Understanding Students with Diabetes: Implications for the Physical Education Professional
Petray, Clayre, Freesemann, Keith, Lavay, Barry, JOPERD--The Journal of Physical Education, Recreation & Dance
Alisha, a fourth-grader, told her physical education teacher that she had diabetes and needed to test her blood sugar level. The teacher told her to wait until later and return immediately to finish the parachute activity. A few minutes after rejoining the class Alisha collapsed. Alisha's physical education teacher did not understand diabetes and the dangers of having a low blood sugar level.
This dangerous scenario could occur if the physical educator does not understand diabetes and the necessary steps for providing safe and successful experiences for students with diabetes. This article will provide the physical educator with an understanding of diabetes and important considerations when teaching physical education to students with diabetes. In this article we discuss four aspects of diabetes: an overview; common questions and answers concerning the control of diabetes; balancing insulin, food intake, and physical activity; and implications for the physical education professional.
Overview of Diabetes
Diabetes, a major national health problem, is now recognized as the third leading cause of death in the United States. People with diabetes have an increased risk of heart attack, stroke, kidney disease, blindness, and gangrene. More than 14 million Americans currently have been diagnosed with diabetes and an estimated 2 million people have diabetes but are not diagnosed. In addition, approximately one in 600 school-age children have diabetes.
Diabetes is a chronic metabolic disease that interferes with the body's ability to produce or use insulin or both. The body fails to burn carbohydrate intake properly, so glucose accumulates in the bloodstream. This condition is known as hyperglycemia, an overabundance of blood sugar. The name diabetes mellitus means literally "sweet urine" and refers to an overabundance of blood sugar in the urine of the uncontrolled diabetic.
A simplified cycle of normal glucose metabolism is shown in figure 1. As the cycle begins, food is consumed and digested (Phase I). Most of the food is converted to glucose and the blood sugar level in the bloodstream rises (Phase II). The increased blood sugar results in the secretion of insulin by the pancreas (Phase III). The insulin enables the glucose to enter the body's cells, providing energy for the body to perform normal functions (Phase IV). As the insulin acts on the raised blood sugar, the food intake is metabolized and broken down into usable form and can be used by the cells of the body, thus decreasing the blood sugar level to a normal range (Phase V) [ILLUSTRATION FOR FIGURE 1 OMITTED].
Diabetes results from the body's inability to produce or use insulin. Little or no insulin is secreted from the pancreas. The result is that glucose is unable to enter the body's cells and the body cannot perform normal functions. As glucose remains unused in the bloodstream, continuing to add to the blood sugar level, the body's cells begin to rely on converting stored fat cells into energy. As this continues, ketone bodies - waste products that result from fat metabolism - accumulate in the bloodstream and are eliminated from the body through the kidneys, spilling over into the urine. In uncontrolled diabetes, the concentration of ketones becomes very high and a strong acid effect known as ketoacidosis occurs (Eichstaedt & Kalakian, 1993; Sherrill, 1993). Ketoacidosis, if left untreated, can lead to death.
The Two Types of Diabetes
Diabetes is categorized into two groups: Type I and Type II. In Type I, known as insulin-dependent diabetes mellitus (IDDM), the pancreas produces little or no insulin. The Type I diabetic needs to administer insulin to properly use glucose and thus remain alive. Type I has a rapid onset that typically occurs in childhood or adolescence.
In Type II diabetes, known as non-insulin dependent diabetes mellitus (NIDDM), the pancreas does produce insulin; however, the insulin does not function properly. …