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Discussion

Diabetes mellitus which is more commonly known as diabetes is associated with a group of disorders related to several metabolic pathways in human body. This is a disorder in which there is a rise in the blood sugar levels for a prolonged span of time (Soriguer et al., 2012). Diabetes, when left untreated can lead to many other complications including hyperosmolar hyperglycemic state, ketoacidosis. It can even lead to death if not diagnosed and left untreated for a long time. Blood sugar is the most important energy source that humans get through consumption of food. The hormone called insulin, which is made in the pancreas, is required by the consumed glucose to be used by the cells for generation of energy. In thepatients of diabetes, the production of the insulin hormone is not regulated properly, that is there is either negligible or no production of insulin in the body, this as a consequence interferes in the process of energy production through glucose in the cells (Rezania et al., 2014). The glucose as a result remains unused in the body which cause disruption of several processes in the human body.

The discussion in the report mainly elaborates about the occurrence ofdiabetes among children and the ways it can be prevented. It also deals with the types of diabetes that occur and the effects it has on the body. The type 1 diabetes mellitus is mainly considered in the report. The discussion includes the strategies that are used by the physicians and recommend the patients to apply to their situation.

The report will also put an emphasis on the management and rehabilitation process of diabetes mellitus type 1 in children, in S.M.A.R.T. (specific, measureable, achievable, realistic and timely) way. 

The disorder of diabetes is mainly divided into four classes type 1, type 2, gestational and monogenic diabetes (Hayashino et al., 2012). Type 1 diabetes is characterized by absence of insulin synthesis in the body, this happens as result of loss of the beta cells that produce the hormone in the pancreas (Ashcroft &Rorsman, 2012). The destruction of the beta cells in the pancreas, happens due to imbalanced working of the immune system. Type 2 diabetes is characterized by irregular synthesis of the insulin hormone, which results in excessive accumulation of glucose in the sufferers’ body (Oram et al., 2014). Both type 1 and type 2 diabetes mellitus are polygenic that is they are related to more than one genes (Davies et al., 2013). Gestational diabetes is the development of diabetes in woman during the period of pregnancy. This kind of diabetes does not require long treatment as it remains only during the period of pregnancy, it is cured after the birth of the baby. Monogenic diabetes is a rare form which results as a single gene mutation. In most of the cases of such diabetes, the gene is inherited from the ancestors (Krug, 2016).

Classes of Diabetes

In the last two decades, the incident of diabetes has drastically increased among children (Dabelea et al., 2014). The causes of the disorder among them are noted to be consumption of unhealthy food items, obesity, lack of activities and due to several genetic factors.  Both type 1 and type 2 diabetes are prevalent among children, the occurrence of type 1 diabetes mellitus is more common among the population of children and teenagers suffering from the disorder (Patterson et al., 2014). The disorder is also termed as juvenile diabetes nowadays, after the increase in occurrence of the disorder. The type 1 diabetes that the children face, needs life-long assistance and treatment as the condition is not curable till date (Atkinson et al., 2014). The symptoms of type 1 diabetes include increase in thirst and frequency of urination, frequent desire to consume food, decrease in weight even after adequate food consumption, occurrence of fatigue, occurrence of mood swing that is the person has a number of behavioral changes, the children have a fruity breath because of production of ketones, the patients also have a blurred vision because high levels of blood sugar results in fluid pull from the eyes. The females also are seen to have yeast infection in the genital areas due to glucose accumulation in those areas. The children suffering from type 2 diabetes have similar symptoms like that of type 1 diabetes, the patients also have itchy skin, dry mouth and they take a long time to heal cuts and sores. The diagnosis of diabetes among children generally remains neglected because of the lack of knowledge of their parents about the occurrence of the disorder at such a tender age (King., 2016). The parents fail to observe the symptoms that the children suffering from diabetes have. The delay of diagnosis is a major reason of the disorder’s rise. If the children are diagnosed at the early stage, the treatment becomes easier. The lower the metabolic disorders associated with it, lesser the deterioration.

The development of diabetes mellitus among the children of Australia has attend significant rise in the last decade (Johnson et al., 2013). A survey done by health official from the government of Australia among the children of Belconnen High School. The school did the survey as the attendance of the students in the school was very low in the age group of ten to twelve due to several illnesses, this made the authorities of the school concerned and as a result they informed the health department of the government of Australia. The symptoms of the ailments that the students were suffering from, made the health inspectors to conduct a checkup session on the students specifically for diabetes mellitus. The aim was to deduce an inference of the degree of increase of diabetes among the student and work on the betterment of the situation. The results showed that a large number of students (about 18%) in the age group of eight to twelve show the symptoms of diabetes. Further examination results, showed that about 11% of the student of the given age group had either of the types of diabetes mellitus but the occurrence of the type 1 diabetes mellitus was far more than occurrence of type 2 diabetes (Farsani et al., 2013).

Diabetes in Children

The objective of the survey was to mainly evaluate the degree of deterioration of the health of the children after the occurrence of type 1 diabetes in children by applying certain methodologies, which are feasible. According to several surveys done by the World Health Organization in different countries across the globe, the cases of diabetes remain unchecked for a long period of time in the age group of ten to twelve due to lack of awareness. The increase in promotion of the fact that diabetes is significantly rising among children will help in depletion of the case. The school authorities should take this matter under consideration and work for the future of the students (Dabelea et al., 2014). The school should conduct regular checkups, so that no case of diabetes remains undiagnosed for long as the results may be detrimental. They should keep in check, the food items that the pantries serve them as consumption of large amount of carbohydrates can be lethal to the patients of both the types of diabetes. For prevention of the disorder the parents of the students should also be given proper lessons about the disorder so that they can act when they observe the symptoms in their children (Davies et al., 2013). The student committee and the authorities of the school are the prime organizations who can have an impact on the pupil and reduce the occurrence of the disease.

The phenomenon of type 1 diabetes in children is increasing with time due to several lifestyle and environmental conditions. Preventing the problem is of high relevance in today’s time because the health of the children is majorly affected due to this. The children who are already suffering from it should be properly administered, the medicines available for reducing the consequential effects of it. The process requires serious commitment of the parents, caregiver as well as the children suffering from it, as the future of the sufferers can totally be ruined if not taken due care of it, at the right time (King et al., 2012). Prevention process needs the implementation of strategies at home as well as in the schools which will be elaborated in the following paragraphs. The awareness about the seriousness of type 1 diabetes is required in the present scenario, among the parents and children. Management strategies to prevent diabetes should be followed by the schools (Hilliard et al., 2013). The committees should have a team to conduct surveys among the students on a regular basis. The primary step for eradication of diabetes requires the involvement of the students as they are the ones who can initially understand the symptoms when it takes place and get the diagnosis done (Cafazzo et al., 2012).

Diabetes Mellitus among the Population of Children at Belconnen High School, Australia

The prevention of the disease requires the assessment of the condition in a S.M.A.R.T way. The first and foremost step that is required to be taken is to educate the students, teachers as well as the parents about type 1 diabetes. Educating people about the threat of type 1 diabetes is crucial because, without the knowledge of the disease one cannot understand the impact and the negativeoutcomesthat the disease can cause (Miller et al., 2015). For educating the students, it is important for the authorities to plan programs according to which, they can act and implement the strategies on a regular basis (Choudhary et al., 2013).Giving lessons to the students about the ways helps in avoiding the disorder and manage it if suffering from the same. The management process reduces the chances of further deterioration of the condition of the patient. Assessment of several ways and programs to keep the occurrence of the disease in check increases the efficiency of the planning process. The parents of the children are the most important people who need to understand the situation because they are the ones who are primarily going to take care of the sufferers when needed. The process in which the disease can be avoided should be given emphasize on, so that the parents get an insight of the ways they can deal with it. Studies on the surveys done in many schools who are implementing strategies have shown that the degree has immensely decreased after the inculcation of the strategies under the program.  The students who were suffering from diabetes were under the process and this lead to the enhancement of their condition.

The second point that should be given importance is the role of proper diet to maintain a healthy life. The food that a person eats, gives an idea of the fitness of the person as it has a major role in building as well as deteriorating that person’s physique. The consumption of excessive carbohydrate on a daily basis is one of the most important reasons behind the occurrence of diabetes type 1 disease (Young et al., 2013). Nowadays, children are more attracted to the junk foods available in the market than vegetable and fruits. The fast foods mostly contain refined flours and monosaccharides like the food products of pizza, burger, pasta and noodles. Consumption of such food materials leads to unregulated insulin synthesis due to destruction of beta cells, that is the requirement of production of the hormone increases with increase in carbohydrate consumption (Wolpert et al., 2013). As a result, the children are prone to the occurrence of the disease. The consumption of green leafy vegetable and fibrous food reduces the possibilityof type 1 diabetes, as it does not create problems in the glucose metabolism pathway (Lipsky et al, 2012). Doctors recommend the consumption of oat meals at least ones a day, this cuts down the influence of the consumed carbohydratesas a balanced diet ensures a healthy life, proper diet is crucial for preventing the disease.

Steps to be Followed for Primary Prevention of Type 1 Diabetes Mellitus

The third category that is of major importance is the influence exercising in having a healthy diabetes free life. The metabolism of one’s body increases and gets enhanced by the process of exercising (Yardley et al., 2012). It helps to controls the levels of sugar or glucose in the blood by decreasing the need of insulin hormone for regulation. In case of the children suffering from type 1 diabetes, exercise decreases their body’s sensitivity towards insulin, which is the core reason for development type 1 diabetes (Kennedy et al., 2013). The patients of diabetes also have high blood pressure and weight related issues, these problems are also kept in check when the patient exercise on a daily basis.

The three strategies discussed above for prevention of type 1 diabetes helps to minimize the impact of the disease, although full recovery from it is yet under speculations. One cannot be totally free from the disorder, critical understanding and evaluation of the ways of prevention are still under research.

Aim: To prevent chronic occurrence of type 1 diabetes mellitus.

Objective

Strategy

Actions

Outcome measures

Outcome indication

By whom?

Timeline

1.      To prevent occurrence of type 1 diabetes among children of Belconnen High School in the age group of 10-12 years.

Awareness program involving the children and their parents.

-          Baseline measurement of the occurrence of the disease

-          Set up selection criteria to plan an effective program.

-          Apply selection criteria among the children

-          Provide medical support

-          Post- awareness survey of the impact of awareness program

-          Baseline surveys

-          Selection criteria documentation

-          Students’ applications and survey; minutes of selection panel

-          Receipts of the conductance of the program

-          Post-program survey

The awareness among the children and parents resulted in the diagnosis of the disease in many children.

Reduced the major impacts that the disease would have if kept untreated.

-          Health officials of government of Australia.

-          Authorities of the Belconnen High School

-          Principal

-          Teachers

2 months

2.      Decrease the occurrence of type 1 diabetes by implementation of proper diet in a span of 2 months.

Type 1 diabetes management program

-          Baseline survey of implementation of proper diet in school pantry

-          Promotion of the program among the children in a regular basis

-          Program workshops

-          Halfway and Post-program measurement of implementation of the required diet and exercise.

-          Baseline surveys

-          Invitation letters, emails, SMS, blackboard announcements to children and their parents

-          Attendance lists; workshop materials; pictures

-          Halfway and post-program surveys/log books

Proper diet lead to the enhancement of health of the children

-          Students

-          Family

-          Authority of BelconnenHigh School

-          Program coordinator

- Nutritionist/Dietitian

2 months

3.      Incorporation of exercise in the school curriculum

-          Decrease  obesity in children

-          Exercise classes in the school

-          Program workshops

-          Halfway and post-program surveys/log books

-          Mandatory physical education classes every week

-          Regular exercise resulted in increased rate of metabolism among the students.

-          Exercise physiologist

-          Physical education instructor

-          Students

2 months

Conclusion:

Therefore, from the above discussion it can be concluded that the menace of type 1 diabetes can have detrimental effects on children if not treated and taken care of, in time. The occurrence of the disease can be reduced up to some extent by making people aware of the fact that the disease can also effect children. The schools have a duty of taking proper necessary steps to prevent the disease as it can affect the quality of interpretation of education among children. Setting up and promotion of programs by the authority of schools, increases the needed awareness about the disease. It helps in proper conductance of the situation by the parents and the caregivers. Implementation of certain action plans helps in planning a program and decreases the time taken for conductance. Type 1 diabetes mellitus as being prevalent among children worldwide, needs major care giving and prevention techniques to be implemented in all the schools across the globe. The risk of fatality due to the disease is high and children dealing with it are under the risk of under developed growth and improper metabolism. The condition should immediately be given attention to, to avoid constricted development of the future generation. The future of the world, is in the hands of today’s children, so to have a bright future of the nations’ worldwide, the children of every country are important.

References:

Ashcroft, F. M., &Rorsman, P. (2012). Diabetes mellitus and the β cell: the last ten years. Cell, 148(6), 1160-1171.

Atkinson, M. A., Eisenbarth, G. S., &Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

Cafazzo, J. A., Casselman, M., Hamming, N., Katzman, D. K., &Palmert, M. R. (2012). Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. Journal of medical Internet research, 14(3).

Choudhary, P., Ramasamy, S., Green, L., Gallen, G., Pender, S., Brackenridge, A., ... & Pickup, J. C. (2013). Real-time continuous glucose monitoring significantly reduces severe hypoglycemia in hypoglycemia-unaware patients with type 1 diabetes. Diabetes Care, 36(12), 4160-4162.

Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., ... &Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 311(17), 1778-1786.

Davies, M. J., Gagliardino, J. J., Gray, L. J., Khunti, K., Mohan, V., & Hughes, R. (2013). Real?world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review. Diabetic Medicine, 30(5), 512-524.

Farsani, S. F., Van Der Aa, M. P., Van Der Vorst, M. M. J., Knibbe, C. A. J., & De Boer, A. (2013). Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches. Diabetologia, 56(7), 1471-1488.

Hayashino, Y., Okamura, S., Matsunaga, S., Tsujii, S., Ishii, H., &Tenri Cohort Study Group. (2012). The association between problem areas in diabetes scale scores and glycemic control is modified by types of diabetes therapy: diabetes distress and care registry in Tenri (DDCRT 2). Diabetes research and clinical practice, 97(3), 405-410.

Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013). Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28-34.

Johnson, S. R., Cooper, M. N., Davis, E. A., & Jones, T. W. (2013). Hypoglycaemia, fear of hypoglycaemia and quality of life in children with type 1 diabetes and their parents. Diabetic Medicine, 30(9), 1126-1131.

Kennedy, A., Nirantharakumar, K., Chimen, M., Pang, T. T., Hemming, K., Andrews, R. C., &Narendran, P. (2013). Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS One, 8(3), e58861.

King, B. R., Howard, N. J., Verge, C. F., Jack, M. M., Govind, N., Jameson, K., ... &Bandara, D. M. (2012). A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes. Pediatric diabetes, 13(8), 647-651.

Krug, E. G. (2016). Trends in diabetes: sounding the alarm. The Lancet, 387(10027), 1485-1486.

Lipsky, L. M., Nansel, T. R., Haynie, D. L., Mehta, S. N., &Laffel, L. M. B. (2012). Associations of food preferences and household food availability with dietary intake and quality in youth with type 1 diabetes. Appetite, 59(2), 218-223.

Miller, K. M., Foster, N. C., Beck, R. W., Bergenstal, R. M., DuBose, S. N., DiMeglio, L. A., ... &Tamborlane, W. V. (2015). Current state of type 1 diabetes treatment in the US: updated data from the T1D Exchange clinic registry. Diabetes care, 38(6), 971-978.

Oram, R. A., Jones, A. G., Besser, R. E., Knight, B. A., Shields, B. M., Brown, R. J., ... & McDonald, T. J. (2014). The majority of patients with long-duration type 1 diabetes are insulin microsecretors and have functioning beta cells. Diabetologia, 57(1), 187-191.

Patterson, C., Guariguata, L., Dahlquist, G., Soltész, G., Ogle, G., &Silink, M. (2014). Diabetes in the young–a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes research and clinical practice, 103(2), 161-175.

Rezania, A., Bruin, J. E., Arora, P., Rubin, A., Batushansky, I., Asadi, A., ... & Yang, Y. H. C. (2014). Reversal of diabetes with insulin-producing cells derived in vitro from human pluripotent stem cells. Nature biotechnology, 32(11), 1121-1133.

Soriguer, F., Goday, A., Bosch-Comas, A., Bordiú, E., Calle-Pascual, A., Carmena, R., ... & Delgado, E. (2012). Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@ bet. es Study. Diabetologia, 55(1), 88-93.

Wolpert, H. A., Atakov-Castillo, A., Smith, S. A., &Steil, G. M. (2013). Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes. Diabetes care, 36(4), 810-816.

Yardley, J. E., Kenny, G. P., Perkins, B. A., Riddell, M. C., Malcolm, J., Boulay, P., ... &Sigal, R. J. (2012). Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes care, 35(4), 669-675.

Young, V., Eiser, C., Johnson, B., Brierley, S., Epton, T., Elliott, J., & Heller, S. (2013). Eating problems in adolescents with Type 1 diabetes: a systematic review with meta?analysis. Diabetic Medicine, 30(2), 189-198.

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