Gates Home Space: Diabetes Info

About Ketones

Sat, 10 Nov 2007 21:47:55 GMT

Ketones are acids in the body that result when the body does not have enough insulin to meet its energy needs.

The presence of ketones in the blood or urine is a sign that the body is breaking down its stores of fat because it lacks access to its normal source of energy — glucose. Starvation is one method by which glucose supplies become depleted, forcing the body to use fatty acids instead. Under normal conditions, fat is broken down into glycerol and fatty acids.

In patients without diabetes, ketone production can occur during fasting or when carbohydrates are inadequate, but the amounts of ketones usually are low and the condition does not progress to ketoacidosis.

In people with diabetes, insulin activity is lacking, due to decreased production of insulin (type 1 diabetes) or reduced sensitivity to insulin (type 2 diabetes). A shortage or absence of insulin approximates a state of extreme starvation, because glucose, even if present, is inaccessible
as an energy source.

Infection or illness is the primary reason that a person with known diabetes develops ketone bodies. Under these circumstances extra energy is required and, if insulin levels are insufficient, fat will be broken down.

Ketones should be tested whenever the blood glucose levels rise above 300 mg/dl (16.5 mmol/l), or if the child has signs of a systemic illness, such as fever, especially vomiting, even if blood glucose is normal.

If blood glucose rises above 300 mg/dl (16.5 mmol/l), the child or school personnel may need to:

inject a corrective dose of rapid- or short-acting insulin
check blood glucose at least every 2 hours
check urine for ketones with a ketone test strip modify food intake increase fluid intake with water or sugar-free drinks.

See About Ketoacidosis for more information.

About Ketoacidosis

Sat, 10 Nov 2007 21:47:18 GMT

Extremely high levels of glucose in the blood and a severe lack of insulin lead to the breakdown of fat for energy. As a result, chemicals called ketones accumulate in the blood and urine. The signs of ketoacidosis include nausea, stomach pain, fruity breath odor, rapid breathing, and frequent urination.

Ketoacidosis occurs in up to 40% of newly diagnosed people with type 1 Diabetes.

Left untreated, diabetic ketoacidosis has a 100% death rate.

Indeed, ketoacidosis is a leading cause of death and disability in children with type 1 Diabetes. Severe acidosis often develops during an extended period in which hyperglycemia-related symptoms are misdiagnosed.

See About Ketones for more information.

Halloween and Diabetes

Sat, 27 Oct 2007 17:11:40 GMT

Halloween is a time for great fun for all kids. Kids with Diabetes should be able to participate in the fun (e.g., eating candy) without feeling different from other kids.

The Children with Diabetes web site has put together some great information about how to kids with diabetes can enjoy Halloween while still controlling their blood-glucose levels.

Here's the link to the Children with Diabetes site and information about Halloween:

http://www.childrenwithdiabetes.com/d_0n_c00.htm

Background Information

Sun, 07 Oct 2007 03:36:04 GMT

LiveJournal Tags: Diabetes

Diabetes is a serious, chronic disease in which the body does not make or properly use insulin, a hormone needed to convert sugar and other food into energy. Diabetes may lead to serious short term and long term complications by blood glucose levels that are either too low (hypoglycemia) or too low (hyperglycemia). Serious immediate consequences, such as brain damage or death can occur if hypoglycemia is not immediately treated. Alternately, too many high blood glucose levels can cause damage to the eyes, kidneys, nerves, heart and blood vessels. Research has shown that these problems can be greatly reduced or delayed by keeping blood glucose levels near normal. Furthermore, when a child with diabetes is out of his or her target blood glucose range, his or her ability to concentrate and learn is affected.

The majority of school-aged youth with diabetes have type 1 diabetes. People with type 1 diabetes do not produce insulin and must receive insulin through either injections or an insulin pump. Insulin taken in this manner does not cure diabetes and may cause the student’s blood glucose level to become dangerously low. Neither insulin nor other medications are cures for diabetes; they only help control the disease. All people with type 1 diabetes must carefully balance food, medications, and activity level to keep blood glucose levels as close to normal as possible.

Accordingly, for Stevie to avoid the serious short and long term complications of blood sugar levels that are either too high or too low, Stevie's Section 504 Plan (Plan), and the accompanying Diabetes Medical Management Plan (DMMP), must be carefully followed and strictly adhered to by responsible school personnel.

To facilitate the appropriate care of the student with diabetes, school and day care personnel must have an understanding of diabetes and be trained in its management and in the treatment of diabetes emergencies. Knowledgeable trained personnel are essential if the student is to avoid the immediate health risks of low blood glucose and to achieve the metabolic control required to decrease risks for later development of diabetes complications.

What is Hypoglycemia?

Sun, 07 Oct 2007 03:24:42 GMT

Low blood glucose (hypoglycemia) is the most common health emergency for students with diabetes. It occurs when one or more of the following happen:

1) the body gets too much insulin,
2) too little food is eaten,
3) a meal or snack is delayed,
4) unplanned or unexpected exercise occurs, or
5) exercise is greater than the usual or expected amount.

Symptoms of mild to moderate hypoglycemia include hunger, shakiness/tremors, pounding/fast heartbeat, “spacing out” (person is not engaging with others in the usual manner), sweating, lightheadedness, irritability, confusion and drowsiness.

A student with this degree of hypoglycemia will need to promptly ingest a quick-acting source of glucose and may require assistance. Severe hypoglycemia may lead to inability to swallow, unconsciousness and convulsions and is life threatening if not treated promptly.

What is Hyperglycemia?

Sun, 07 Oct 2007 03:22:14 GMT

LiveJournal Tags: Diabetes , Hyperglycemia , Hypoglycemia

High blood glucose (hyperglycemia) occurs when the body gets too little insulin, when food is not covered by insulin or from too little exercise; it may also be caused by stress, injury, menstrual cycles or an illness such as a cold.

The most common symptoms of hyperglycemia are thirst, frequent urination, fatigue, and blurry vision.

Hyperglycemia, if left untreated, can lead to a serious condition called diabetic ketoacidosis (DKA) characterized by nausea, vomiting and a high level of ketones in the urine. For students using insulin infusion pumps, lack of insulin supply may lead to DKA in several hours. DKA can be life-threatening and, thus, requires immediate medical attention.

Affects on Major Life Activities

Sun, 07 Oct 2007 03:18:27 GMT

LiveJournal Tags: Diabetes , Section 504 , Hypoglycemia , Hyperglycemia

Major life activities, as defined in the Section 504 regulation at 34 C.F.R. 104.3(j)(2)(ii), include functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. This list is not exhaustive. Other functions can be major life activities for purposes of Section 504. Consequently, if a child with Diabetes requires medical interventions and/or monitoring at school to attend school safely, she qualifies for Section 504.

All individuals who take insulin are subject to insulin reactions, including insulin shock. When an insulin reaction occurs, it can substantially limit Stevie’s major life activities by impairing her ability to see (blurry vision), walk (dizziness/confusion), learn (confusion), speak (confusion), breathe (severe hyperglycemia), and most importantly, to care for herself (confusion, as well as other physical symptoms).

Diabetes must be managed 24 hours a day, 7 days a week. Both high blood sugar levels and low blood sugar levels affect Stevie’s ability to concentrate and learn, as well as seriously endangering her health. Blood glucose levels must be maintained in the prescribed range for optimal learning and testing of academic skills. Stevie has a recognized disability, type 1 diabetes, that requires the accommodations and modifications set out in this plan to ensure that Stevie has the same opportunities and conditions for learning and academic testing as classmates, with minimal disruption of her regular school schedule and with minimal time away from the classroom.

When Stevie's blood glucose levels are either too high or too low, she feels poorly, concentration is difficult, and her mental skills can be significantly impaired until her condition is treated and corrected. In severe cases she may become disoriented and incapable of rational thought. She may act irrationally, and may be unable to sit upright, walk, remain alert, care for herself, or reason until her condition is corrected. These episodes can occur during class, or during testing - classroom or standardized. During these times learning is difficult, and self-care is not possible - so accommodation is necessary.
Due to this condition Stevie may frequently have to leave class, or have others attend to her in class while learning or testing activity is occurring. She may have to leave class to go to the bathroom more frequently than others. She may also be out sick more than other children or have to leave more frequently for other medical treatments or appointments. During these times when she is absent her learning is obviously affected and requires special accommodation.

During standardized testing, Stevie may require special accommodations - such as the ability to eat or to leave for bathroom or water fountain visits without penalty, and therefore, be given extra time to complete the testing. She may also be unable to perform well and/or complete testing due to serious high or low blood sugar episodes, and the impact that they have on her mental acuity. Again, she would need to be given an alternate opportunity to finish the testing when her glucose levels are within range.
In order to prevent life-threatening complications, as well as to ensure Stevie’s long-term health, steps to prevent hypoglycemia and hyperglycemia, and to treat these conditions if they occur, must be taken in accordance with Stevie's Section 504 Plan and with her Diabetes Medical Management Plan, which is attached to the Section 504 Plan and incorporated into it.