wellness

Understanding Juvenile Diabetes

Optometrists can play a major role in diagnosing Type 1 diabetes.

RICHARD S. KATTOUF, O.D., D.O.S.

In previous articles, I've reminded you that we're optometric physicians. As O.D.'s, our obligations include diagnosing disease in children and consulting their parents. In this column, I'll discuss juvenile diabetes, a terrible systemic condition.

Juvenile diabetes occurs in children ages 12 and younger. It's classified as Type 1 diabetes.

The cause is due to the deficiency of insulin secretion in the pancreas. These patients require insulin injections for survival. Since Type 1 affects children, they're more prone to complications involving many organs, such as the heart, eyes, kidneys and nerves — especially if they have poorly controlled their blood sugar through the years.

The symptoms of Type 1 diabetes may occur suddenly and may include:

► breath odor (fruity or sweet)
► fatigue
► respiratory difficulty
► numbness in hands or feet
► blurred or fluctuation of vision
► nocturnal urination
► weight loss
► hunger
► excessive thirst
► frequent urination

Education

As optometric physicians, we must counsel and provide handouts to Type 1 diabetics and their families, which teach the following:

► avoidance of junk food.

► avoidance of over-eating (especially important during parties or holidays).

► sleeping for longer than normal is dangerous. Blood sugar (glucose) levels can drop dangerously during an extended sleep.

► plans to locate a safe and private place to monitor glucose levels and inject oneself.

► following the M.D.'s guidelines and ours to achieve the highest level of success.

► If the Type 1 diabetic isn't compliant with his insulin, he could exhibit seizures.

Glucometry: an obligation?

I feel you have an obligation to perform glucometry screenings on all children. My practice has been performing glucometry for at least 20 years. No State Board requires this screening. Since diabetes is the leading cause of blindness in our country, I feel it's our obligation to add this critical test to our comprehensive visual analysis. Rather than using one child as an example, allow me to explain that my practice, as well as some of my clients, find many undetectable cases per year. All these cases would've gone undetected since no ocular signs exist at early or mid stages.

Parents are busy, and many times unaware of any of the aforementioned symptoms. I've examined numerous incipient Type 1 diabetics who are in denial. When the glucometer readings are high, I question the child regarding symptoms. Many deny any symptoms. I ask these patients to return in the morning, prior to eating, to perform a fasting screening. When this second reading is high, many times the child begins to cry. Often, he doesn't want to face the reality of the disease.

Numerous referrals from my office to the pediatrician or family physician have led to immediate hospitalization. Reports from M.D.s compliment our office for our diligence in the diabetic arena. These reports indicate that without our referral, the child may have gone into a diabetic coma.

As O.D.'s, we're part of the health and wellness community. Considering the ocular consequences of Type 1 diabetes, we must raise our level of clinical care and our image as healthcare professionals. OM

DR. KATTOUF IS PRESIDENT AND FOUNDER OF TWO MANAGEMENT AND CONSULTING COMPANIES. FOR INFORMATION, CALL (800) 745-EYES, OR E-MAIL HIM AT ADVANCEDEYECARE@HOTMAIL.COM.