From: steve@microware.com (Steve Guntly)
Newsgroups: misc.kids
Subject: Re: juvenile diabetes (LONG)
Date: 10 Apr 92 20:31:32 GMT
Followup-To: misc.kids
Distribution: world
Organization: Microware Systems Corp., Des Moines, Iowa

In article <1992Mar26.145558.25441@wupost.wustl.edu> bloch@informatics.wustl.edu (Charlene Bloch Abrams) writes:
>In article <1992Mar25.200444.13491@morrow.stanford.edu> AR.AEH@forsythe.stanford.edu (Aleta Hanna) writes:
>>
>>My question is: is there any way to tell when child has diabetes when
>>there has been no other sign or warning?  This little girl got sick on
>>the weekend and was dead on Tuesday.
>>
>>Does any one know the symptoms of the onset of juvenile diabetes?
>>
>[explanation of typical scenario deleted]
>
>There may be other symptoms of which I am unaware, but this one is
>relatively easy to spot, even if you DON'T know the child's usual
>drinking habits - they tend to drink unusually large volumes.
>
>Charlene

This is a rather interesting thread, and one which I happen to have
a fair amount of information about (having been diagnosed with insulin
dependent diabetes in 1980).  Most of the responses have been pretty
accurate, but there's still some information that people may find
useful.  I worked as a volunteer with the American Diabetes Association
for several years, and continue to be a member of that organization.

I'll break this article into two parts (because of its length -- sorry,
I didn't mean to be so long-winded! :-).  The first is general
information about the disease, and the second is personal information
about my experiences and experiences of other diabetics I know.

General Information

There are basically three forms of diabetes:  Type 1 (insulin-dependent
diabetes; previously referred to as juvenile diabetes), Type 2 (non-
insulin-dependent diabetes; previously referred to as adult-onset
diabetes), and gestational diabetes.  In the U.S., the estimates for
people afflicted by diabetes is around 6% of the population.  This
probably does not count gestational diabetes which tends to be a
transient problem (women don't *REALLY* stay pregnant forever, it
just seems that long :-).  Roughly half of these people are not aware
that they have the disease.  The breakdown between Type 1 and Type 2
is around 15% Type 1 and 85% Type 2.  Certain groups of people tend
to be more prone to diabetes (particularly Type 2).  These include
women, blacks, Hispanics, and Native Americans (in no particular
order).

As mentioned by others, the main symptoms of undiagnosed diabetes
are the unquenchable thirst and frequent urination.  Other typical
symptoms include significant weight loss, vision changes, excessive
hunger (can't really "feed" the cells in your body), excessive mood
swings, change in bowel habits, excessive tiredness, and I think
there's some others that escape me at the moment.

The immediate problems with diabetes relate to blood suger control.
If the blood sugar drops too low, a bout of hypoglycemia (insulin
reaction) occurs.  If the blood sugar goes too high, hyperglycemia
(diabetic acidosis) occurs.  Hypoglycemia is typically the result
of too much insulin, eating too little food, delaying meals, or
excessive exercise.  Hyperglycemia is typically caused by too little
insulin, a failure to follow your diet (eating too many "sweets"),
infection and/or fever, and emotional stress.

Of the two, hypoglycemia is the more immediate concern, as an untreated
insulin reaction can lead to death very quickly.  Any diabetic who
has had the disease for a while can tell you of cases where they have
"passed out" due to an insulin reaction.  This is particularly dangerous
during the night, where you may not notice the symptoms of an insulin
reaction.  Symptoms of hypoglycemia include sweating, faintness,
headache, heart palpitations, hunger, impaired vision, confusion,
irritability, and personality change.  Symptoms tend to vary depending
on the individual.  Medication also has an impact.  Persons using
human insulin tend to have less pronounced symptoms than those using
animal source insulin, for example.  These symptoms come on quickly
(within a matter of minutes) and need to be treated immediately.
There are numerous over-the-counter forms of glucose that can be
used to treat insulin reactions.  Should an insulin reaction cause
a person to become unconscious, the suggested treatment is a shot
of glucogon, which is available with a prescription.

Hyperglycemia tends to come on more slowly, over a period of days.
Typical symptoms include increased thirst and urination, presence
of ketones in the urine, weakness, loss of appetite, nausea, vomiting,
and heavy labored breathing.  Treatment would usually include extra
insulin (if the person is on insulin), or perhaps other changes in
medication.  Consultation with your physician is typically desirable
to adjust other medications in the case of Type 2 diabetics.

With current blood testing equipment, most diabetics (or their
parents, in the case of a child) should be able to adequately monitor
their blood sugar to ascertain whether their blood sugars are within
the "normal" range (which is roughly 80 - 120 mg./dl.).  Blood testing
monitors are readily available for $50.00 (which most health insurance
plans cover).  The serious expense is the test strips which tend to
cost around $50.00 for 100.  Again, health insurance should cover the
cost of these supplies (I shudder at the thought of trying to pay for
this without health insurance, but that's another story :-( ).  If
you do the recommended testing of around 4 times per day, you can see
that this is a rather expensive venture.  There are other supplies
also required (lancets, etc.).

Long term complications from the disease include:  heart and ciculatory
problems, kidney failure, blindness, loss of limbs, and impotence (in
males).  In all cases, these tend to be related to the quality of
control maintained.  There are lots of people that have lived with
diabetes for 30 or 40 years without any complications.  What is typical,
however, is for problems to begin to appear after 10 to 15 years with
the disease.

Personal Experiences

The tragic case that started this thread is not the typical scenario,
but diabetes tends to be diagnosed following some significant event.
In my case, my mom decided to draw some blood (she worked in a medical
laboratory) after seeing me drain three *LARGE* cups of soda at supper
one night when I was on break from graduate school.  That combined
with my frequent trips to the rest room were all the signals she
needed.  She started asking other appropriate questions, like "Have
you lost a lot of weight?" (I'd lost about 30 pounds -- went from 175
to 145 on a 6'4" body), and "Are you tired a lot?" (absolutely -- I
was blaming it on school).  If I'd have known what the warning signs
of the disease were, I would have had things checked out months earlier.

The truth of the matter was that it was very hard for me to get through
my one hour lectures for the class I was teaching, because I *REALLY*
had to go to the bathroom.  Even though I had gone right before class.
Typical intervals between visits tended to be more on the order of 4 or
5 hours.  That's what they mean by more frequent urination.

The cause for insulin dependent diabetes is still not known.  In my
case, the suspicion is that a flu-like illness that I had had about
two years (!!) prior to the diagnosis was a virus that resembles the
Beta cells in the pancreas (the insulin producing bodies).  After this
was introduced into my system, and following the illness, the immune
system attacked the Beta cells to make sure that the virus was
eradicated.  There are now some tests available (that are quite
expensive) to check for the antibodies to a virus that seems to be
related to a scenario like this.

The scary thing for me is the insulin reactions.  In general, my
blood sugars tend to be pretty close to normal throughout most of
the day.  I've only had one serious insulin reaction.  I had sat
down to eat breakfast one morning, and then my wife heard a "Thud!"
from the other room.  She walked in, found me on the floor of the
kitchen, unconscious, in convulsions.  I've since seen other diabetics
in this state also.  It's not pretty.  She had the presence of mind
to call for an ambulance, and they were there within a few minutes.
After getting an IV started, I sort of came to, and remember part of
the ambulance ride to the hospital.  Most of the ride was spent going
into and out of consciousness.  I didn't have my eyes open, but was
sort of aware of where I was, and what was going on around me.  After
getting breakfast in the emergency room, they said I was free to go.
I went home, got some sleep, and went into work that afternoon.

In this case, we never will know what caused the insulin reaction.
My guess is that my morning injection got into the blood stream too
quickly.  The injection was with NPH insulin, which is a intermediate
acting insulin.  It's effectiveness is supposed to peak between four
and twelve hours (if I remember right).  Unfortunately, the shot that
morning struck a blood vessel, and I had a heck of a time getting it
to stop bleeding.  So I think that precipitated the whole thing.

One thing that is interesting is that several diabetics that I've
talked with have said that the symptoms of insulin reaction become
less obvious the longer that you have the disease.  In some cases,
it gets to the point where there are *NO* symptoms.  That can be
*VERY* dangerous.  I've seen some of that myself.  If I feel like
I might be having a reaction, I reach for my meter to find out where
my blood sugar is at.

For the mother asking about specific issues related to insulin, etc.,
send me some mail and we can discuss the issues (I believe the address
was "claudia@lonex.rl.af.mil").  The one issue that may be of general
interest was:  "What causes blood sugars to go up (out of control)
when a child is sick?"  As I understand it, what happens is that the
immune system is activated to attack the illness.  In the process,
there are substances secreted into the bloodstream (I don't remember
all of the specifics) that cause the blood sugar to go up.  This is
kind of strange, because you can eat next to nothing, take your
normal medication, and the blood sugar still goes through the roof.
It's frustrating, but part of what goes with living with the disease.
Note that this happens for all diabetics, not just children.  Actually,
you can use it as a barometer of whether you're coming down with
something, if you know what your blood sugars are usually like.  I've
noticed that my blood sugars tend to start rising a day or two before
I come down with a cold, for example.

As far as long-term complications are concerned, the current theory
is that good control of the diabetes decreases the risk of serious
complications.  I know of many people that have had the disease for
more than twenty years that have not exhibited any of the typical
complications.  However, these are also people that watch themselves
closely, and do what their doctor(s) ask of them.  There are lots of
researchers trying to develop a cure for this disease.  I think that
merging a lot of the work that is going on could provide a "replacement"
pancreas within the next 10 to 15 years.  There are blood glucose
meters that work without actually sampling blood (no more finger
sticks -- yeah!!!), and there are working implantable insulin reservoirs.
All that is required (not that it's easy, by any means :-) is to merge
some of these technologies into a unit that samples the current blood
sugar level, and adjusts the flow of insulin based on those readings.
Could be some interesting things coming in the next few years.

Well, that's enough rambling.  Sorry I wasted so much bandwidth, but
this is a disease that a lot of people only know a little bit about,
so I thought I would try to do some educating.  If anyone wants any
more specific information, send me some mail.  Thanks for reading...

					Steve Guntly
					steve@microware.com
					Daddy to Danielle, 4 years
					     and Courtney, 20 months

Newsgroups: misc.kids