Diabetes Type 1 and Type 2

Approximately 23.2 million Americans have diabetes—a condition in which the body is unable to use food properly. When food is digested, it breaks down into a sugar called glucose. Glucose is absorbed into the blood and is carried by the bloodstream to body cells, where it will be used for energy. Glucose requires the assistance of a hormone called “insulin” to enter into the cell. The pancreas, a gland behind the stomach, produces insulin. The production or utilization of insulin is decreased or absent in diabetes. Without sufficient insulin, the body cannot use glucose for energy, and high blood sugars (hyperglycemia) result.

Currently, diabetes cannot be cured, but it can be managed. The goals of diabetes self-management include promoting normal growth and development, maintaining overall health and emotional well-being, and normalizing blood sugar levels.

Two main types of Diabetes

Type 1 Diabetes (insulin dependent)
The pancreas stops producing insulin. Type 1 diabetes requires daily insulin injections for survival. Although type 1 diabetes typically starts in children or young adults (previously known as juvenile-onset diabetes), it can occur at any age. The cause of type 1 diabetes is not known, but research indicates it may involve a disorder in the functioning of the body’s immune system. The immune system protects the body against disease. When this system malfunctions, the body can destroy one of its own parts. This is called an autoimmune response. In type 1 diabetes, the body destroys its own insulin-producing beta cells. Genetics and the environment may also play a part. At this point, type 1 diabetes cannot be prevented and onset is not related to poor diet.

Type 2 Diabetes
In type 2 diabetes, the pancreas still makes insulin, but the body does not use the insulin normally (insulin resistance).This type of diabetes typically develops in adults over 40 years of age, but there is an increasing incidence of newly diagnosed type 2 diabetes in youth in the United States.

Students at greatest risk for developing type 2 diabetes have one or more of these factors:
• Obesity
• Physical inactivity
• Family history of type 2 diabetes
• Exposure to diabetes in utero
• Non-European origin (Hispanic, African-American, Native American)
• Signs of insulin resistance called acanthosis nigricans (dark, velvety patches on the skin around the neck or armpits)

Obesity is a growing epidemic in the school-age population and should be addressed as a public health issue by healthcare providers and school health personnel. “Teaching a healthy lifestyle—one that includes good nutrition and physical activity—can reduce the risk of type 2 diabetes more effectively than medication designed to decrease the risk of diabetes.” (from Health in Action: Diabetes and the School Community, a 2002 publication of the American School Health Association)

Symptoms of Hyperglycemia (High Blood Sugar)
Frequent Urination Decreased insulin production causes the blood sugar (glucose) level to rise (hyperglycemia) and spill into the urine. The glucose pulls body fluid along with it into the urine, resulting in the formation of large volumes of urine and frequent trips to the bathroom. This is the body’s way of attempting to remove excess sugar.
Excessive Thirst Due to the body fluid loss caused by frequent urination, the body becomes dehydrated. The brain signals its thirst center for additional fluid.
Increased Hunger Since the body is unable to utilize the glucose circulating in the blood for energy, the brain sends out a signal for more food.
Weight Loss The body, unable to use blood sugar for energy, utilizes stored body fat and muscle, which decreases body weight. As the body uses fat, ketones (a waste product of fat utilization) accumulate in the blood and urine. Ketones cause diabetic ketoacidosis (DKA) a serious condition, which can be life-threatening.
Fatigue The pancreas does not produce enough insulin to allow glucose to be used for energy.
Blurry Vision
Dry Skin
Slow Wound Healing

The management components of type 1 and type 2 diabetes are:
Blood sugar testing Before meals, before and after physical activity, whenever symptoms of high or low blood sugar levels are noted, student is “not acting right” or feels ill. A student will also need to check blood sugar levels before and after PE until a pattern in how their body responds and a plan for adjusting their regimen can be established. This will need to be done in collaboration with their endocrinologist.
Insulin administration Typically given with meals, and sometimes with snacks. Given according to the Diabetes Management Plan
Oral diabetes medications According to the Diabetes Management Plan (type 2)
Regularly scheduled meals and snacks Depending on the types of insulin the student uses, the schedule may or may not be flexible. Allow AT LEAST 2 hours in between a rapid-acting insulin dose and the next blood glucose test. Due to the action time of insulin, there must be enough time for injection to take full effect. Follow the Diabetes Management Plan for specific instructions on correcting blood glucose.
Ketone testing When blood sugar level is over 300 (when on injections) or over 250 (when on insulin pump) or student is ill (vomiting, diarrhea, fever, infection).
Identifying and quick response to low blood sugar levels All school personnel that come in contact with a student who has diabetes need to know signs and symptoms of hypoglycemia and what actions to take. 

Nutrition Management
A diet with a variety of nutrient rich foods is recommended for children with diabetes and their families. Following the USDA Dietary Guidelines, below, is one way to meet nutrient needs:
• Make half the plate fruits and vegetables
• Enjoy food, but eat less
• Drink water instead of sugary drinks
• Make at least half of grains whole grains
• Avoid oversized portions
• Compare sodium in foods and choose foods with lower sodium
• Switch to fat-free or low fat (1%) milk
• Limit solid fats such as butter, margarine, shortening and lard, as well as foods that contain solid fats
• Eat a variety of proteins, including seafood, lean meats such as poultry, eggs, legumes, nuts and seeds
• Find a balance between food and physical activity to maintain a healthy weight

Balancing children’s plates will help them receive the nutrients they need for growth and maintaining optimal blood sugar levels: ¼ with starch or grain; ¼ with lean meat, poultry or fish; ¼ with non-starchy vegetables or salad; ¼ with fruit. These nutrients are carbohydrates, protein, fats, vitamins, minerals and fiber. Three of these nutrients, carbohydrates, proteins and fats, have the greatest impact on blood sugars.

Carbohydrate foods, such as grains, pasta, bread, cereal, starchy vegetables (like potatoes, beans, corn, peas and butternut and acorn squash), fruit, milk, yogurt, snack foods, desserts and sweets raise blood sugar levels, so the child needs to pay attention to how much of these foods they eat. However, carbohydrates also provide energy needed to grow and to do everyday activities, so it is important for children with diabetes to eat foods that contain carbohydrates.

Protein is found in meats, cheese, fish, poultry, eggs and nuts. Protein helps grow and repair body tissue such as muscle and bones, but it does not affect blood sugar levels. Many foods high in protein are also high in fat. Fats are foods such as margarine, butter, oils, salad dressings, nuts, cheese and meat.

Fat does not affect blood sugar levels, but that does not mean a child can eat all they want. Too much fat can cause weight gain and other problems like elevated cholesterol. The healthiest fats are monounsaturated or polyunsaturated fats that protect the heart. Some examples of monounsaturated fats include: canola and olive oils, nuts, avocado and seeds. Examples of polyunsaturated fats include: corn oil, soybean oil and sunflower oils, as well as Omega-3 (fish) oils.

Regular exercise is important but it increases the risk of hypoglycemia for students taking insulin. Children will need to check their blood sugar levels and may need a carbohydrate snack before and/or after exercising. Refer to student’s health care plan for specifics on blood sugar testing and snacks with exercise. 

It is important to have an updated diabetic plan from your child’s provider. Any time there is a change, please ask for an updated plan to give to the school. Please complete the Assistance With Medication Form when giving medications to the Health Monitor.

Should you have any questions, please feel free to contact your schools Health Monitor or Douglas County Nurse.

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