- Type 1 vs. Type 2 diabetes
- Risks and side effects
- Diabetes management in the classroom
Diabetes occurs when the body either fails to produce enough insulin or is unable to properly use the insulin it does produce. Insulin is needed to metabolize glucose (sugar) in order to generate the energy the body needs to function. In diabetics, the sugar is not broken down and metabolized properly, so blood sugar levels become too high. Diabetes is a chronic health condition; although helped by treatment, it is not curable.
Type 1 diabetes used to be called juvenile diabetes because it is most often diagnosed among children or young adults. It is usually an autoimmune disorder in which the body’s own immune system destroys the cells in the pancreas that produce insulin. In type 1 diabetes, the body makes very little insulin. Type 1 diabetes usually develops very quickly.
Type 2 diabetes is by far the most common type among adults. In type 2 diabetes the pancreas still produces insulin, however, the body’s tissues do not respond to it properly. This is called insulin resistance. Unfortunately, type 2 diabetes and insulin resistance are becoming much more common in children and adolescents because this type of diabetes is highly associated with obesity. There is often a strong family history of type 2 diabetes and it is commonly seen in children with African-American, Native American, and Pacific Islander backgrounds. Type 2 diabetes usually develops slowly over many weeks.
The Center for Disease Control (CDC) reports that 151,000 people under age 20 have diabetes. In the United States, the rate of type 1 diabetes in children is 150 to 200 cases per 100,000. The exact prevalence of type 2 diabetes in children and adolescents is not known.
When the blood sugar is too high, sugar is excreted into the urine by the kidney. This causes frequent urination in the daytime and bedwetting at night. Children with diabetes often drink a lot to try to replace lost fluids. Hunger is common, but children with diabetes may eat a great deal without gaining weight.
When children with diabetes don’t have enough insulin to burn glucose, they metabolize fats for energy instead. By-products of fat metabolism called ketones accumulate in the blood and can cause nausea, vomiting, fatigue, rapid breathing, and even diabetic coma.
Patients who are getting adequate treatment may have no symptoms at all. Sometimes children with diabetes may develop low blood sugar (hypoglycemia) if they have vomiting, get too little to eat, or get too much insulin. Hypoglycemia can cause anxiety, perspiration, rapid heart beat, weakness, tremors, headache, confusion, seizures, and speech or vision problems. Sometimes low blood sugar will cause inability to concentrate and personality changes.
When a doctor suspects diabetes, blood and/or urine tests looking for high levels of sugar and ketones are usually performed to make the diagnosis. Even if the patient is not ill, the urine usually contains sugar in type 1 diabetes.
Type 2 diabetes is harder to diagnose and usually requires a fasting blood glucose level. If the blood sugar level is less than 100 after an overnight fast, the patient’s blood sugar level is deemed normal. If the sugar is over 125 on two tests, conversely, the patient has diabetes. Patients with fasting blood sugar levels between 100-125 are more likely to develop diabetes in the future, so their health status is referred to as “pre-diabetic.” Measuring antibodies against pancreatic cells will help differentiate type 1 from type 2 diabetes (These antibodies are found in type 1, but not in type 2 diabetes). A test called the hemoglobin A1c, or glycosylated hemoglobin, is used by physicians to see if blood sugar levels are too high over a several month time period.
- Insulin. The only treatment for youngsters with type 1 diabetes is insulin, which must be injected under the skin. There is no insulin pill or syrup. The dose of insulin is determined by blood sugar levels and the amount of carbohydrates (sugars) eaten in the diet. Some students receive insulin from hypodermic injections several times per day, others by use of insulin pumps. In either case, insulin is designed to keep blood sugar levels within an acceptable range. Children with diabetes check their sugar levels by getting a small drop of blood from their finger and testing it with a glucose meter. This is often done with each meal and at bedtime. Some patients with type 2 diabetes will need insulin when first diagnosed or during a crisis, such as a hospitalization.
- Pills. Pills, taken orally, have a role in treatment for many patients with type 2 diabetes. These pills help by allowing the body to use its own insulin better, enabling the pancreas to produce more insulin, or reducing the amount of sugar in the blood stream. A medication called metformin (Glucophage) is often used in children with type 2 diabetes.
- Exercise and weight control. Exercise and weight control are potential treatments for many teens with type 2 diabetes. Better eating and exercise help the body use its own insulin better.
- Controlled food intake. Students with diabetes must balance the food they intake with the insulin that is administered. Consequently, food intake must be planned and monitored at mealtimes and during scheduled snacks, which are almost universally prescribed. Some children will take a specific amount of insulin for every gram of carbohydrates eaten (i.e., 1 unit of insulin for every 20 grams of carbohydrates). This is called a “Carb Ratio.
The biggest short-term risk is actually a low blood sugar level caused by getting too much insulin from the amount of food eaten. Low blood sugar (hypoglycemia) can cause several problems that are listed in the symptoms section above, but the most serious problem is seizures or convulsions. Patients with hypoglycemia need to eat food or drinks with high sugar content. Sometimes a medicine called glucagon is injected to raise the blood glucose level in severe hypoglycemic emergencies (i.e., seizures).
Long-range risks and complications of diabetes can be quite serious. Many patients, including your affected students, may be alarmed upon first learning about them. Complications include poor growth, heart disease and high blood pressure (cardiovascular), visual loss (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Complications can often be minimized when the blood sugar levels are controlled within a very strict range. A set of classroom problems related to learning, attention, and memory are discussed in the Classroom Problems and Solutions section.
The EdMedKids website does not make recommendations about medical management. We offer general information to help inform teachers. Most students with diabetes require their blood sugar to be checked before each meal, at bedtime, and when they have symptoms of either high or low blood sugar. This means that a skin prick and blood glucose monitoring needs to occur at school. For each student, a plan will need to be generated to assure that this is consistently accomplished. Options include allowing students to perform testing themselves or requiring them to take a trip to the nurse’s office. EdMedKids provides a link to a comprehensive Diabetes Management Plan developed by the National Institute of Health that can be used to help manage the disease in class.
Most students with diabetes will also need options for snacks at school. Thus, most carry various sugar sources, such as juice or other sugar-containing beverages, glucose tablets, or raisins with them while at school. Most physicians recommend that Glucagon is available in the school for hypoglycemic emergencies.