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  • Diabetes and Bad Behavior in Kids: Check Their Blood Sugar!

    IMAGE The symptoms of poorly controlled type 1 diabetes may cause behaviors that can be perceived as rebellious or cantankerous. Education of everyone involved—family, healthcare providers, teachers, nurses, and fellow students—is the best way to stabilize behavior.

    Type 1 Diabetes in a Nutshell

    Type 1 diabetes is caused by an inability of the pancreas to secrete any or enough insulin—the hormone responsible for letting glucose into the body's cells. Under normal conditions, the body breaks down sugars into glucose, and the glucose travels through the bloodstream as fuel for the body's cells. Aided by insulin, glucose freely enters the cells to be used primarily for energy. If insulin is not available—as is the case in diabetes—glucose cannot enter the cells and continues to circulate in the blood and build up over time.
    The typical symptoms of diabetes occur as glucose accumulates in the bloodstream and causes an imbalance between glucose in the blood and glucose in the cells. Although there is no cure, symptoms can be controlled with injections of insulin to replace what is not produced by the pancreas.

    Recognizing the Symptoms

    A parent's first indication that a child might have type 1 diabetes is the occurrence of one or more of the typical symptoms that include:
    • Headaches
    • Increased thirst
    • Increased hunger
    • Frequent urination
    • Unexplained weight loss
    • Extreme unexplained fatigue
    • Weakness or dizziness
    • Blurry vision
    • Fruity breath odor
    • Irritability
    • Drowsiness
    • Vomiting and nausea

    Managing at School

    While many parents find that their diabetic children receive both excellent education and in-school management of their diabetes, others report a variety of problems.
    One parent tells the story of her fifth grade son's move from a familiar, small private school to a large public school. She gave the registrar an information packet about her son's diabetes and was assured that her son would be watched carefully. She later discovered that an unfamiliar privacy act prevented several teachers and school workers from ever being informed of her son's condition.
    Alarmed to receive a midterm progress report of failing grades for her son—who had previously been an honor student—she arranged a teacher conference. She was astonished to learn that the science teacher perceived her son as passively rebellious and a daydreamer. It turns out that her son was embarrassed to request early dismissal from midmorning class to have time for his snack. By the time he reached science class (right before lunch), his blood glucose levels fell dangerously low, causing him to become confused and disoriented.

    Knowing What to Look For

    Dr. John Germak deals with similar situations as a pediatric endocrinologist at Children's Medical Center of Dallas. He recommends to parents of diabetic children, "Be on the lookout for any sudden behavioral changes."
    If a normally quiet child suddenly becomes rowdy and uncontrollable, check his blood sugar. Or, if a normally active child suddenly seems subdued and quiet, check her blood sugar.
    "Low blood sugars are the most important to recognize," says Dr. Larry Deeb, medical director of the Diabetes Center of Tallahassee Memorial Hospital. "Any behavior change is important. As blood sugar falls, the ability to think diminishes...and if left unchecked, can go all the way to coma . But, it can be subtle, confusion," he explains, "...maybe a silly answer or a stupid answer in an otherwise good student. Some kids get nasty, cantankerous, or short-tempered. I have seen them just withdraw, dreamy to even sleepy."

    Communication Is Key

    The key to good diabetes management at school is educating the teacher and the school nurse. Today, teachers deal with overcrowded classes, so monitoring a particular student's behavior can be challenging. Dr. Germak recommends making contact with each teacher at the beginning of the school year to point out the child's typical behavior patterns so they know what to look for. Any time a child becomes unusually subdued or hyperirritable, it is time to check her blood glucose level. After matching the results with particular behaviors, the teacher should become accustomed to the warning signs.
    Gloria Young, a certified diabetes educator specializing in pediatric endocrinology, stresses the importance of maintaining ongoing contact with the child's teachers. She also encourages parents to arrange a conference with the principal, teacher, and the school nurse to resolve conflicts with teachers who are reluctant to recognize that behavior changes may be related to abnormal blood glucose levels. There are also federal laws that help children with chronic illnesses obtain a free, appropriate education if parents can show that their child’s illness adversely affects his or her performance in school.

    Even Tougher For Teens

    The issue of blood glucose levels affecting behavior and moods becomes increasingly important during puberty. Increased hormone levels further complicate the picture, causing fluctuations that cannot be anticipated simply by monitoring dietary intake, while stereotypical teen behaviors complicate matters even more. For example, a teen with a disoriented or confused manner, may be mistaken for a drug or alcohol abuser. Educating an ever-changing roster of your child's junior and senior high school teachers can be challenging, but it is well worth the effort.

    How Can You Avoid These Problematic Situations?

    It is important that you understand your child's condition, because you are responsible for his or her safety. Plus, medical personnel who do not regularly manage people with type 1 diabetes can make mistakes.
    Make an information packet for each of your child's new teachers every year. Arrange conferences periodically. Accompany your child's class on field trips and become active in parent-teacher organizations. Also, get to know your child's friends and teach them to recognize subtle hints that the child's glucose levels may be running high or low.
    Arrange for your child to attend camps or workshops with other children who have diabetes. At a time when "fitting in" is so important, it is vital that your child interact with other children who share some of the same challenges.
    Be diligent in monitoring your child's blood glucose levels and dietary intake. Children sometimes deviate from prescribed regimens as they become more independent and may even lie about meter readings. They may also try to inject extra insulin to cover up overeating with friends. Complications from erratic control may not surface for several years, but when they do, they can be devastating.
    A diabetic reaction is not the time to discuss the situation with your child. When blood glucose levels are low, the child is unable to think clearly.
    At this time, there is no cure for type 1 diabetes, although researchers are making great strides. It is a life-long disease, but it can be managed to allow a happy and healthy life. Because the formative years are critical, it is your responsibility to help your child accept and control the disease.

    RESOURCES

    Children with Diabetes http://www.childrenwithdiabetes.com

    Juvenile Diabetes Research Foundation International http://www.jdf.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Canadian Diabetes Association http://www.diabetes.ca/

    References

    Barrett JC, Goodwin DK, Kendrick O. Nursing, food service, and the child with diabetes [Review]. J Sch Nurs . 2002 Jun;18(3):150-6.

    McCarthy AM, Lindgren S, Mengeling MA, et al. Effects of diabetes on learning in children. Pediatrics . 2002 Jan;109(1):E9.

    Roche, EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes . 2005; 6:75.

    Type 1 diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated 9/20/2011. Accessed April 26, 2012.

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