
Diabetes Mellitus Type 1
› (Juvenile)

Diabetes Mellitus Type 2
› Used to be later onset, but now developing younger
related to rise of obesity

JDRF Video
DM Type 1
 Type 1 diabetes is usually diagnosed in children
and young adults, and was previously known as
juvenile diabetes. Only 5% of people with
diabetes have this form of the disease.
 In Type 1 diabetes, the body does not produce
insulin.

› a hormone that is needed to convert sugar and other
food into energy needed for daily life.
www.diabetes.org/living-with-diabetes.
DM Type 2
 Type 2 diabetes is the most common form of
diabetes.
 If you have Type 2 diabetes your body does not
use insulin properly. This is called insulin
resistance. At first, your pancreas makes extra
insulin to make up for it. But, over time, it isn't
able to keep up and can't make enough insulin to
keep your blood glucose at normal levels.


Common symptoms of diabetes:
› Urinating often
› Feeling very thirsty
› Feeling very hungry - even though you are eating
› Extreme fatigue
› Blurry vision
› Cuts/bruises that are slow to heal
› Weight loss - even though you are eating more (Type 1)
› Tingling, pain, or numbness in the hands/feet (Type 2)

- See more at: http://www.diabetes.org/diabetesbasics/symptoms/#sthash.LgxPa60k.dpuf

EARLY DETECTION and treatment of
diabetes can decrease the risk of developing the
harmful complications of diabetes:
› damage to the eyes, heart, blood vessels, nervous
system, teeth and gums, feet and skin, or kidneys

Studies show that keeping blood glucose, blood
pressure and LDL cholesterol levels close to
normal ranges can help prevent or delay these
problems.

There are several ways to diagnose diabetes.
› Each way usually needs to be repeated on a second
visit to diagnose diabetes

A1C
› Hemoglobin A1C

FPG
› Fasting Plasma Glucose

OGTT
› Oral Glucose Tolerance testing

Random Plasma Glucose test
The A1C test measures your average blood
glucose for the past 2 to 3 months. The
advantages of being diagnosed this way are that
you don't have to be fasting or drink anything.
 Diabetes is diagnosed at an A1C of greater than
or equal to 6.5%

RESULT
A1C
Normal
Less than 5.7%
Prediabetes
5.7%-6.4%
Diabetes
6.5% or greater
http://www.diabetes.org/diabetes-basics
FPG
 This test checks your fasting blood glucose levels.

› Fasting means not having anything to eat or drink (except
water) for at least 8 hours before the test. It usually done
first thing in the morning, before breakfast.

Diabetes is diagnosed at fasting blood glucose of
greater than or equal to 126 mg
RESULT
FPG
Normal
Less than 100mg/dl
Prediabetes
100-125mg/dl
Diabetes
126mg/dl or greater
http://www.diabetes.org/diabetes-basics
OGTT
 The OGTT is a two-hour test that checks your
blood glucose levels before and 2 hours after you
drink a special sweet drink. It tells the doctor how
your body processes glucose.
 Diabetes is diagnosed at 2 hour blood glucose of
greater than or equal to 200 mg/dl

RESULT
OGTT
Normal
Less than 140 mg/dl
Prediabetes
140-199 mg/dl
Diabetes
200 mg/dl or greater
http://www.diabetes.org/diabetes-basics/

Happens before people develop Type 2 diabetes
› Type 2 diabetes develops most often in middle-aged and
older adults but can appear in young people.
› Blood glucose levels that are higher than normal but not
yet high enough to be diagnosed as diabetes

Doctors sometimes refer to prediabetes as impaired
glucose tolerance (IGT) or impaired fasting glucose
(IFG), depending on what test was used when it was
detected.
› This condition puts you at a higher risk for developing
Type 2 diabetes and cardiovascular disease.
http://www.diabetes.org/diabetes-basics

You will NOT develop Type 2 diabetes automatically
if you have prediabetes.
› For some people with prediabetes, early treatment can
actually return blood glucose levels to the normal range.

Research shows that you can lower your risk for
Type 2 diabetes by 58% by:
› Losing 7% of your body weight (or 15 pounds if you weigh
200 pounds)
› Exercising moderately (such as brisk walking) 30 minutes a
day, five days a week
› Don't worry if you can't get to your ideal body weight.
Losing even 10 to 15 pounds can make a huge difference.

Type 1:
› Insulin regimen
 Different types with different onsets means different
dosing and regimens
 May get insulin twice a day, or multiple times, depending
on their control
Type 2
 Different regimens for different people.

› Most people with Type 2 diabetes are treated with pills,
but may need one injection per day.
› Some may need a single injection inserting liquid
medication or nutrients into the body with a syringe.
› Sometimes diabetes pills stop working, and people with
Type 2 diabetes will start with two injections per day of
two different types of insulin. (They may progress to three
or four injections of insulin per day.)

See more at: http://www.diabetes.org/living-withdiabetes/treatment-and-care/medication/insulin/insulinroutines.html#sthash.R7F7bpP4.dpuf
For Type 1 and Type 2
 Multiple types of Insulin

› Short, intermediate, and long acting
 Depends on onset, peak, and duration
› Single dose
 Syringe vs. Insulin Pin
› Pump

Insulin Pins
› The insulin dose is dialed on the pen, and the insulin is injected
through a needle, much like using a syringe.
› Cartridges and pre-filled insulin pens only contain one type of insulin.

Insulin Pump
› Small computerized devices that deliver insulin in two ways:
 In a steady measured and continuous dose (the "basal" insulin)
 As a surge ("bolus”: an extra amount of insulin taken to cover an
expected rise in blood glucose, often related to a meal or snack.) dose,
at your direction, around mealtime.
› Size of a deck of cards that can be worn on a belt or kept in a pocket.
› Many people prefer this continuous system of insulin delivery over
injections.

See more at: http://www.diabetes.org/living-withdiabetes/treatment-and-care/medication

Main tool you have to check your diabetes control.
This test tells you your blood glucose level at any
one time.
› Keeping a log of your results is vital.

Your doctor may recommend blood sugar testing
three or more times a day if you have Type 1
diabetes.
› Testing may be before and after certain meals, before and
after exercise, before bed, and occasionally during the
night.You may also need to check your blood sugar level
more often if you are ill, change your daily routine or
begin a new medication.

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-bloodglucose.html#sthash.wOSwY5GJ.dpuf
Hunger
Anxiety
Paleness
 Blurry Vision
 Irritable
 Behavior Changes
 Crying
 Confusion
 Dazed Appearance
 Seizures
 Unconsciousness/coma



Headache
 Stomach pains
 Weight Loss
 Irritable
 Flushed Face
 Sleepiness/Fatigue
 Dry Mouth
 Nausea
 Confusion
 Labored breathing
 Profound weakness
 Unconscious


Exercise makes insulin work more effectively because it
takes less insulin to balance the carbohydrates consumed.
› May result in lower blood sugar levels

In physical education classes, activities and intensity levels
vary daily.
› Children with diabetes should be more aware of how they are
feeling. Physical education teachers should monitor the student
more closely before and during the activity.

A child may also be more active during recess and field
trips. Older children with diabetes who participate in a
sport need to plan for this additional activity. They may
reduce insulin intake or eat extra food before the activity
begins.
› These changes must be indicated through the authorized
Primary Care Provider (PCP) form.
Illness and stress, on the other hand, often cause
blood sugar levels to rise
 A child who doesn’t feel well may have trouble
performing in class.

› May have difficulty concentrating, for example.

Early adolescence is an especially difficult time:
the body grows and HORMONES change
everything.
› May have more issues with blood sugar at this time
and require more help emotionally and physically.
Diagnosis effects children differently based on
development
 Social Exclusion
 Denial > Depression > Diabetes Distress >
Diabetes Burnout
 Aggression
 Eating Disorders
 Family Distress

 Adjustment
to diagnosis
› 6-9 months for the CHILD
› 9-12 months for PARENTS
 Stressors
such as divorce, violence and
abuse negatively effect adjustment
http://spectrum.diabetesjournals.org/content/16/1/7.full

Feeling different from peers
› Desire to be “Normal”
Good and Bad (“good” or “bad” blood sugars)
 Fear of safety when returning to
school/separating from parent/caregiver
 Need support from school staff

› Encourage parents to meet with teacher/trained
personnel/ nurse

Denial
› Feel fine

Ignore Vulnerability
› Live in here-and-now, feel invulnerable to long-term
complications
 Only 1/5 adolescents report that they fully comply with
diabetes management
› Adopt risky behavior while they perceive they are
able
Some children are excluded
from sleepovers, birthday
parties and camps because of
fears from other parents and
adults.
 “Diabetes is like being
expected to play the piano
with one hand while juggling
items with another hand, all
while balancing with deftness
and dexterity on a tight rope.”

www.idf.org/psychological-challenges-living-diabetes
http://diabetes.about.com/od/doctorsandspecialists/a/diabetesdenial.htm

Internalized and externalized behavior problems
were increased in children with diabetes.
› Boys with diabetes became more aggressive than
general peer population.

A high level of family conflict acts as a predictor
of behavioral problems.
http://spectrum.diabetesjournals.org/content/16/1/7.full

15-25% of adolescents with Type 1 DM
diagnosed with depression
› (14.3% adolescents w/out chronic disease)
Lower self-efficacy
 Diabetes distress –negative feelings directly r/t
diabetes (frustration, “bogged down” by routine,
isolation)
 Leads to “Burnout”-being unable to cope with
diabetes

› Those with poor coping skills, problem-solving and
self-care
http://idf.org/psychological-challenegs-children-living-diabetes





Prevalence of eating disorder in diabetics is 2-6X
higher than peers
25% of females with diabetes are diagnosed with an
eating disorder
Correlation, not causative effects
Both emphasize body states, weight management,
control of food
Anorexia, Bulimia, Insulin Abuse
› (20-40% alter insulin doses to control weight)

Diabetes can camouflage eating disorder
› “Just practicing dietary control”
www.diabetes.org/living-with-diabetes/

Often experience stages of grief:
› Anger, denial, bargaining, depression, and
resolution/acceptance

Parental conflict
› Overprotective vs. Neglectful
Children report that parents “nag them” or
chastise them more than siblings.
 Close supervision of diabetic child may lead to
sibling rivalry and jealousy.
 Siblings may fear developing diabetes.

http://spectrum.diabetesjournals.org/content/16/1/7.full
Promote supportive environment
 Encourage social support
 Communication
 Treat the child normally
 Reduce social exclusion

› Non-food rewards and parties
Respond to ineffective coping skills
 Encourage participation in SELF-MANAGEMENT

› Appropriate for child’s developmental level

Just a reminder:
Any student with a health condition must have
the proper authorized Primary Care Provider
form complete.
 Staff must attend Health Services training before
they can provide a service or administer
medications.
 Health Services Nurse Practitioners need to be
invited to ALL IEP, ARC, Placement, & 504
meetings for anyone with a health condition.

› Especially those that require nursing care

Area 1: Angela Hayes
› angela.hayes@jefferson.kyschools.us

Area 2: Megan Habich
› megan.habich@jefferson.kyschools.us

Area 3: Mary Texas
› mary.texas@jefferson.kyschools.us

Area 4: Holly Walker
› holly.walker@jefferson.kyschools.us

Area 5: Amanda Burks
› amanda.burks@jefferson.kyschools.us

Area 6: Blaire Adams
› blaire.adams@jefferson.kyschools.us

Or, please call Health Services at 485-3387

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

Diabetes and Eating Disorders. Diabetes Spectrum.
http://sectrum.diabetesjournals.org, vol 15, no 2, April 2002.
Eating Disorders. American Diabetes Association.
www.diabetes.org/living-with-diabetes.
Eating Disorders and Diabetes: A Dangerous Connection.
www.raderprograms.com/health-concerns/diabetes-eatingdisorders.html.
Guthrie, D., Bartsocas, C., Jarosz-Chabot, P., & Konstantinova, M.
“Psychological Issues for Children and Adolescents with Diabetes:
Overview and Recommendations.
http://spectrum.diabetesjournals.org/content/16/1/7.full. Vol 16, no
1, Januray 2003.
Hicks, Jennifer. What’s the Big Deal? Denying a Diagnosis of
Diabetes. http://diabetes.about.com. October 23,2007.
Naranjo, Diana and Hood, Korey. “Psycholigical Challenegs for
Children Living with Diabetes.” www.idf.org/psychologicalchallenegs-children-living-diabetes. August 21, 2013.