Michael F. Shaughnessy Senior Columnist EdNews.org
Eastern New Mexico University

Dr. Christina Bratcher is affiliated with the Diabetes Centers of America She is a board certified endocrinologist whose primary interest is diabetes. Her undergraduate degree is in pharmacy from the University of Oklahoma. She practiced hospital pharmacy for two years before entering medical school. Dr. Bratcher attended Louisiana State University School of Medicine in New Orleans where she was elected to Alpha Omega Alpha medical honor society. She completed her internal medicine and endocrine training at the University of Oklahoma, where she served as Chief Resident in Internal Medicine. Dr. Bratcher has practiced two years of general internal medicine and seven years of clinical endocrinology. Prior to joining the Diabetes Centers of America, she was a faculty member of Tulane University School of Medicine. Dr. Bratcher is married and has four children. Her family recently moved to Plano,Texas and they are enjoying becoming Texans—just ask her kids, they'll tell you "Everything's bigger (and better) in Texas!"

1) First of all, how big a problem is juvenile diabetes in the schools?

When you refer to it as juvenile diabetes, it implies type 1 diabetes, in which there is a total reliance on insulin to live. Type 1 diabetes, formerly known as juvenile-onset diabetes, occurs when the body's immune system destroys the cells that make insulin. This is an autoimmune disease that affects approximately 1 child/adolescent in 400-600.

The problems in schools generally come from a lack of understanding about management requirements and recognition of high and low blood sugar.

In 2005, in the U.S., about 176,500 people aged 20 years or younger have type 1 diabetes, representing 0.22% of all people in this age group.

According to the CDC website- 13,000 young people are diagnosed with type 1 diabetes each year, so, it is unclear whether the frequency of type 1 is increasing among US youth, although European studies show an increase there.

Unfortunately, type 2 diabetes is a growing problem in childhood especially in high risk populations such as Native Americans, African Americans and Hispanic/Latino Americans. Good statistical data is lacking. This is generally related to genetics and obesity as well as environmental factors of unhealthy food and little exercise.

Two (2) million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes. (ADA website)

2) Why does this seem to be increasing? Lack of exercise, diet, or both?

Regarding obesity and type 2 in children, it is a compilation of societal changes- fast food and processed foods readily available with inappropriate marketing.

There is also a sedentary lifestyle- lack of daily P.E. in schools, access to computer games and TV, lack of physical chores and lack of walking.

Genetics and exposure to diabetes in utero may contribute to increased risk and development of Diabetes

Children and adolescents diagnosed with type 2 diabetes are generally between 10 and 19 years old, obese, have a strong family history for type 2 diabetes, and have some physical characteristics that indicate insulin resistance

3) What exactly is the difference between hyperglycemia and hypoglycemia?

What are some of the signs and symptoms that a regular education teacher should be looking for?

Hyperglycemia is high blood sugar and conversely, hypoglycemia is low blood sugar.

a. Symptoms of high blood sugar are thirst, dry mouth, excessive urination, lethargy, and decreased ability to concentrate.

b. Low blood sugar may have some similar symptoms as above, with sleepiness and an inability to focus. Persons with low blood sugar can become combative, yell or use language they normally wouldn't, be very confused, and "not make any sense." The physical signs can be sweating, and shaking, rapid heart rate, a glassy-eyed look or blank stare. Frequently, a person with diabetes will have the same warning signs or actions each time, so asking the individual about his or her usual low blood sugar episode will help identify when this person is experiencing hypo- or hyperglycemia. Severe repeated hypoglycemia leads to the inability for the person to recognize an oncoming episode, may lead to seizure, "brain damage", and long term cognitive problems. Fortunately, this is not common.

4) How can you encourage parents (and kids) to get those bracelets indicating their diabetic status?

They are making much "cooler" looking bracelets and tags now. Check out the Website below.

5) How does diabetes affect learning? Do kids with juvenile diabetes sleep a lot?

Children who are well controlled, physically, don't have additional learning problems. The social implications and disciplined regimens they must follow may hamper adjustment, etc. Children who are poorly controlled may need more sleep/rest, but it doesn't come as a given with the disease. Children in this country aren't getting the appropriate amount of sleep in general (adult either).

6) Briefly, what is the distinction between Type I and Type II diabetes? I know one can be controlled by diet.

Type 1 diabetes is an autoimmune disease where the pancreatic cells that make insulin are destroyed. The body mistakenly attacks its own cells. Insulin is the key therapy and required to live. There is a genetic contribution though not nearly as much as type 2 diabetes.
Type 2 diabetes is a function of obesity and insulin resistance: the body utilizes insulin inefficiently and therefore needs to make much larger quantities than usual to keep blood sugars normal. When that balance is gone, blood glucose levels increase and diabetes is diagnosed. Usually, but not always, patients also manifest hypertension and abnormal cholesterol. This set of patients is at a much higher risk of cardiovascular disease, and in fact, this is the major cause of death.

Diet can sometimes control type 2 diabetes along with exercise and weight loss, especially early in the course of the diagnosis. However, type 2 diabetes is generally a progressive disease, so most patients require medication and eventually insulin injections

7) How big a problem is this in both the short term and the long term?

Diabetes is a daily and generally lifelong disease that requires intensive management and intervention, and extreme self discipline in order to control it appropriately.
Some of the long term complications are blindness, amputations, kidney failure, and
cardiovascular disease such as heart attacks and heart failure. And that has to be topped off
with the psychological and socioeconomic implications.

8) What else can you add about juvenile diabetes?

The good news is that diabetes care improves constantly with new technology and medications, and diabetes research is getting more attention and funding (though probably not as much as needed) than before. Persons with diabetes are living longer, healthier, and hopefully happier lives than ever before. Just think about some of the celebrity role models- actresses Mary Tyler Moore and Halle Berry; Olympic swimmer Gary Hall; NBA rookie Adam Morrison , and Miss America 1999 Nicole Johnson!

Published February 12, 2007