up any longer, since this was making the dehyrdration even more dramatic. It was amazing the change that took place once my son was properly hydrated and had normal glucose again. Though he was exhausted from being up all night, he came home and slept and was no worse for wear. I cannot stress enough the importance of acting on the situation I described above immediately, it can be deadly.
To my sons credit, he continued on the pump for the rest of his senior year in highschool. However, many things contributed to him finally reaching the decision to quit the pump. My son has always been very slim, and he just seemed to struggle with finding a good spot to place the pump. Since he had very little body fat to speak of, he would usually be able to feel the pump the entire time it was in place, and it was not comfortable for him. In addition, since my son was very big into athletics, he had a routine problem with keeping the adhesive patch in place that covered and kept the candula in place. Because of this, he was having to re-insert the pump sometimes on a daily basis. Of course this chipped away at the benefits the pump provided, thus eventually leading my son to switch back to multiple daily injections.
My son has always been good at checking his blood sugars, and treating any highs or lows promptly. There are many days that he gives himself 4-8 insulin injections in order to keep his blood sugar where it is supposed to be. Routinely it take 4-5 injections, however on days he has repeated high blood sugars he must act appropriately with more injections. Thankfully the needles really don't hurt going in, and if there is any pain, it is probably due to the insulin being injected too quickly, or cold.
The current bottle of insulin being used by my son is kept at room temperature, which is what is recommended. Insulin should never be exposed to extreme hot or cold temperature since this can affect it's ability to work properly. Insulin stored at room temperature however, can only be used for a month before needing to discard and start a new bottle. One needs to change the bottle of insulin regardless of how much insulin still remains in the bottle. If one uses insulin over 30 days at room temperature, the risk is great that it will lose its effectiveness.
I'm happy to say that my son is healthy, goes to his check ups regularly, and continues to take care of his diabetes to the best of his ability. He remains very active, and works out regularly at a gym besides being involved in a soccer league. N.
References and other links of interest
Boitard et al. “Anti-pancreatic Immunity. In vitro Studies of Cellular and Humoral Immune Reactions Directed Toward Pancreatic Islets.” Clinical and Experimental Immunology. March 1984, Volume 55 Issue 3, p571-580.
“Diabetes: Type 1” Diabetes: Type I Annual Report. February 2005, Report 9, p1-16.
“Possible Mechanism Found For Type 1 Diabetes Trigger.” Countdown. Spring 2006, Vol. 27 Issue 2, p8-8.
[Juvenile Diabetes Research Foundation]
[Department of Health and Human Services: Helping the Student with Diabetes Succeed]
