Diabetes, which is medically known as diabetes mellitus, is the condition in which the body has trouble regulating its

blood glucose, or blood sugar, levels. There are two major types of diabetes: type 1diabetes and type 2 diabetes. Type 1 was previously known as juvenile diabetes. It accounts for 5-10% of all diabetes in the United States. It occurs most frequently in children and young adults, although it can occur at any age. It is caused by the inability of the pancreas to produce insulin. In this type, the insulin-producing cells in the pancreas are destroyed. There does appear to be a genetic component to Type 1 diabetes, but the cause has yet to be identified. Diabetes type 1 limits childrens everyday habits such as food choices, exercise, and school activities. The main symptoms for diabetes are thirst, weight loss, tiredness, frequent urination. Its important to take care about the food choices of children with Type 1 Diabetes. The children with diabetes have the same nutritional needs for growth and development as other children; they do not need to be on a special diet. The childrens meal plan is one of the most important parts of managing diabetes. Children should be taught proper nutrition management. Their diet should include lots of vegetables, fruits and high in fiber and carbohydrates. Nonstarchy vegetables such as spinach, carrots, broccoli or green beans should be given with meals. The dried beans, fish, non-dairy products such as skim milk, non-fat yogurt and non-fat cheese are preferred in their meal. Eating too much of even healthful foods can lead to weight gain. They should watch their portion sizes. The children should be taught how food, especially carbohydrates such as breads, pasta, and rice affects type 1 diabetes and blood glucose levels. Too many carbos or those of the wrong kind can quickly lead to an imbalance in blood sugar
levels. Children should be helped to understand the correct portion sizes and number of calories

as well as how to make healthy food choices.

As diabetes patients can no longer produce insulin, another common treatment for diabetes is insulin. Insulin must be given by multiple injections or an insulin pump, daily, in order to survive. People diagnosed with type 1 diabetes usually start with two injections of insulin per day of two different types of insulin and generally progress to three or four injections per day of insulin of different types. The types of insulin used depend on their blood glucose levels. Three or four injections of insulin a day give the best blood glucose control and can prevent or delay the eye, kidney, and nerve damage caused by diabetes. Apart from food habits, exercise also plays an important role. As the exercise uses glucose as a fuel, it is an effective way to control blood sugar levels. Exercise has an insulin-like effect on glucose, enhancing its uptake into cells and counteracting elevated blood glucose levels that frequently occur after eating. With exercise, the amount of insulin injected for controlling blood glucose can be lowered in those in type 1 diabetes. In general, the exercise program should include aerobic exercise, strengthening exercises and stretching. When children exercise aerobically, their heart rate will increase and their breathing will become deeper. Walking, running, and swimming are good aerobic exercises for people with type 1 diabetes. By doing strengthening exercises, people get stronger muscles that will help them burn more calories at rest, get around better, have better balance, and strengthen their bones. Regular stretching will make children more flexible and help prevent muscle soreness from aerobic and strengthening exercises. There are few types of exercises that are to be avoided. They are: Heavy weight lifting. If people have diabetic eye problems, lifting heavy weights can put

extra pressure on the blood vessels in your eyes.

High-impact exercises. If nerve damage has caused numbness in peoples feet, their

doctor may recommend them to do a low-impact aerobic exercise like swimming instead of running. Some additional precautions are to be taken when Diabetes patients exercise. They need to consult their doctor about proper footwear. Patients feet will have difficulty healing, so blisters and cuts can be a problem. They should wash and examine their feet daily. After exercising, it would be a good time to examine. Diabetes patients should check their blood sugar every 30 minutes when exercising. When patients inject insulin, they should avoid their arms and legs prior to a workout. The exercise will cause insulin to be absorbed more quickly. Instead, they can use stomach as an injection site. In addition, activities during school should be monitored by the school nurse. Childrens school activities also have great impact on their health. Each child with diabetes is unique in his or her disease process, developmental and intellectual abilities and levels of assistance required for disease management. The school nurse develops the Individual Health Plan (IHP) from the Diabetes Medical Management Plan (DMMP), by collaborating with the childs family, obtaining additional assessment findings, and outlining the diabetes management strategies and personnel needed to meet the students health goals in school. The IHP identifies the students daily needs and management strategies for that student while in the school setting. The school nurse also coordinates the development and staff education of the Emergency Care Plan (ECP), which directs the actions to be taken by school personnel for symptoms of hypoglycemia and hyperglycemia. Children with diabetes should be able to participate fully in all sports and physical education activities, and attend field trips. Indeed, physical activity is a critical part of diabetes management. Exercise improves general fitness and strength, cardiovascular endurance, and

lowers blood pressure and levels of blood fat. The nurses in the school should monitor the blood glucose levels when children with type 1 diabetes take part in sports. The blood glucose levels to be monitored for each sport vary. They are. for football the blood glucose level can be <100mg/dl, for hockey it can be 100-180mg/dl, and for basket ball the blood glucose level can be 180-350mg/dl. If there is any drift in the glucose level, immediate action is to be taken by the school nurse to control it. Treatment for hypoglycemia or hyperglycemia should be readily available in the classroom or at activity sites and are to be administered immediately. Care should be taken by the school nurses that the diabetic children take their food or snacks at regular intervals and their lunch at appropriate time during the school hours. Diabetes type 1 is a serious condition. A student experiencing hypoglycemia should never be left alone or sent anywhere alone. This is because the student may not be able to selfmanage due to impaired cognitive and motor function during hypoglycemic conditions. It is important that kids with type 1 diabetes not be made to feel that their diet makes them outsiders in their family. A diabetic diet is very healthful for individuals with diabetes but for non diabetic people as well. Parents should try making eating health food a family affair. They should fix the same meals and snacks for all family members, and shouldn't allow siblings (or themselves) to munch on off-limits foods without offering similar alternatives to your diabetic child. Denying the child can create feelings of resentment or of being left out. Generally, it is best to avoid having foods in the house that only some members of the family can eat. The health condition of the diabetic children can be maintained by helping them practice good food habits, exercises regularly with some precautions, and motivating them to participate in almost all the school activities. More importantly, the diabetic children should be given moral support.

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http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullV iew/tabid/462/ArticleId/22/Diabetes-Management-in-the-School-Setting-Adopted-January-2012 http://www.idf.org/sites/default/files/attachments/article_507_en.pdf http://ndep.nih.gov/media/SNN_May_2004.pdf