Diabetes is a chronic incurable disease
in which persistent high blood sugar levels (hyperglycemia)
are due to the body's inability to produce enough insulin, or
effectively use insulin already present in the body. Insulin
is a hormone produced by the pancreas and is necessary to break
down sugar and other foods into glucose. A lack of insulin makes
it impossible for glucose to enter cells where it is used for
energy. Therefore, the glucose remains in the bloodstream. When
blood sugar levels become too high, the blood sugar "spills"
over into the urine. This spilling forces the kidneys to work
overtime in an effort to flush out the sugar.
Nearly
sixteen million people in the United States have diabetes. Five
hundred thousand to one million are insulin dependent. The peak
incidence of new onset diabetes in adolescents occurs during
puberty (approximately ages 10 to 12 for girls and 12 to 14
in boys). There are two main types of diabetes:
- Type
1 Diabetes or Insulin Dependent Diabetes - the pancreas
does not produce enough insulin; blood sugar must be closely
monitored and insulin injections are needed daily; usually
occurs during childhood or early adult years.
- Type
2 Diabetes or Non-insulin Dependent Diabetes - the pancreas
produces enough insulin but it is not effectively used; usually
occurs after 40 years of age.
The
demands of a complex diabetes treatment plan are complicated
by the many physical, psychological and social changes which
take place during adolescence. It is of utmost importance that
you establish a good relationship with the health care team
that will assist you with your treatment plan and understand
all aspects of the plan including the signs and symptoms of
both hypo and hyperglycemia, diet and exercise, glucose monitoring,
and insulin administration. Your primary care physician will
refer you to other members of the health care team in order
to meet all of your learning needs( i.e. a dietitian for your
special diet and a nurse to learn about blood glucose monitoring
and insulin injections).
Diagnosis
and Symptoms:
If
you visited your doctor with the following symptoms the diagnosis
of diabetes would be considered and could be confirmed with
a simple blood test.
- Constant
hunger
- Excessive
thirst
- Frequent
urination
- Weight
loss (without dieting)
- Tiredness
- Difficulty
seeing
Diabetic
Treatment Plan
Keeping
your blood sugar levels under control is the number one goal
of your diabetic treatment plan. Your treatment plan will include:
- Blood
sugar monitoring
- Diet
- Exercise
- Insulin
injections or oral medication
Blood
Sugar Monitoring
Accurate
blood sugar monitoring is critical in order to maintain your
glucose levels within a normal and consistent range. A glucose
monitor is used to determine your blood sugar levels throughout
the day. There are various types of glucose monitors available.
Your physician will recommend the monitor that is best for you.
Your
doctor will refer you to a specially trained nurse to assist
you with becoming familiar with your glucose monitor. This learning
session is an opportunity to ask questions about all aspects
of blood glucose monitoring as well as learning to operate and
troubleshoot your monitor. A hands-on demonstration will help
you in remembering the steps on how to obtain an accurate glucose
reading. Your physician will set a "glucose range" for you so
you can take the necessary actions if your blood sugar gets
too high or too low.
Monitoring
your glucose levels will help you detect and treat high or low
blood sugar. It will also assist you in determining which foods
and activities make your blood sugar go up or down. This process
is simply done by placing a drop of blood from your finger onto
a special test strip.The strip is then inserted into the monitor
and the amount of glucose in your blood will appear on the screen.
There are certain times you will need to monitor your blood
sugar more often such as when you are ill or taking over-the-counter
medications approved by your doctor or if you have made any
changes in your lifestyle which affect your activity, diet or
sleep pattern (such as traveling).
Reading
your Blood Glucose Level
|
|
|
Normal |
Goal |
Action
Necessary |
| Average
glucose *(before meals) |
<100
|
80-120 |
<80
hypoglycemia |
| |
|
|
>140
hyperglycemia |
| Average
glucose *(bedtime) |
<110 |
100-140
|
<100
hypoglycemia |
| |
|
|
>160
hyperglycemia |
*(blood
glucose measured by: mg/dl)
Hypoglycemia
or low blood sugar occurs when blood levels get near 70 mg/dl.
Eating meals and snacks as scheduled will help prevent the risk
of hypoglycemia.
Hypoglycemia
can be caused by:
- Not
eating at the appropriate time
- Not
eating enough at meal time
- Skipping
a meal or snack
- Strenuous
or prolonged exercise
- Taking
too much insulin
Early
symptoms of hypoglycemia include:
- Weakness
- Hunger
- Shakiness
- Dizziness
- Sweating
- Heart
pounding
Later
symptoms of hypoglycemia may include:
- Headache
- Blurred
vision
- Confusion
If
hypoglycemia is ignored or not treated quickly enough a person
may lapse into a coma. Early detection and treatment are necessary
in order to prevent a severe hypoglycemic reaction.
Early
Detection & Treatment of Hypoglycemia:
- First,
and most important, do not panic.
- Always
wear your medical identification .
- If
possible test your blood sugar as soon as you feel your symptoms
coming on.
- Always
carry a carbohydrate drink, hard candy or piece of fruit "just
in case".
- Keep
some glucose tablets with you at all times.
- Wait
10 - 15 minutes for the ingested carbohydrate to begin raising
your blood sugar.
- Seek
immediate medical attention if you are not feeling better
soon after you have taken in some carbohydrates.
Diabetic
Ketoacidosis (DKA)
DKA
occurs when blood sugar levels are too high. The occurrence
of diabetic ketoacidosis may be the first indication of Type
I Diabetes (insulin-dependent) or the result of increased insulin
needs for a previously diagnosed diabetic. Insulin may need
to be increased during times when the body is stressed( i.e.
infection).
Poor
compliance with the treatment plan may also lead to DKA. The
starving body begins to break down fat for energy and this leads
to the production of ketones or acid in the blood.
It
is important to check urine for ketones when your blood glucose
level is elevated above the range your physician has prescribed.
You can easily check for ketones in your urine by using a test
strip available at your local pharmacy. Symptoms of Diabetic
Ketoacidosis:
- Nausea
- Vomiting
- Thirst
- Frequent
urination
- Difficulty
breathing
- Weakness
- Flushed
skin
- Fruity
breath
Call
your health care provider immediately if:
- Your
blood sugar is near 240 mg/dl.
- You
are experiencing any of the above symptoms.
- You
are ill or experiencing a stressful situation(s).
- Have
changed your diet, exercise pattern, or insulin dosage.
Diet
Complying
with your prescribed diet, that is taking in the correct amount
of calories, eating meals and snacks at the appropriate times,
and having a carbohydrate snack readily available in the event
of a hypoglycemic reaction, is of utmost importance in maintaining
normal glucose levels.
A
visit with a registered dietician can put you on the right track
with your specific dietary needs. Based on your weight, activity
level, and the amount of insulin prescribed for you, your dietician
can assist you with planning healthful meals while maintaining
your prescribed daily caloric intake.
Together
you will need to review the American Diabetic Association Food
Exchange List in order to ensure that you are eating the correct
amount of carbohydrates, proteins and fats. Once you become
comfortable with food trading or substituting, and reading food
labels, meal and snack planning will be simple.
Discuss
the following with your dietician:
- What
your daily schedule is like (usual meal times).
- Foods
that you especially like or dislike.
- Activity
/ exercise level.
Together
a workable plan can be accomplished. Keep in mind that as your
schedule changes (travel, holidays, sporting events, or if you
are ill) you will need to adjust your food intake as well.
Exercise
Exercise
can be especially helpful for diabetic teens. Being active helps
glucose to go into your cells to be used for energy, therefore
lowering the amount of glucose in your bloodstream and the amount
of insulin you will need. Sounds great.But remember to discuss
your normal activities, whether it be bike riding or soccer,
with your healthcare team in order to regulate your diet and
insulin doses appropriately.
Insulin
Insulin,
the hormone normally released by the cells of the pancreas,
is necessary to help the body use glucose for energy or store
it to be used at a later time.
There
are many different types of insulin. Insulin is categorized
by:
- Onset
- how soon the insulin starts to work
- Peak
time - when the insulin is working the hardest
- Duration
- how long the insulin lasts in your body
Onset,
peak time and duration time of insulin are all very important
in maintaining a normal blood glucose range. It is not possible
to take insulin orally because it will breakdown in your stomach
and therefore cannot be used effectively to control blood sugar
levels. Insulin must be given by injection into your fatty tissue.
You will be instructed by a health care professional, specially
trained in caring for diabetic patients, on how to give yourself
shots. This will be scary at first but soon after you will become
comfortable with the routine.
See
All
About Insulin for proper insulin storage, dosage, timing,
administration, self-monitoring, injection technique, site rotation,
insulin syringes, pens and pump therapy, and safe needle disposal.
Even
the perfect treatment plan will not work to keep blood glucose
levels under control if you are not compliant. Family, friends,
teachers and coaches must all be aware of your diabetes, the
symptoms of hypoglycemia, and the immediate interventions necessary
to assist you in the event of a hypoglycemic reaction.
Use
Daily Record Keeping to Manage your Diabetes:
Accurate
daily record keeping of the following is useful for both your
health care team and family to assist you with managing your
diabetes.
- Food
intake
- Blood
and urine monitoring
- Insulin
administration (times, type, dose)
- Marked
variation in exercise
- Illness
and/or stress
Years
of uncontrolled diabetes can cause damage to your eyes and kidneys,
as well as your heart and blood vessels. Taking care of your
skin, especially of your legs and
feet, is critical in preventing serious problems. Keeping
glucose levels under control will allow you to feel your best
as well as minimize diabetes -related complications later in
life.
Click
here for more information on how to watch out for and
deal with foot problems that are associated with diabetes.
Links
to Diabetic Care Sites
Just
for Teens
National
Institute of Diabetes/Digestive/Kidney Diseases (NIDDK)
Joslin.harvard.edu
noah.cuny.edu
International
Diabetic Athletes Association
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