Topic: Juvenile Diabetes
Researched and written by:  Erica Bryant
                                                I attest that the following report is a product of my own original work.

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Juvenile Diabetes Overview of Juvenile Diabetes             There are two types of diabetes that are common in children.  The first one is type-one diabetes and the second one is type-two diabetes.  Type-one diabetes is referred to as juvenile diabetes mellitus.  It is one of the most common chronic diseases that affects children.  About 150,000 children are affected by it nationwide (Band & Weisz, 1990).  It is a disorder of the endocrine system and affects about 0.1 percent of children that are school age.  Also, out of all the cases diagnosed, type-one makes u p 5-10 percent of them.  There are major health problems associated with type-one including troubles physically, psychologically, behaviorally, socially and educationally (Yousef, 1993).  Type-one comes about when the pancreas ceases to produce insulin the body needs to break down glucose in the blood.  These diabetics give themselves injections of insulin to keep their glucose level in their blood down (Cauchi, 2002).   Type-two diabetes is caused by children being overweight or obese.  Up until about a decade ago, this type was rarely heard of in children.  This sudden increase of type-two diabetes in children is caused by kids eating too much junk food and their lack of physical exercise.  Type-two occurs when the body has a glucose level in the blood that is too high and it consumes the insulin produced by the pancreas.  If the disease is left untreated, children with diabetes may experience heart attacks, blindness, or kidney disease by time they are in their late 20s.  According to endocrinologist, a twenty fold increase in type-two diabetes is predicted within the next decade among teenagers (Cauchi, 2002).   Statistics of Juvenile Diabetes Type-one diabetes has equal incidence of males and females, but occurs more in Caucasians than non-Caucasians.  Type-two used to be primarily found in people who were older and overweight, and now the younger ages are starting to be more predominant in type-two than the older people.  Also, type-two is more predominant in African Americans, Indian Americans, and Hispanic Americans. In the United States, studies were done on age, sex, and season of onset of juvenile diabetes in four geographic regions.  The four geographic regions were Pittsburgh, Gainesville, Galveston, and Melbourne.  The study concluded that the sex of the child with type-one diabetes is equal in frequency for both males and females (Fleegler, Rogers, Drash, Rosenbloom, & Travis, 1979).  Also, reports indicated that the highest frequency of onset of diabetes was in the fall and winter and the lowest was in the summer, except for in Melbourne.  Melbourne had a reverse trend in that it had its highest onset in the summer.  Similar results were received in Great Britain and in Australia (Fleegler et. al, 1979).             In Hungary, another study was done on incidence of type-one diabetes in Hungarian children.  In 1990, central/eastern Europe reported an increase in the incidence of type-one diabetes in Hungarian children aged 0-14 years over a 10-year period from 1978-1987.  A second decade was studied from 1989 to 1998.  During the second decade in Hungary, there was a change in the political system and it produced economic, social and environmental changes as well.  The results were that there were no differences between sex, both male and female had the same incidence of diabetes, but the incidence of getting diabetes was lowest in the youngest age group of children and the highest in the oldest age group (Gyurus, Green, Patterson, & Soltesz, 2002).              In Australia, there was an interview done on a 15-year-old girl named Sally Hoss (not her real name, as stated in the interview).  Sally was diagnosed with type-two diabetes.  She was not obese, but she was a medium height and 60 kilograms.  Although she was susceptible because she was overweight, her ethnicity was part of it as well.  She is an Aborigine as she as well as others on that side of the world are not used to Western food from the United States.  When they eat junk food and things that they are not used to, they are vulnerable to the disease.  It was guessed that 5000 children in Australia under the age of 18 had type-two diabetes, and 100,000 with type-one.  It is also predicted that in 10 years there will be more cases of type-two diabetes than there are of type-one (Cauchi, 2002).  Characteristics of Juvenile Diabetes             Some symptoms of having Type-one diabetes are being extremely thirsty, frequent urination, increase in appetite, drowsiness, dry and warm skin, sweet or fruity odor on the breath, and deep breathing.  Type-one is a lifelong disease where your body cannot metabolize glucose because of a lack of insulin produced by the body.  In maintaining normal blood concentration, the kidneys pull out sugar and mass amounts of water from the body.  This results in frequent urination, which results in dehydration and then causes the child to become very thirsty and drink large quantities of liquid.  Because the sugar going into the body is not used by the cells due to the lack of insulin, the child feels hungry and eats mass amounts of food, loses weight, and becomes tired and weak.  Diabetes is most often a hereditary disease.  Other factors that may cause a person to get diabetes are obesity, viruses, lack of physical activity, poor diet, and a high consumption of sugars and fats (Yousef, 1993).              Psychological problems are not typically found in children with diabetes, but having diabetes may lead to psychological reactions to living with the disease.  Children may be in denial of their illness or behave like they don’t know what the dangers of their illness are.  Dependency for children with diabetes is another difficulty.  Having diabetes requires lots of attention because of the involved medical treatments and restricts the child’s activities.  Some other reactions are blaming other people for them being sick, showing arrogance and being rebellious, withdrawal from activities because of depression, being very emotional, exaggerating their responsibilities to the disease and loss of their childhood.  Having diabetes as a child can be very stressful.  It causes negative views of self-concept and just being aware that you are diabetic can be stressful for a child (Yousef, 1993).             Parental reactions and attitudes also play a part in the characteristics of children having diabetes.  The child being hospitalized, their diet and medical regime, financial problems, and knowing that the disease is hereditary can all cause distress on the family.  There are 6 criteria that can have an influence on the family’s response to the child having diabetes: 1) the severity of the illness, 2) the age of the child when they experience symptoms, 3) the nature of the illness, 4) the family’s psychological adjustment, 5) how the siblings are affected and 6) the cost of treating the illness (Yousef, 1993).  If the parent accepts the child’s disease, then the child will be on a better mental status to learn to accept it themselves.  There are many types of coping behaviors that can be done to help both the family and the child.  It is important that the child receives support from both parents or both members of the couple.  Promoting communications with the child and the family about coping strategies and reactions could improve the situation of dealing with the disease for the entire family (Goldbeck, 2001). Classroom Issues             Children that are diabetic have certain issues within a classroom setting.  They are normal students with normal minds that are ready to learn and have expectations of fitting in to a regular school.  If their disease is not controlled properly, it may cause difficulties for successful academic performance.  Being absent from school, being late for school, missing classes and bad attitudes from parents and teachers will contribute to poor educational performance.  A child may have poor attendance due to them not taking them medications and having symptoms of their attacks of low or high blood sugar, like convulsions and vomiting.  When the child leaves classes to give themselves injections or check their blood sugar, they are missing classes which can affect their academic performance.  If the child doesn’t get the support they need from the school, then the parents get involved and get bad attitudes because it is a public school and the child should get the same opportunities as the other children (Yousef, 1993).  On the teacher’s part though, they may not be trained or have the time to give a child with special needs all the attention they need to succeed.  Even though the child is normal and can function in a regular school, the child may need special help or attention when it comes to dealing with their diabetes.  Along with the child presenting issues for the school to deal with, the school also provides issues for the student to deal with.  Things like not having the resources or trained staff to deal with emergencies when they arise, the school providing the right diet for the child because some families don’t have much money and their child needs to eat on a meal plan from the school, so can the child’s dietary needs be met ?  Also, another issue is ensuring that the staff of the school is educated on the illness, because if they don’t know anything about it, how can they help the child to do things like remember to take their medicines.  Also, because of the stress the child experiences from having the disease, they may reject school because of their depression or denial and refuse to make friends or feel insufficient to them.  Issues like participating in gym class should be regulated by a doctor.  The school staff should be trained in regulating the child’s physical activity, diet and injections.  If the child is hurt and receives a wound to the skin, the school staff should be trained in how to address it and they should monitor the progress how it is healing.  The school staff should also know the symptoms of low blood sugar and high blood sugar so they can take action if necessary.  If the blood sugar is too low, then it may be because of too much insulin in the body, too much physical activity or irregular amounts of food.  When low blood sugar is demonstrated in the child he or she usually appears restless, has blurred vision, exhibits behavior changes, has excessive sweating, headaches, vomiting, cold hands and feet, and may experience convulsions and eventually comas.  If the child is given concentrated sugar like orange juice or fruit flavored candy this can stop the reactions.  If the child has blood sugar that is too high it could be caused by low insulin or a viral infection or disease.  The symptoms develop slowly and include dry and warm skin, sweet or fruity odor to the breath, deep breathing and coma.  Injecting the child with insulin can stop the problems (Yousef, 1993).  Treatment Issues             Children with diabetes monitor their blood levels and inject themselves three to five times per day.  An issue with this in the school is finding a place that is safe and private to do all the procedures.  Doing it in the bathroom is unsafe and embarrassing for a child.  Some kids are afraid to be around when that is going on because they are afraid that things will go wrong.  Another issue is that injections need to be timed in accordance with mealtime because after injections the levels of insulin can go up and down (McNamara, 2000).  A new way to get insulin and not have to worry about all the injections is to switch to an insulin pump, which is a needle under the skin in the stomach that releases insulin as you need it from a remote control sized device.  This saves time so classes are not missed, it helps to take it with meals better than injections, and it does not require a safe private place.  An issue that comes along with treatment is having a school staff that knows how to deal with a child with diabetes, especially how to deal with emergency situations (McNamara, 2000).  With the physical needs addressed, the psychological issues needs to be assessed by the school as well.  If the child is going through the adjustment process with things like denial, depression and lack of self -esteem, they may reject a classroom setting.  They would not make friends, not succeed academically or have any kind of experience a normal child would have.  Implementing counseling sessions with the guidance counselor can help.  The counselor needs to have knowledge and training with dealing with children with diabetes or any other lifelong disease like diabetes.  They first need to establish a trusting relationship with the child so the child will open up to them and talk to them about how they are feeling inside.   Also, working with the family to set up an IEP will help if the child is absent frequently or has to miss class.  Also it can help if the child is just starting the adjustment process and is rejecting school.  The IEP will help to give more attention to the child and address their needs on an emotional, educational and personal level.  The people on the child’s IEP team can be the parents, teachers, school nurse, school psychologist and the guidance counselor.  The child would also have to be evaluated for their emotional status and social maturity.  Also the guidance counselor can help the parents with their child’s home life.   If the parents are having adjustment problems the counselor could recommend family counseling to help out (Yousef, 1993). Conclusions about Juvenile Diabetes Juvenile diabetes is a disease that affects many children in the world and it is continually growing each day.  It is a disease that puts stress on everyone that is affected by the child, like family, friends, school, and doctors.  If knowledge of the disease is not obtained by people that deal with children like this on a regular basis, the child may suffer severely for it.

Band, E. B. & Weisz, J. R.  (1990).  Developmental differences in primary and secondary control coping and adjustment to juvenile diabetes.  Journal of Clinical Child Psychology, 19(2), 150-158.

Cauchi, S.  (2002).  Diabetes in children reaching epidemic levels.  Nutridate, 13, 8. 

Fleegler, F. M., Rogers, K. D., Drash, A., Rosenbloom, A. L., & Travis, L. B.  (1979).  Age, sex, and season of onset of juvenile diabetes in different geographic areas.  Pediatrics, 63, 374-379.

Garner, A. M. & Thompson, C. W.  (1975).  Psychological factors in the management of juvenile diabetes.  Journal of Clinical Child Psychology, 4(3), 43-45.

Goldbeck, L.  (2001).  Parental coping with the diagnosis of childhood cancer: Gender effects, dissimilarity within couples and quality of life.  Psycho-Oncology, 10(4), 325-335.

Gyurus, E., Green, A., Patterson, C. C., & Soltesz, G.  (2002).  Dynamic changes in the trends in incidence of type 1 diabetes in children in Hungary.  Pediatric Diabetes, 3, 194-199. 

MacMillan, D. R., Kotoyan, M., Zeidner, D., & Hafezi, B.  (1977).  Seasonal variation in the onset of diabetes in children.  Pediatrics, 59,113-115.

McNamara, D.  (2000).  Overcoming juvenile diabetes with a little planning and high tech tools.  FDA Consumer, 34, 28.

Yousef, J. M.  (1993).  Meeting the counseling needs of children with diabetes.  International Journal for the Advancement of Counseling, 16(1), 29-36.