Isabelle Knott's whole world changed drastically three years ago when she was diagnosed with type 1 diabetes. Here she is shown with her school nurse, Michele Barland, checking her blood glucose level.  Isabelle produced a video about being a kid living with type 1 diabetes.

Michele Barland is a registered nurse and certified diabetes educator (CDE) at Creekland Middle School.  She knows that on any given day she will monitor nine students who have type 1 diabetes. First things first, she helps these students to select breakfast, check blood sugar and draw their insulin.

"Just today, one of my kids is 463 milligrams per deciliter," said Barland. "He is way too high.  I don't know what he ate at home or how much insulin he took there."  

She gave this student plenty of water to dilute his blood sugar and the correcting formula of insulin as prescribed by his doctor.
    
Barland knows personally what type 1 diabetes can do to a child's young life.  She was diagnosed with the same disease at age 5 years old.  

"Since there is no cure, I still have type 1 diabetes," said Barland.  

Her siblings and father, age 79, were all diagnosed with the same disease. Her father was an Air Force candidate in his early 20s and failed his flight physical.  He learned then that he had type 1 diabetes. With her training with the American Diabetes Association (ADA) as a CDE, Barland knows that it's not rare to see the disease passed to offspring.  

"I also have a younger sister who at age 4 was diagnosed with type 1 diabetes," explained Barland. "That sister has a fraternal twin who does not have the disease. However, she is now the mother of an 11 year old boy who was diagnosed with type 1 diabetes at 26 months."   

According to the CDC, type 1 diabetes accounts for about five percent of diabetes cases. CDC also reports that there is no known way to prevent type 1 diabetes and effective treatment requires the use of insulin. Type 1 diabetes can develop at any age, although it typically develops in children and young adults, usually before the age of 30.

Like Barland's case, type 1 diabetes is a lifelong disease that develops when the pancreas stops producing insulin, a hormone that lets sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.
   
Type 1 diabetes is also referred to as juvenile diabetes.  It has also been known as insulin-dependent diabetes mellitus (IDDM) because of the daily insulin injections.

According to medical experts, if a child's sugar cannot move from the blood into the cells, the child's blood sugar rises above a safe level and the cells cannot function properly. Barland has seen several cases where the child's sugar levels were too high or too low which can be dangerous to a child's health.

On a normal school day, she had a student whose sugar levels were out of the proper range.

"He had a sausage biscuit for breakfast," described Barland. "He only calculated the biscuit for about 30 grams. The student did not include the sausage which had about 15 grams of hidden carbs. It is a lot to expect these kids to calculate every gram of carb to keep their sugar levels in the target range while attending school all day," stated Barland.  "But it's a lifestyle adjustment for anyone with type 1 diabetes until there is a cure."

There are some symptoms of type 1 diabetes that can develop quickly, over a few hours or a few days. Symptoms can appear after an illness, such as the flu. The early warning signs for diabetes include blurry vision, extreme thirst, frequent urination, increased hunger and weight loss.  As blood sugar levels increase, more noticeable symptoms may develop including blurred vision, drowsiness, fast and shallow breathing;, a strong fruity breath odor, loss of appetite, abdominal pain and vomiting.

Barland teaches her patients how to keep their blood sugar level within a target range. She encourages them to always eat a balanced diet with fruits and vegetables, drink plenty of water, take insulin injections and get at least 60 minutes of daily exercise.

Low blood sugar, or hypoglycemia, is a blood sugar level less than the normal range.  It can occur because of too much insulin, too little carbohydrates or induced by exercise.  

Barland described what happened to two students whose insulin levels were too low.  

"One of my kids, 11 years old, at the end of the week had a blood sugar of 64 milligrams," said Barland.  "The normal range is 75-140 milligrams. He was out of range and his blood sugar was too low. I gave him 20 grams of carbohydrates in a juice box and 15 minutes later, he recovered from hypoglycemia and could safely ride the school bus home."  

In another school example, Barland had a substitute teacher who looked after one of her kindergartners.  She checked the student's blood sugar and he was at 105 milligrams. According to the substitute, the student had eaten a slice of pizza which represented 38 grams of carbs.  

"He took four units of insulin for that lunch," said Barland.  "That's the algebraic formula as prescribed by his doctor."

But there was a problem.  This student had consumed the pepperoni and cheese and not eaten the crust.  The child's blood sugar dropped dangerously to 39 milligrams and he could barely walk or talk. He experienced all the signs and symptoms of hypoglycemia.

"Since the student's blood sugar had dropped lower than 45, he could have lost consciousness, had a seizure, coma or died," explained Barland.  

Other visible signs of hypoglycemia include confusion, dizziness, trembling, shaking, and incoherent speech.  Sometimes, persons with hypoglycemia can be mislabeled or misdiagnosed as being intoxicated because of their medical condition. That's why it is extremely important for family, friends, and co-workers to understand the visible signs of hypoglycemia.  Moreover, it's equally as important for children with type 1 diabetes to wear a medical alert bracelet before the emergency occurs and this will aid others in getting the proper medical assistance.

As a school nurse and health coach, Barland listens as well as monitors students throughout the day to make sure they are at optimal health to maximize their development as life-long learners and responsible members of society.

-Story by Connie F. Smith, DPH Communications