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What You Should Know About Juve

What You Should Know About Juve

WHAT YOU SHOULD KNOW ABOUT JUVENILE (INSULIN-DEPENDENT) DIABETES

This brochure is reprinted with the permission of the Juvenile Diabetes Foundation International, 60 Madison Avenue, New York, NY 10010.

WHAT IS DIABETES?

No one knows for sure what causes diabetes. Many researchers are trying to find its cure, or at least a better means of treatment for it. If you have diabetes, it means you have a chronic metabolic disease.

Metabolism is the process by which the body takes the food we eat and breaks it down into elements and compounds that the cells can use to build and repair tissue, and to produce energy to sustain life.

Our bodies make a substance called glucose from the sugars and starches (carbohydrates) that we eat. In order for the body to use glucose properly, it needs insulin. Insulin regulates the amount of glucose the body can use. If the glucose is not processed properly, too much remains in the blood stream, instead of being used by the cells to produce energy. The body is then starved of that energy. The excess, or wasted, glucose which builds up in the blood stream spills out into the urine and show as “sugar in the urine.”

People who have diabetes are not able to produce enough insulin. some diabetics (non-insulin-dependent, or adult-onset or Type II) can make up for this lack of insulin with a carefully restricted diet which avoids too many carbohydrates; or they take special pills, in addition to following a special diet, in order to control their blood sugar levels. People who have juvenile diabetes (insulin-dependent, or Type I) have to take one or more injections of insulin every day of their lives in order to metabolize their food, in addition to watching what they eat.

Most people with juvenile diabetes become diabetic when they are children. However, no matter how old they are, if they must take insulin, they are referred to as “juvenile-type,” or “Type I,” or “insulin-dependent” diabetics.

Today, there are many different types of insulin, which vary in how quickly and how long they work. Depending on the life style of the diabetic, his age and condition, one or more kinds of insulin might be used. Each type has its own characteristics, and the doctor will decide which kind the person needs. (For more information on insulin, see the article entitled “What You Should Know About Insulin” in the Prevalent Health Conditions/Concerns area of NORD Services.)

SOME SYMPTOMS OF DIABETES

If you find that you are…

  • urinating frequently, and in large quantities
  • unusually thirsty
  • extremely hungry, and very often
  • suddenly losing weight, for no apparent reason
  • feeling weak, drowsy and tired
  • experiencing sudden vision changes, and noticing blurring or other differences
  • annoyed by itching of the genitals and skin
  • developing skin disorders and infections

…..you may have diabetes.

If you notice one or more of these symptoms on a recurring basis, you should see a doctor who can find out through a simple series of tests if you have diabetes.

ABOUT JUVENILE (INSULIN-DEPENDENT) DIABETES

Juvenile diabetes is not an obvious disease. In fact, many people are amazed to learn that Jackie Robinson had diabetes, and that Ron Santo, Bobby Clarke, Mary Tyler Moore, Dan Rowan, Billy Talbert and Catfish Hunter all have diabetes. These are people who lead active and useful lives.

People with diabetes must take good care of themselves. They must take their injections of insulin at specified times. They must exercise regularly. They must be careful with their diet, eating on time. In short, they must understand the relationship between their insulin dosage, their exercise, and the food they eat. They must test their urine or blood (called self blood glucose monitoring) at specified times of the day. And they must be prepared to respond to certain warning signs very quickly.

IF YOU HAVE JUVENILE DIABETES

Taking insulin injections every day is the only way now available for supplying the diabetic with the hormone his or her body does not produce on its own. But it’s not a very good way.

In the non-diabetic, the amount of insulin and the amount of sugar the body requires is taken care of automatically. The insulin and the sugar (glucose) are sent to different parts of the body as they are needed, depending upon what the person is doing at the time.

When one has diabetes, the injected insulin taken at, let us say, 7 a.m., will work independently of one’s needs. That is, it starts to act within the body according to its own time schedule and continues at its own speed, regardless of how much insulin might actually be required at any time. So, if someone on insulin treatment wants to play baseball, or go swimming, the insulin taken that morning doesn’t take into account the extra energy that person will be expending in that activity. Thus the diabetic will discover that he is burning up more sugar because of the exercise he is doing, and will be left with too LITTLE sugar and too MUCH insulin. This imbalance between sugar and insulin can trigger an INSULIN REACTION or HYPOGLYCEMIA (low blood sugar).

This can be a very dangerous situation, which may come upon the diabetic very quickly, and which must be treated immediately. Any person with juvenile diabetes learns that before he engages in strenuous activity, he must take some extra carbohydrate such as candy, non-diet soda or orange juice into his body to make up for the sugar that will be burned up while exercising.

Keeping the balance between sugar and insulin is not always easy. It can be difficult for many different reasons…not just because of physical activity. Illness (even a head cold), infection, periods of growth, fatigue, excitement, anxiety, and other things one might not even be aware of, can upset the balance. That is why a person with diabetes must always be prepared to treat an insulin reaction by carrying a fast-acting sugar. It can be in the form of orange juice, candy, a non-diet soda, or sugar itself. It is common sense that a person taking insulin must carry a supply of sugar or candy with him at all times. Also, he should always have orange juice (or something similar) available to him at home.

In those cases where the reaction isn’t caught in time and the person becomes unconscious, a drug which raises blood sugar, called glucagon (a prescription drug), must be injected into the buttocks. If glucagon is not available, honey should be rubbed on the inside cheek of the unconscious person, where it can be absorbed without the risk of choking. However, if this doesn’t work within a few moments, the person must be rushed to a hospital emergency room.

On the other hand, if a person with juvenile diabetes doesn’t take his insulin, or takes too little, he runs into a different problem. This problem comes on more slowly. It takes many hours, or even days, but it can also cause unconsciousness. A DIABETIC COMA occurs when too much sugar (hypoglycemia) remains in the blood over too long a period of time because the body doesn’t have enough insulin to use it up properly. Since the body can’t use the sugar to supply its energy needs, it starts to “steal” energy from the fats stored in the body. When fats are broken down, acids called ketones are formed in the body, and these acids upset the body chemistry. If this condition goes on too long, diabetic coma will occur and hospitalization will be necessary.

It is particularly important for the person to carry identification stating that he is a diabetic, and enough money to summon help or for taxi fare, in case he must get to a hospital.

IF YOU KNOW A DIABETIC

A person who works, lives, or goes to school with a juvenile diabetic should be aware of the first signs of an insulin reaction. Sometimes, it can be a sudden reaction. Sometimes, it comes on more slowly. It can be signaled by sweating, weakness, dizziness, headache, heart pounding, a fast and weak pulse, irritable behavior, and mental confusion. The important thing is to get the person to quickly eat something containing a lot of sugar, such as candy or non-diet soda.

If a person is found staggering, unable to speak clearly, or is already unconscious, many people assume he or she is drunk and not in need of immediate help. This is a potentially dangerous situation because the staggering, confused or unconscious person may be in a severe insulin reaction or entering a diabetic coma. It is easy to know if a person is drunk: you can smell alcohol. But if a person’s breath smells sweet (or “fruity”), and if the person’s skin is flushed, hot and dry, think of a diabetic coma. If the skin is pale, cold, damp with perspiration, think of an insulin reaction. In either case, the person needs immediate medical attention. If there is doubt, treat a conscious diabetic with sugar. This relatively small amount won’t hurt.

CHILDREN WITH DIABETES

Children with diabetes are faced with challenges and problems in daily life that require special care and understanding. However, the child with diabetes does not want to be singled out. He or she can participate in all activities and can be expected to do what every other child does. With a little attention to some simple guidelines, and a little knowledge, no one should be anxious about taking care of such a child, either at camp, in school, or on a “sleep-over” date.

It is important for teachers, nurses, principals, lunchroom personnel, playground and hall supervisors and bus drivers to be notified that a student has diabetes. A special diet, regular meal and snack times, and the possibility of an insulin reaction must be taken into account by all supervisory personnel who are in contact with the diabetic child. It is also advisable for teachers to meet with the parents of a child with diabetes to learn about that particular child’s routine.

In general, if a diabetic child is under your supervision:

  • Watch his performance just before mealtimes.
  • Don’t assign physical exercise just before lunch.
  • If he needs a mid-morning (or afternoon) snack, help him eat it as casually and inconspicuously as possible.
  • Keep sugar readily available.
  • Encourage the youngster to carry some form of sugar with him: diabetic children soon learn to recognize and treat their own reactions.
  • Make sure that he takes extra nourishment (carbohydrates) before planned strenuous exercise to avoid a reaction.
  • Any child suspected of being in “reaction” must ALWAYS remain in the company of an adult.
  • Do NOT send the child home by himself. You must make sure that the reaction has been taken care of.

WHAT THE FUTURE HOLDS

We don’t know what causes diabetes, or how to cure it. We know that it is not a simple disease. As time goes on, diabetes can cause complications in organs and systems throughout the body. It affects the blood vessels and causes circulatory problems. As the diabetic gets older, cuts and sores frequently don’t heal properly because of the poor circulation. Diabetes is the leading cause of new blindness in the United States today. It also greatly increases the risk of heart attack, stroke and kidney disorders. It can shorten the life expectancy of its victims. Simply put, diabetes is a chronic, complicated and destructive disease.

But there is increasing hope that diabetes and its problems can be helped.

Medical science is looking for two things: a means of controlling diabetes in a better way, hoping that good control of blood sugar levels will reverse or eliminate the complications; and a cure for the disease itself.

With these objectives in mind, researchers in laboratories and medical schools throughout the world are constantly exploring new areas. Many interesting and promising results are now coming forth, such as the development of human insulin in the laboratory, experimentation with an artificial pancreas, beta cell transplantation, identification of viral causes of diabetes, and tissue information and exchange programs.

The insulin that non-diabetic people produce is made in the part of the pancreas called the islets of Langerhans. The islets contain many different cells, but the beta cells are the ones that actually produce the insulin. Research scientists are working on the possibility of transplanting beta cells from a non-diabetic person or animal into a diabetic person through a simple injection process: taking a syringe of beta cells that are healthy, and injecting them into a person whose beta cells don’t produce insulin. The successful transplanting of beta cells has already been accomplished in experiments involving rats, in which the rat’s immune system has not rejected the new cells and the transplanted cells have produced insulin. Although much progress has been made, there are many problems yet to be solved.

There is also the possibility of transplanting healthy, functioning whole pancreases or pancreas segments from human donors. However, there are the same problems here that scientists face with any other transplant procedure: the body tends to reject most transplanted organs because it regards them as foreign bodies.

Some researchers are trying to find a way for insulin to be taken orally. It would be much more pleasant to be able to take a pill of insulin every day instead of injecting oneself with a needle. So far this has not worked. Insulin cannot be given by mouth, as yet. The body’s digestive juices destroy it, so it must be administered by injection under the skin where it can be absorbed directly into the blood stream.

A new device becoming more common, though still experimental, is an insulin delivery pump which delivers a pre-programmed flow of insulin to the diabetic.

A more practical development may be the artificial pancreas. An artificial pancreas would be a miniature computer that regulates the ratio of sugar and insulin the body needs by monitoring the blood sugar and releasing insulin into the body automatically as the body requires it. There are still many technical problems to be resolved before the artificial pancreas becomes a reality.

Other researchers are working on a hormone, called somatostatin, which seems to be useful in preventing or controlling vascular problems in diabetes. There is much to be learned, but certainly it is exciting to think of the possibility of a substance which, when taken with insulin, could help avoid the complications of eye, kidney and heart disease.

Many additional investigators are working to find out what causes diabetes. No one knows for sure how it is inherited or acquired, or how to predict accurately the chances of getting the disease. Recently, evidence was presented showing that some juvenile diabetes seems to be triggered by a Coxsackie B4 virus. Researchers theorize that other viruses may also be involved, in addition to inherited susceptibility to diabetes and weakness in the person’s immune system.

The Juvenile Diabetes Foundation International is devoted to supporting diabetes research and is determined that a cure will, one day, be found.

A PERSON WITH JUVENILE (INSULIN-DEPENDENT) DIABETES MUST:

  • take insulin every day.
  • understand the importance of diet and exercise.
  • test urine or blood as needed.
  • have annual physical and eye examinations and other special tests available through physicians.
  • carry sugar or candy at all times.
  • have identification indicating that he or she is a diabetic, is taking insulin, and listing the doctor’s name and phone number.

He or she must plan ahead by:

  • remembering to carry insulin and needles in hand baggage when traveling. Luggage compartments, especially on airplanes, are often very cold and insulin may freeze. Further, luggage can get lost. Insulin, syringes, and the diabetic should always stay together.
  • having emergency money at all times.
  • carrying food when traveling in case of delay.

***KNOW THESE SIGNS***

INSULIN REACTION – Comes on quickly

  • Pale, perspiring skin
  • Dizzy
  • Rapid pulse
  • Normal urination
  • Normal thirst
  • Shallow breathing
  • Breath smells normal
  • Confused, strange behavior
  • Little or no sugar in urine
  • Nausea

DIABETIC COMA – Comes on slowly, over a longer period of time

  • Dry, hot skin
  • Not dizzy
  • No rapid pulse
  • Not hungry
  • Excessive urination
  • Excessive thirst
  • Deep, labored breathing
  • Breath smells fruity
  • Drowsy, lethargic
  • A lot of sugar in urine, probably with acetone, as well