A Balancing Act - A Good Explaination of Type 1 Diabetes

Today started off well because the weather was great and I got out to exercise. However, my enthusiasm led me to push myself too hard. And I ended up with hypoglycemia, low blood sugar, in the middle of my day. When it's a bad one like today's I'm usually zapped for the rest of the day. Hence why I'm sitting here typing rather than doing something else like going out tonight.

Instead, I decided to search about diabetes, fatigue and insulin reactions. I've not found anything particularly interesting on that, but I did find a well written web page for people who have Type 1 diabetic children in their care. It's on the Juvenile Diabetes Research Foundation Canada's website. It explains how the disease works in awesome detail. I'd say it's not just for people looking after kids. It's for anyone who wants a clear, but fairly short explanation of what Type 1 diabetics have to deal with and how to help them when needed.

A Child With Type 1 Diabetes Is In Your Care

Facts You'll Need to Know

This information is for people who may from time to time be responsible for a child with type 1 diabetes. It is designed to provide basic information about type 1 (insulin-dependent or juvenile) diabetes so that you can feel comfortable with the child.

Whether you are a teacher, a camp counselor, a baby sitter, or a relative, you should realize that:

* Children with type 1 diabetes have the same needs for guidance, support, and understanding as other children.
* Type 1 diabetes is not contagious.

Type 1 Diabetes Defined

Type 1 diabetes is a chronic disease. In the child with type 1 diabetes (juvenile diabetes), the pancreas does not produce insulin, a hormone necessary to sustain life. Without insulin the sugar in the blood can't be used. It builds up in the bloodstream even while the body is starved for energy. A person with type 1 diabetes must take one or more injections of insulin daily to stay alive.

Insulin, however, is not a cure. It is only a means of controlling the disease.

How Type 1 Diabetes Is Controlled

Type 1 diabetes control means keeping the level of sugar (glucose) in the blood as close to normal as possible. The three variables of type 1 diabetes control are: food, exercise, and insulin. Self monitoring of blood glucose is the tool for tracking and maintaining the balance among these variables.

The rule of thumb is: food makes the glucose level rise; exercise and insulin make the glucose level fall. Type 1 diabetes control is a constant balancing act of food, exercise, and insulin. Blood glucose monitoring is the tool for maintaining this balance. If the balance is thrown off, either of two type 1 diabetic emergencies might occur: hypoglycemia (low blood sugar, an insulin reaction, or insulin shock) or hyperglycemia (high blood sugar).

Low Blood Sugar (Hypoglycemia)

The emergency situation you are most likely to encounter in caring for a child with type 1 diabetes is low blood sugar, also known as an insulin reaction or insulin shock. Low blood sugar may be caused by eating too little food or not eating soon enough after a previous meal, by too much physical activity without eating, or by too much insulin. Symptoms listed below appear suddenly.

Each child has a particular set of personal symptoms that you will come to recognize.

* Headache
* Sweating
* Shakiness
* Pale, moist skin
* Cold and clammy
* Extreme hunger
* Weakness/Dizziness
* Fatigue/tiredness
* Rapid pulse rate
* Blurred vision
* Shallow breathing
* Inability to concentrate
* Loss of coordination
* Mental confusion
* Seizure
* Loss of consciousness

Treatment

If the child is awake and can swallow, provide sugar immediately. Give 1/2 cup of fruit juice, non-diet soda, or two to four glucose tablets. The child should be feeling better within 10 minutes. The child should then eat some additional food, such as half a peanut butter, meat, or cheese sandwich. The child can then resume normal activities. If the child does not respond immediately or does not improve in 10 to 15 minutes, treat the reaction again. Make sure the reaction has been taken care of before the child is left alone or allowed to go home.

If the child has lost consciousness or is having a seizure, administer glucagon and call your doctor. If you do not know how to give glucagon or do have it available, call 911. Do not give anything by mouth if the child is unconscious or having a seizure.

High Blood Sugar (Hyperglycemia)

Blood sugar levels can increase rapidly in children. It is suggested by the following symptoms of hyperglycemia:

* Increased thirst
* Weakness or fatigue
* Blurred vision
* Frequent urination
* Loss of appetite

Hyperglycemia can be caused by too much food, too little physical activity, not enough insulin, or illness or infection. High blood sugars can be confirmed by testing with a glucose meter. If hyperglycemia occurs, the parent or guardian should be notified.

Ketoacidosis

Ketoacidosis is a diabetic emergency. In most, but not all cases, very high blood sugar levels are also present with ketoacidosis. Signs of ketoacidosis may include:

* Dehydration
* Labored breathing
* Vomiting
* Abdominal pain
* Fruity-smelling breath
* Weakness or fatigue

Diabetic ketoacidosis requires prompt attention; untreated, a child with ketoacidosis can lapse into a coma. If there are signs of ketoacidosis, the child should be taken to the emergency room.

Daily Routine of A Child with Type 1 Diabetes

Consistency is the key—regular meals, regular exercise, regular insulin. In addition, the child will need to test his or her blood sugar level at various times of the day to determine food or insulin needs.

Diet
Children with type 1 diabetes can eat the same healthy foods as other children. The lunchroom manager should be aware of the child's diet restrictions, but usually the child is taught to select the right foods.

Frequent Snacks
A child with type 1 diabetes may require snacks at mid-morning, mid-afternoon, and bedtime. These and regular meals must occur on time so insulin usage is properly balanced and low blood sugar does not occur.

Exercise
Children with type 1 diabetes can participate in all kinds of active sports. However, since exercise burns up a lot of sugar, the child should have an extra snack of juice or crackers before planned strenuous exercise to avoid low blood sugar. Exercise should not be scheduled just before a meal.

Self-Monitoring of Blood Glucose
Several times a day, before meals and before bedtime, a child with type 1 diabetes may need to test his or her blood sugar. Usually this process involves pricking the finger, putting a drop of blood on a chemically sensitive strip, and taking a blood sugar reading on a meter. Older children usually are able to do this themselves; younger children may need help. The parents will give you instructions.

How You Can Help the Child with Type 1 Diabetes in Your Care

* Treat the child normally. The child with type 1 diabetes will be able to function as a normal participant in group activities. While the fact that he or she has diabetes should not be hidden, the child does not want to be singled out for special treatment. A quiet understanding should exist between you and the child about the necessary precautions to be taken.
* Allow the child to follow his or her routine inconspicuously. When the child needs extra snacks, to test blood sugar, or to take insulin, help by allowing the necessary time and not calling attention to these special actions.
* Be alert to the changes that signal low blood sugar.

If behavior problems arise as a result of an insulin reaction, you should not blame the child. Quick action on your part can prevent a medical emergency.

General Tips

* Watch the child's behavior before meals and snacks.
* Make sure meals are eaten on schedule.
* Don't assign physical exercise just before a meal when the child may be in need of food.
* Arrange an inconspicuous means of taking the mid-morning and/or afternoon snacks.
* Keep a source of sugar readily available, and encourage the child to carry some form of sugar.
* Make sure all necessary personnel are informed.
* Most children need a snack at night before bed.

I can't stress how important it is, even for an adult diabetic, to be treated with understanding. Saying silly stuff like "I'd never be able to give myself a shot" is really irritating to hear. If it's between death and a shot, you take the bloody shot. I really hate having to point that out to people silly enough to say that to me.

Ooops. It looks like the side effects of low blood sugar for me tonight is some major crankiness.

Anyway, I hope you learned something about Type 1 diabetes if you didn't already know how the disease works.

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