What is Diabetes?
Diabetes occurs when the pancreas is either unable to produce sufficient insulin (Type I), or body cells are unable to utilize effectively the insulin that the pancreas produces (Type II). Ten percent of diabetics have Type I and the remaining ninety per cent have Type II. Generally, Type II diabetes develops in middle or later adult life, while diabetics who are diagnosed as a children and young adults have Type I. Recently, increasing numbers of children, in high-risk populations, are being diagnosed with Type II diabetes. Risks include a number of factors, some genetic, e.g. Aboriginal Canadians are at greater risk; and some environmental factors, e.g. poor diet, excessive body weight and inactive lifestyle. With both Type I and Type II diabetes, there is usually a history of the disease in the family. Diabetes is not contagious.
What are the symptoms of diabetes? (hyperglycemia)
Symptoms of both types of diabetes are similar, however, with Type I diabetes, the onset of symptoms is more acute. Symptoms include:
- unusual thirst
- frequent urination
- rapid unexpected weight loss
- lack of energy/extreme fatigue
These symptoms occur because the body is unable to utilize the glucose in the blood to feed the cells. Without treatment, the blood glucose levels will continue to climb. This results in poor blood circulation and eventual damage to vital body organs such as kidneys, heart, eyes, and brain. This condition is called Hyperglycemia.
Treatment of Diabetes
Treatment is aimed at lowering blood glucose levels to a more normal range. In non-diabetic individuals, the normal range is between 5.0 to 7.2 mmol/L, depending on how recently a person has eaten and what food they have ingested. The natural control of blood glucose is through the release of insulin from the pancreas. Type I diabetics must take their insulin by injection, usually two to four times a day, as recommended by their doctor. Diet and exercise are also essential elements of diabetic control. Insulin requirements will vary considerably with the type and quantity of food eaten and the amount of physical activity a diabetic has had. For this reason, regular self-monitoring of blood glucose is essential, preferably at least four times daily.
Blood glucose is monitored by a glucometer, a pocket sized electronic device that reads the blood glucose level from a small drop of blood. The diabetic person will obtain the blood for testing through a shallow finger prick with a sterile lancet. A small drop of blood is squeezed from the finger onto a testing strip. The drop is left on the strip for a timed interval, (30 to 60 seconds), then wiped away. The strip is then placed in the glucometer and a blood glucose reading is obtained.
What is Hypoglycemia?
A blood glucose reading of 4.0 mmol/L or less indicates a dangerous condition called Hypoglycemia. This has occurred because the diabetic has used most of the glucose in their blood and is unable to convert fat stores to glucose in the way a non-diabetic can. This has occurred due to one or more of the reasons listed below:
- the diabetic has injected more insulin than required for the amount of food that was consumed
- a snack was missed or a meal was not finished
- the meal was not properly balanced to provide enough carbohydrates
- the diabetic exercised strenuously and did not adjust his/her insulin requirements accordingly
Hypoglycemia can have a rapid onset and may result in some or all of the following symptoms:
- sweating
- trembling
- dizziness
- mood changes and irritability
- hunger
- headaches
- -blurred vision
- -extreme tiredness and paleness
If left untreated, Hypoglycemia may lead rapidly to coma.
How to manage the diabetic student in school
At the beginning of each school year, the diabetic student and his/her parents should meet with the principal and relevant school staff. The following are issues that should be discussed:
- the time, frequency and location for the student to eat snacks, test blood glucose levels, and administer insulin. With primary school aged diabetic students, the teacher may want to allow the whole class to have a snack when the diabetic student is having his/her snack. The older student may be reluctant to eat during class when other students are prohibited from doing so.
- establish a small, private location for the student to test blood glucose levels, eat snacks and administer insulin. The younger student may have an adult aide to assist with diabetic management at school
- determine whether or not the student wants classmates to know of his/her diabetes and if so, how to present this information
- determine how the student and his/her parents want to manage good sharing that may occur during recess and lunch time, class parties, special events and field trips
- be aware that food requirements may change with gym, strenuous activities and active play
- discuss the strategy for the student to use when frequent trips to the bathroom and extra water is required. This may be due to hyperglycemia, too much glucose in the blood. It is important for the student not to be ridiculed or punished for these needs
- become familiar with the early signs of hypoglycemia that the student experiences
- determine a strategy to deal with these symptoms
- prepare several kits of high sugar agents, containing: juice boxes or regular pop, packets of sugar or honey, glucose tablets. Distribute these kits to the student’s teacher(s). Keep a kit in the gym and one for the schoolyard. These items can be kept in or near the general first aid kit. Become familiar with the emergency treatment of hypoglycemia.
- with older students, determine if the school should notify parents when symptoms of hypoglycemia or hyperglycemia have occurred at school
Whenever possible, be discrete and respect the privacy of the diabetic student.
References
The Canadian Diabetes Foundation
15 Toronto Street, suite 800
Toronto, Ontario
M5C 2E3
Web Site:
www.diabetes.ca
Ph.: (416) 393-0177 or 1-800-BANTING, (1-800-226-8464)
Fax.: (416) 214-1899