Type 1 Diabetes

Type 1 diabetes mellitus is one of the most common of all chronic illnesses of childhood, occurring in approximately 1 of every 400-600 children. The

American Diabetes Association (2009b) estimated that approximately 186,300 youth under age 20 years have been diagnosed with type 1 diabetes. The International Diabetes Federation (2006) estimated that worldwide, 440,000 children ages 0-14 years have been diagnosed with type 1 diabetes, with 70,000 new cases expected each year. Type 1 diabetes is an autoimmune disorder in which pancreatic islet cells have been destroyed, resulting in permanent insulin deficiency. Because insulin replacement is essential for survival, youth with type 1 diabetes must receive daily insulin injections or delivery of insulin through an insulin pump. Currently, the exact cause of type 1 diabetes is unknown, although both environmental and genetic factors have been implicated (American Diabetes Association 2009a).

The treatment for type 1 diabetes is complex and multifaceted (Wysocki et al. 2003). On a daily basis, children are asked to monitor their dietary intake, monitor and test their blood glucose levels, receive varying amounts of insulin injections, reduce stress, and limit physical overexertion (American Diabetes Association 2009c). Testing of blood glucose levels is usually conducted via finger pricks at set times throughout the day, such as before meals and at bedtime, to inform the child and parent if any changes in dietary intake or insulin administration need to be implemented. Because carbohydrates greatly affect blood sugar levels, children are asked to count or monitor the amount of carbohydrates they consume during meals and snacks. Maintaining a balance of blood glucose is critical for the child's well-being and livelihood. Adhering to this regimen helps to ensure that individuals avoid low or high blood glucose levels (hypoglycemia or hyperglycemia, respectively). Hypoglycemia can cause dizziness, hunger, nausea, confusion, light-headedness, sweating, and shaking and is usually the result of not eating, excess amount of insulin through injections or medication, physical overexer-tion, and excessive alcohol intake (Wysocki et al. 2003). Hyperglycemia can result in fatigue, loss of consciousness, and diabetic ketoacidosis if untreated (Delamater 2000). Therefore, children must strictly adhere to their treatment regimen to avoid these short-term complications.

The potential long-term complications of type 1 diabetes are serious and sometimes life threatening; these include damage to the eyes (retinopathy and possible blindness), damage to nerves in the extremities and possible amputation (neuropathy), heart damage, and renal failure. Importantly, research has demonstrated a linear relationship between blood glucose levels and health outcomes, such that maintaining normal to near-normal levels of glycosylated hemoglobin (HbA1c) can significantly reduce the risks of developing such complications (Diabetes Control and Complications Trial Research Group 1994). Therefore, health care providers have increasingly adopted aggressive approaches to diabetes management, including comprehensive training of parents in diabetes care, frequent glucose testing, and use of team approaches (Wysocki et al. 2003).

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