ABOUT DIABETES
                                 for the
                          TEACHERS and COACHES 
                             [child's name]

[child's name] is different than other diabetics you may know.  He/She is
on a regimen of Intensive Insulin Therapy and uses an Insulin Pump.

Please take the time to read this information.  Therapeutic strategies
for diabetes are changing rapidly and it is important that individuals
supervising young people afflicted with diabetes be aware of the
nature of the disease, the treatment as well as the  problems that can
occur on a daily basis.  Some of the material covered is technical;
however, I have tried to present it in a non-technical fashion.  Much
of the information presented is applicable to other children (and
adults) with diabetes.

What is an Insulin Pump       
An Insulin Pump is a miniaturized version of the
device you see in hospital movies attached to a pole that meters bags
of "liquid stuff" into the patient's I.V.  An Insulin Pump contains a
large syringe filled with insulin, a computer which allows the user to
time and adjust the administration of insulin to their bodies, and a
small motor to drive the syringe.  Attached to the end of the syringe
is a sterile tube (infusion line) fitted with a needle which is
inserted into the soft tissue of the lower abdomen.  The entire fluid
system (needle, infusion line, and syringe) must be changed every few
days to maintain a sterile environment and avoid infection at the
infusion site on the abdomen.

Diabetes Explained: [child's name] suffers from Insulin Dependent
Diabetes Mellitus (IDDM) also known as Type 1 Diabetes or Juvenile
Diabetes.  IDDM is an AUTOIMMUNE disease that destroys the cells in
the pancreas that produce the hormone insulin which is required to
metabolize glucose (blood sugar) and provide energy for cells in the
body.  People afflicted with IDDM produce no insulin whatsoever.
Approximately one million people in the United States suffer from
IDDM.  Another 10 to 12 million people suffer from Type 2 (adult
onset) diabetes where the pancreas fails to produce enough insulin. 
Type 2 diabetes is a 'different' disease with symptoms and
complications that are similar to Type 1 diabetes. Type 2 diabetics
can sometimes control their disease with diet alone or with the help
of oral medications.

Short Term Problems Associated with Diabetes

HIGH BLOOD SUGAR    Without insulin the body cannot use glucose and
shifts from metabolizing carbohydrate (glucose) to metabolizing fat
for energy.  This shift is accompanied by elevated blood sugar levels
(hyperglycemia) and  normal, acidic by-products of fat metabolism
known as ketones.  When fat is the main energy source, ketones
accumulate and move the body's electrolyte balance into the acidic
range, causing excessive urination and dehydration as the body tries
to reestablish its acid balance by excreting the ketones.  This life
threatening condition is known as diabetic ketoacidosis (DKA).  Total
interruption of insulin to a person with IDDM can result in DKA within
4 to 8 hours.  Regular blood sugar testing can detect elevated blood
sugar levels and the onset of DKA and timely action can be taken to
prevent problems from occurring.

LOW BLOOD SUGAR     Without an adequate supply of carbohydrate to
support immediate metabolic requirements, a diabetic may experience
low blood sugar (hypoglycemia).  The symptoms of mild low blood sugar
may include among other things; tremors, tingling, palpitations,
sweating, anxiety, shivering, dizziness, confusion headache, speech
impairment, drowsiness, weakness, hunger, and blurred vision. Severe
low blood sugar is associated with impaired cognitive function that
results directly from brain glucose deprivation and may lead to
unresponsiveness, coma, or seizure.  The changes mentioned above may
go unnoticed by a casual observer, however, the person experiencing
low blood sugar can usually recognize and treat the symptoms without
outside help.  Because symptoms of low blood sugar can rapidly
progress from moderate to severe if untreated, a person experiencing
these symptoms should not be left alone until action is taken to raise
blood sugar levels.

Known Long Term Problems Associated with Diabetes 
and Long Term Elevated Blood Sugar Levels

Diabetic Retinopathy          the deterioration and
                              destruction of small blood
                              vessels in the retina leading
                              to loss of vision.  The
                              leading cause of blindness in
                              the United States

Proteinuria and               elevated levels of protein 
Nephropathy                   in the bloodstream
                              damaging the kidneys and 
                              other organs.  The leading
                              cause of kidney failure in 
                              the United States.

Neuropathy                    damage to the nervous system
                              resulting in the loss of
                              sensation in the skin and
                              extremities.  Combined with
                              the effects of peripheral
                              vascular complications, the
                              leading cause of amputations
                              in the United States.

Cardiovascular and            damage to capillaries,
Peripheral Vascular           increased risk of stroke,
Complications                 ischemic heart death, and
                              other microvascular

Any or all of these complications may appear in as little as five
years if blood sugar levels are not maintained at near normal levels.

Example:  One of [child's name] diabetic friends has been twice 
to summer camps sponsored by the local Diabetic Foundation.  
The cabin counselor for the friend's cabin last year visited 
the girls at camp this summer.  The counselor has just undergone 
eye surgery to forestall damage to her retinas (both of them) 
caused by Diabetic Retinopathy.  She is 20.

Treatment of IDDM   
For years, most diabetics have taken two and sometimes
three injections a day of insulin to control their blood sugar levels
and manage their diabetes.  With this level of control it is almost
impossible to maintain near normal blood sugar levels and the onset of
long term complications is inevitable.  Since 1923 it has been
recommended by diabetologists that blood sugar levels be maintained as
close to normal as possible.  It was not until 1993, however, that it
was unequivocally demonstrated by the conclusion of the 10 year
Diabetes Control and Complications Trial (DCCT) that intensive blood
sugar management can dramatically reduce the risks and complications
of diabetes.  The trial consisted of 9000 patient years of observation
of one group of patients on intensive insulin therapy and another
group using the conventional 2 to 3 shots a day.  The results of the
trial demonstrated for the intensive therapy group a 76 percent
reduction in the risk of development of retinopathy , a 54% reduction
in incidence of nephropathy (kidney disease), a 60% reduction in
incidence of neuropathy, a 34% reduction in the development of high
cholesterol, and  a 41% reduction in the risk for heart attack and

The intensive therapy group used two methods to control their blood
sugar levels: 

1)   Multiple Daily Injections (MDI) consisting of three
     or more injections of insulin combined with regular
     testing of their blood glucose levels;
2)   and Continuous Subcutaneous Insulin Infusion (CSII or
     more simply - new technology in the form of an Insulin
     Pump) combined with regular blood glucose testing.

"Intensive Therapy" is just now emerging onto the clinical scene with
the publishing in 1994 of the results from the DCCT.

Example:  When a friend went to diabetes camp in 1994 there were
300 kids and 30 to 40 counselors.  Only one counselor had an Insulin
Pump.  The summer of 1995 the camp participants counted 3 pumpers (one
counselor, the friend and one other kid).

Conventional insulin therapy practiced by most diabetics requires
testing blood sugar 2 or three times a day and the periodic  injection
of a long and a short acting insulin. Meals and exercise must be
carefully controlled and timed to match their body's insulin uptake
and energy needs.  The most noticeable element of this type of
management is the periodic snacks required to maintain adequate blood
sugar levels.

Insulin Pump users test their blood sugar 4 to 6 times a day and
program their Insulin Pump to provide a continuous small drip of
insulin that matches their body's background (fasting) insulin
requirements (this is called the "Basal Rate").  In addition, pumpers
program their pumps as needed to provide the exact amount of insulin
to match the food they eat at the time that it is consumed (this is
called a "Bolus").   The management effect of an Insulin Pump can be
approximated by using MDI (multiple daily injections) and frequent
blood sugar testing, however, MDI to achieve intensive therapy is much
more rigorous and difficult to maintain (especially for a kid).

What's Normal  Blood sugar levels for a non-diabetic fall in the 80 to
120 range. Glycosylated hemoglobin levels ( a measure of average blood
sugar levels over a three month period) for a non-diabetic average
around 5%.  For a diabetic, consistently maintaining near normal blood
sugar levels of 150 or below on a day-in day-out basis will produce a
Glycosylated hemoglobin level of around 7% and a reduced incidence of
complications as demonstrated by the DCCT.  In the course of a day, a
diabetic in "good control" may have blood sugar levels that swing from
50 to almost 200.  The body's blood sugar servo-mechanism does not
work and is replaced by machines; i.e., a Glucometer, Insulin Pump,
and the brain of the patient to close the servo loop in real time. 
Blood sugar control for a diabetic is analogous to steering a car on a
winding road from the back seat with two long rubber bands attached to
the steering wheel while watching the road through the wrong end of a

What does this mean for you as a teacher or coach???  Now that
you've read all about what can go wrong, what happens on a day to day
basis?  Usually everything works OK and [child's name] takes care of
problems that develop.  Diabetics need the people around them to
simply be aware that they may suffer from low blood sugar and need
assistance to correct a SEVERE low blood sugar or simply your patience
and indulgence until they can correct a MILD low blood sugar.  On the
average, diabetics suffer a reaction which requires the assistance of
others a couple of times a year or less.  However, not to get
complacent, moderate low blood sugars can and often do occur on a
daily basis. Diabetics on intensive therapy on the average suffer 50%
more low blood sugar reactions.   (child's name) suffers 2 to 5 mild
reactions a week which she has always caught and corrected herself. 
Someday this will not be the case and that is why the people around
her must constantly be vigilant in the event that she needs your

ABOUT your child



DOCTORS                       FIRST CHOICE     
HOSPITAL                      SECOND CHOICE
after hours

If [child's name] is in need of medical treatment it is IMPORTANT that
the medical team be aware that she is an "Insulin Dependent Diabetic".
It is common practice for emergency rooms to give patients fluids and
glucose which is not necessarily a good idea for diabetics.

YOU       [child's name] can usually tell when he/she is LOW and will
NEED      test and correct blood sugar levels as needed; 
TO        however, if he/she appears moody or upset when there 
KNOW      is no apparent good reason ASK IF HE/SHE IS LOW

Physical exercise is not appropriate when [child's name's] blood sugar
levels are below 80 or above 150.  hE/She can correct a low blood sugar
in 10 to 20 minutes using glucose tablets but should have food
containing carbohydrate for long term correction.  High blood sugars
can be aggravated by exercise and may take several hours after an
insulin infusion to return to acceptable levels.  Likewise, [child's
name] should not eat when her blood sugar levels exceed 160. 
[child's name] can usually correct high blood sugar levels in
anticipation of a meal within an hour using an accelerated bolus. 
However, if he/she uses an accelerated bolus to lower blood sugar levels
there is an increased risk for low blood sugar, he/she MUST eat within
the appropriate time frame to avoid a subsequent severe low blood
sugar level and insulin reaction.


In the event [child's name] experiences a severe insulin reaction (low
blood sugar), he/she carries in his/her pack the following items.

1)  Glucose tablets           1 to 3 tablets taken orally 
                              if awake and cognizant

2)  Glucose gel               in a tube or large foil
                              packet.  Administer entire
                              contents if groggy or
                              incoherent but breathing ok--
                              squeeze into mouth and rub on
                              gums. Glucose enters the blood
                              stream directly through the
                              mucous membrane, it does not
                              require digestion.

3)  Glucagon Emergency Kit    In a small plastic box
                              containing a syringe filled
                              with sterile fluid and vial of
                              dry powder.  Squirt syringe
                              into vial, shake vigorously,
                              draw mixture into syringe,
                              expel bubbles, then administer
                              in muscle of butt or
                              leg.  DO NOT HESITATE TO
                              ADMINISTER if unconscious and
                              you suspect an insulin
                              reaction.  No permanent harm
                              will result if you are wrong.
                              In any event, call 911 and
                              notify responding team that
                              she is a diabetic then call

Glucose and glucagon usually work within 10 to 15 minutes.  Other
forms of sugar are not suitable because they take much longer to enter
the bloodstream since they must be broken down into glucose by the
digestive system before the body can use them.  A soda cracker or
white bread is the next best thing to bring blood sugar levels up if
glucose is not available.  Simple starch is converted to glucose by
the body within 30 minutes or less.

Sports and Exercise Physical activity increases the body's need for
glucose and lowers blood glucose levels (as long as there is adequate
insulin).  Most ordinary exercise that is not strenuous or prolonged
does not require any particular action on the part of the diabetic
person.  Prolonged physical activity such as marathon runs, or other
activities that extend more than an hour, AND PARTICULARLY SWIMMING,
require the intake of additional energy (glucose).  [child's name]
burns an extra 10 grams of carbohydrate an hour while swimming.  You
may see [child's name] munching on a cracker or other snack before or
during exercise.  This is normal.

Thank you for taking the time to read this and help [child's name].

for [child's name]


[mom and dad's name]

Copyright © 1998, Insulin Pumpers.
Permission to use, copy, distribute this document for any purpose is hereby granted. This document is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY, either expressed or implied. While every effort has been taken to ensure the accuracy of the information documented herein, the author / editor / maintainer assumes NO RESPONSIBILITY for any errors, or for any damages, direct or consequential, as a result of the use of the information documented herein.

If you have a child with diabetes and would like to talk to other parents about the Insulin Pump, please contact Diabetes@Insulin-Pumpers.org or visit our Insulin-Pumpers website.