Type 1 Diabetes in Children
Wilson, Sarah A. B., Posey, W. Mark, Schneider, Elizabeth M., National Association of School Psychologists. Communique
Type 1 diabetes is a relatively common childhood chronic health condition in which the pancreas makes insufficient insulin (Watson & Logan, 1998). Insulin is necessary in order to metabolize glucose (or sugar) in the blood, which the body then uses as its main source of energy. Type 1 diabetes is an autoimmune disease for many patients because the pancreas stops making enough insulin when the immune system destroys most of the beta cells in the pancreas. Still, for some patients with Type 1 diabetes, there is no known cause.
Prior to diagnosis, children with Type 1 diabetes often experience a combination of the following symptoms: increased blood sugar, frequent urination, excessive thirst/appetite, weight loss, elevated blood sugar (hyperglycemia), glucose in the urine, and a significant increase in ketones found in the blood and/or urine. Ketones are chemicals produced when the body breaks down fat for energy due to insufficient insulin. Because the child with Type 1 diabetes does not produce sufficient insulin, insulin must be administered, usually by insulin pump or insulin injection. Most children maintain healthy blood sugar levels by using a combination of rapid acting and long acting insulin. Rapid acting insulin begins to lower blood sugar almost immediately, while long acting insulin begins to lower blood sugar within 4 to 6 hours. In order to determine how much insulin they need, children with diabetes must check their blood sugar multiple times per day using a blood glucose meter. In addition, a child's HbA1c (glycosylated hemoglobin) is a blood test that provides a measure of average glycemic control over several months. Glycemic control is the degree to which blood glucose is maintained within the normal range of glucose values. The amount of insulin that the child needs throughout the day is also determined by counting the number of carbohydrates the child will eat or has eaten during meals or snacks. Thus, the treatment regimen for children diagnosed with Type 1 diabetes requires frequent, close monitoring of the child's diet and blood sugar levels. Consequently, parents and children must be educated in the skills necessary for successful treatment adherence. A certified diabetes educator provides this education to families, most commonly at a local hospital. Typically, an Individualized Health Plan (IHP) is developed with the school to ensure that the child's health needs are recognized and addressed in the school setting as well.
Without acceptable treatment adherence and the availability of sufficient insulin, children with Type 1 may experience a range of short-term and long-term effects (Watson 8c Logan, 1998). A child's treatment adherence determines how well the diabetes is controlled, and poor glycemic control has been associated with increased negative effects. These effects may be physical, cognitive, academic, psychosocial, or behavioral in nature.
Diabetes often results in acute effects because of hypoglycemic or hyperglycemic episodes. These episodes arise when insulin, diet, and physical activity are not properly balanced. Hyperglycemia occurs when blood glucose is abnormally high, while hypoglycemia occurs when blood glucose is lower than normal. The short-term physical effects of poor control may include a return of prediagnosis symptoms if the child is hyperglycemic. Individuals experiencing hyperglycemia or hypoglycemia may present with symptoms that include confusion, hunger, trembling, sweating, sleepiness, inability to speak, blurred vision, fatigue, dry mouth, irritability, excessive thirst, and/ or excessive urination. A child experiencing hypoglycemia with a rapid drop in blood glucose levels may appear shaky, pale, or sweaty. At this time, children may require an injection of glucagon in order to raise their blood sugar. Glucagon is a hormone produced by the pancreas that acts to raise blood sugar. The potential similarity in symptoms between hypoglycemia and hyperglycemia highlights the importance of learning the child's unique behavioral symptoms for each condition. …