The Effects of Attention Deficit Disorder on Jacob's Life

Jacob told me that he has felt "dumb" in school and also felt like it has been difficult to talk to people because he has felt "slow" his whole life. When he was growing up the doctors just assumed he was having trouble focusing because of fluctuating blood glucose levels with his diabetes. Sometimes this is true because he has told me that his blood glucose has gone very low during a test before and he winds up failing because he can't concentrate. In high school he was not doing well at all. Hwe said he could never concentrate long enough to study, read or do homework. His ACT score was not very high either. So his doctor decided to give him a written ADD test to see if there was concern and he scored at a very high level of concern. She put him on medication in August of 2010, right before starting his senior year of high school. After he started the medication he retook the ACT and scored 2 points higher than he had before. He was on the medication for awhile and then he started to feel very depressed at times. He would throw tantrums for no reason. The medication was causing him to be bi-polar. So, he switched medications once and then was put on an anti-depressant which also treats ADD but not as well. He is doing a lot better now. I was confused because Jacob told me he had ADD but my mom said he had ADHD and I found out that they are sometimes used interchagably depending on what the root of the problem is. Here is an article I found describing ADD from the Attention Deficit Disorder Association.


IS IT ADD?  OR ADHD?  WHAT'S THE DIFFERENCE? 
The difference is mainly one of terminology, which can be confusing at times.  The "official" clinical diagnosis is Attention Deficit Hyperactivity Disorder, or AD/HD.  In turn, AD/HD is broken down into three different subtypes: Combined Type, Predominantly Inattentive Type, and Predominantly Hyperactive-Impulsive Type.
Many people use the term ADD as a generic term for all types of AD/HD.  The term ADD has gained popularity among the general public, in the media, and is even commonly used among professionals. Whether we call it ADD or AD/HD, however, we are all basically referring to the same thing.

DEFINITION OF AD/HD: 
AD/HD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common core features include:

• distractibility (poor sustained attention to tasks)
• impulsivity (impaired impulse control and delay of gratification)
• hyperactivity (excessive activity and physical restlessness)

In order to meet diagnostic criteria, these behaviors must be excessive, long-term, and pervasive. The behaviors must appear before age 7, and continue for at least 6 months. A crucial consideration is that the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. These criteria set ADHD apart from the "normal" distractibility and impulsive behavior of childhood, or the effects of the hectic and overstressed lifestyle prevalent in our society.

According to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) some common symptoms of ADHD include: often fails to give close attention to details or makes careless mistakes; often has difficulty sustaining attention to tasks; often does not seem to listen when spoken to directly; often fails to follow instructions carefully and completely; losing or forgetting important things; feeling restless, often fidgeting with hands or feet, or squirming; running or climbing excessively; often talks excessively; often blurts out answers before hearing the whole question; often has difficulty awaiting turn.

Please keep in mind that the exact nature and severity of AD/HD symptoms varies from person to person. Approximately one-third of people with AD/HD do not have the hyperactive or overactive behavior component, for example.

Jacob has been known for his artwork since he was very young. However, he told me that once he started his ADD medication he was able to focus more on it and felt like he had more ideas and talent with his art. He has won numerous awards for his artwork and has even had people buying it from him for up to $100 a piece! I am so happy that this medication has given him the opportunity to take his artwork to another level. He worked very hard to put together a portfolio for a Half Tuition Scholarship for the Institute of Art and that is why a lot of the art he has done is not pictured. He likes to work on his paintings and drawings in his room alone while listening to music to help him focus.

I wanted to see if I could find any research on ADD related to art because I had heard some rumors that people with psychological disorders like ADD usually are more artistic. I was not sure if I should believe this but I found an interesting article called Artists and Attention Deficit Disorder which starts off by saying "Artists have often been stereotyped as having an "artistic temperament." This phrase has been used to explain many traits, including moodiness, quick temper, chronic forgetfulness, disorganization, jumping from one project to another, and obsession with one’s work. These are also typical traits of a person with Attention Deficit Disorder, or ADD." Here is a link to the rest of the article if you would like to read it.

Artists and Attention Deficit Disorder 

Here is more of Jacob's art work that I thought I'd share with you.

Made for my sister's birthday

He is known for this picture. Made with sharpie and colored pencil.

Portrait of my mom with oil paints.

 

Portrait of my sister. Won first place in the art show!

The Risks of Type 1 Diabetes

Even though Jacob is able to live a pretty normal life today, he may encounter some major health issues in the future. Therefore, every year we raise money for the Juvenile Diabetes Research Foundation to find a cure for Type 1 Diabetes. We have also done many walks in various places to raise money for this cause. Here is a picture of our family at the JDRF walk in October 2000.

I have already encountered a few times when Jacob had problems with his diabetes. He encountered extreme hypoglycemia (low blood glucose) where he would get really shaky and could barely speak. A few times he tried to come downstairs from his bed room to get help from my parents and eat or drink something and wound up tumbling head first down the stairs. His body had started shutting down and he could not control his muscles. This is very scary because he could have broken his neck and been paralyzed or dead from a fall like this. He has also encountered hyperglycemia (high blood glucose) and feels nauseous, tired and has blurry vision. I found what risks Jacob may have over time if these blood glucose fluctuations continue to occur and how to avoid them at US News Health: Managing Type 1 Diabetes.

Hypoglycemia
Low blood glucose, or hypoglycemia, is one of the most common problems associated with insulin treatment. In general, hypoglycemia is defined as a blood glucose level below 70 mg/dl (if your meter tests whole blood) or 80 mg/dl or lower (if, like most new meters, it tests plasma), or below 90 mg/dl if you have symptoms. Be sure to ask your healthcare team what would be considered a low blood glucose requiring treatment for you.

Hypoglycemia is usually unpleasant, with the most common symptoms being shakiness and sweatiness and having one's heart pound. The most common reasons for hypoglycemia are too much insulin, too little food, or too much activity. Another cause is drinking alcoholic beverages. Most hypoglycemia, if quickly and appropriately treated, it is more of an inconvenience than a cause for alarm.

However, severe hypoglycemia can cause mental confusion, antagonistic behaviors, unconsciousness, and seizures. The biggest danger is not the condition itself but what may happen as a result: a motor vehicle accident caused by passing out at the wheel or swerving into oncoming traffic, or a tumble down the stairs, for example. In rare cases, seizures can result in brain damage.

To avoid problems with hypoglycemia:

• Recognize the symptoms, which are specific to each individual and may change over time. If you have symptoms, test immediately if possible to see if your blood glucose is low.
• Understand the interaction between food intake, treatment, and physical activity so you can anticipate when hypoglycemia is a risk.
• Always carry carbohydrates for treatment. Don't overdo it: The most common error is to overtreat low blood glucose.
• Check blood glucose levels again in 15 minutes, and repeat treatment if symptoms persist or blood glucose levels have not risen to your target level or above.
• Check blood glucose levels before driving if you think you may be low—and stop the car immediately if you're already underway. Treat immediately with the appropriate amount of fast-acting carbohydrate. Check blood glucose levels again in 15 minutes and do not start driving again until you're no longer hypoglycemic.

Hyperglycemia

People who do not have diabetes typically have blood glucose levels that run under 126 mg/dl, measured two hours after eating. Your physician will define for you what your target blood glucose should be—identifying a target as close to normal as possible that you can safely achieve given your overall medical health. Be sure to ask your healthcare provider what he or she thinks is a safe target for you for blood glucose before and after meals.

In general, high blood glucose, also called hyperglycemia, is reached when the level is 160 mg/dl, or when it is above your individual target. If your blood glucose is high for long periods of time, you run an increased risk of complications over the long term: eye disease, kidney disease, heart attacks, and strokes, to name a few. High blood glucose can pose health problems in the short term as well. Your treatment plan may need adjustment if your blood glucose stays over 180 mg/dl for three days in a row.

Symptoms of high blood glucose include increased thirst, increased urination, dry mouth or skin, tiredness or fatigue, blurred vision, more frequent infections, slow-healing cuts and sores, and unexplained weight loss.

High blood glucose can be caused by too much food; too little exercise or physical activity; poorly calibrated treatment; or illness, infection, injury, or surgery.

What should you do if you have hyperglycemia?

• Be sure to drink plenty of water.
• If your blood glucose is 250 mg/dl or greater, check your urine for ketones. If they are present, call your healthcare team, as you may need additional insulin.
• Ask yourself what may have caused the high blood glucose, and take action to correct it. Ask your healthcare team if you are not sure what to do.
• Check your blood glucose before meals three days in a row. If it's higher than your target level for three days, a change in your treatment plan may be needed.

I also found another problem linked to Hyperglycemia. I know Jacob has ketone testing urination strips but here is more information about it.

Diabetic ketoacidosis (DKA)

When the body cannot use sugar for energy, it uses stored fat. Acids known as ketones may build up in the blood and spill into the urine when fat is burned for energy; when blood sugar is also high, a life-threatening medical emergency called diabetic ketoacidosis, or DKA, can result.

You may develop DKA quickly if you are sick, so it's important to check your blood every four hours when you have an illness or infection. You may also get DKA slowly, however. Check for ketones whenever your blood sugar is 250 or above.

If you are getting DKA, you may:

• Have to urinate a lot
• Be extra thirsty or hungry
• Feel sleepy
• Feel weak
• Vomit for an extended time
• Have stomach pains
• Have chest pains
• Breathe hard
• Experience confusion
• Call your doctor immediately or go to the emergency room if you develop symptoms.

 Another problem I thought that Jacob may encounter in college if not already, is alcohol consumption. I know I experimented with alcohol before turning 21 and I know he has too. He has just graduated high school and I feel that in college he will have more opportunities with alcohol and that can be dangerous for him as a diabetic. I did more research and found that alcohol consumption can be a problem for diabetics however it is not as severe as people may think. (I think my mom stressed how dangerous it is for him as a scare tactic.) On the other hand, many teenagers and college students do not have a drink or 2 with a meal. Instead they play drinking games and drink many drinks in one night. This is where the problems may occur, however heavy drinking is a problem for all people.

I found an article about alcohol consumption by the American Diabetes Association.

Alcohol

Beyond all the health and safety concerns about alcohol, if you have diabetes and are on diabetes medications that lower blood glucose, you need to practice caution. The action of insulin and some diabetes pills, sulfonylureas and meglitinides (Prandin), is to lower blood glucose by making more insulin. So, you should not drink when your blood glucose is low or when your stomach is empty.

Alcohol can cause hypoglycemia shortly after drinking and for 8-12 hours after drinking. So, if you want to drink alcohol, check your blood glucose before you drink and eat either before or while you drink. You should also check your blood glucose before you go to bed to make sure it is at a safe level -- between 100 and 140 mg/dL. If your blood glucose is low, eat something to raise it.

The symptoms of too much alcohol and hypoglycemia can be similar — sleepiness, dizziness, and disorientation. You do not want anyone to confuse hypoglycemia for drunkenness, because they might not give you the proper assistance and treatment. The best way to get the help you need if you are hypoglycemic is to always wear an I.D. that states "I have diabetes."

Another problem with alcohol can be that it may lessen your resolve to stay on track with healthy eating. Contemplate this situation. You sit at a restaurant and sip a glass of wine while you peruse the menu. As you slowly relax your tastebuds might be more easily tempted to overindulge. You may also be interested in our book, Diabetes Meal Planning Made Easy, 4th Edition.

A Few Guidelines

• If you choose to drink alcohol, limit the amount and have it with food. Talk with your health care team about whether alcohol is safe for you.
• Women should drink 1 or fewer alcoholic beverages a day (1 alcoholic drink equals a 12 oz beer, 5 oz glass of wine, or 1 ½ oz distilled spirits (vodka, whiskey, gin, etc.).
• Men should drink 2 or fewer alcoholic drinks a day.
• If you drink alcohol at least several times a week, make sure your doctor knows this before he/she prescribes a diabetes pill.

More Tips to Sip By

• Drink only when and if blood glucose is under control. Do not omit food from your regular meal plan.
• Test blood glucose to help you decide if you should drink.
• Wear an I.D. that notes you have diabetes.
• Sip a drink slowly to make it last.
• Have a no calorie beverage by your side to quench your thirst.
• Try wine spritzers to decrease the amount of wine in the drink.
• Use calorie-free drink mixers -- diet soda, club soda, diet tonic water, or water.
• Drink alcohol with a snack or meal. Some good snack ideas are pretzels, popcorn, crackers, fat-free or baked chips, raw vegetables and a low-fat yogurt dip.
• Find a registered dietitian to help you fit alcohol into your food plan.
• Do not drive or plan to drive for several hours after you drink alcohol.

Managing His Diabetes

Jacob has to do many things to manage his diabetes on a daily basis. He tests his blood glucose level about 6 times a day or even more depending on what he's doing. He carries his kit which has the tiny pricks and pricker, tests strips, the meter and alcohol swabs. (Seen top left) He pricks a different finger every time and then has to draw the blood onto the test strip while in the meter. This tells him what his blood glucose level is. (Seen top right) Jacob told me that his doctor tells him to try and keep his blood glucose levels between 80-120mg/dL (milligrams per deciliter). However as you can see from the picture above, that does not always happen. When Jacob's levels are too low he needs to eat or drink something with a lot of sugar in it. He usually chooses juice because it is quick and easy.




 













If his blood glucose levels are too high, that is when he gives himself insulin injections. However, Jacob has used an insulin pump every day since 7th grade because it is a lot more convenient. His blood testing meter sends a signal to his pump which tells him the right dose of insulin he needs to regulate his blood glucose levels. He can either take this amount or take less if he knows that he is going to be very active and burning carbohydrates. Diabetics measure their food with carbohydrates instead of calories. When Jacob eats he keeps track of how many carbohydrates he eats and then plugs that number into the meter to dispense the insulin. He changes his pump and adds more insulin every 3 days. Today I was able to watch him change his pump site. Every time he changes it, he needs new insulin, an insulin catheter (the thin tube which sticks to his skin and dispenses the insulin into his body), a reservoir and an IV prep wipe. All of this is called an infusion set. (seen above right)

First, he uses the IV prep wipe on the area where he will be putting the catheter (somewhere on the buttocks). Then he draws the insulin into the reservoir. Next, he uses a thin needle which allows the catheter to slide under his skin and then sticks it on. It is hard to believe but it stays in him for 3 days and he says it is not painful at all!

This all seems so complicated to me but I have seen that Jacob can still live a normal life like other kids. He has always been very active in sports like basketball, diving, skate boarding and recently cross country. He also likes to run for exercise and for fun! He ran in Shamrock Shuffle (seen right) and also a half marathon Chicago. People think that diabetics can only eat certain things, but he is able to eat anything he wants in moderation as long as he keeps track of the carbohydrates and takes his insulin. He can still have fun just like any other 18 year old.

Carbohydrates

The American Diabetes Association says that foods that contain carbohydrate raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. There are 3 types of carbohydrates: Starches (complex carbohydrates), Sugars and Fiber. You'll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains, and whole grains. This can be confusing! On the nutrition label, the term "total carbohydrate" includes all three types of carbohydrates. This is the number diabetics pay attention to when carbohydrate counting.

Low Blood Glucose After Physical Activity

I found this article from US News Health: Managing Type 1 Diabetes. I thought it might be useful for a diabetic like Jacob because he is very active on a daily basis.

A common cause of low blood glucose is too much physical activity without compensating for it. In fact, moderate-to-intense exercise may cause your blood glucose to drop for the next 24 hours. This post-exercise hypoglycemia is often referred to as the "lag effect" of exercise.

When you exercise, the body uses two sources of fuel to generate energy: glucose and free fatty acids—or fat. The glucose, stored in the body in a form called glycogen, comes from the blood, the liver, and the muscles. During the first 15 minutes of exercise, most of the glycogen is drawn from the bloodstream or the muscles. After 15 minutes of exercise, the body is fueled more by glycogen stored in the liver; and, after 30 minutes of exercise, by the free fatty acids.

The body will replace its depleted glycogen stores, but this process may take four to six hours, or even 12 to 24 hours when the physical activity has been intense. During this period, a person with diabetes is at higher risk for hypoglycemia—though there are precautions that can prevent it:

• Check your blood glucose before exercising to make sure your blood glucose is sufficient. If necessary, eat an appropriate snack.
• Avoid exercise at the peak of your insulin action.
• Avoid late-evening exercise. Exercise should be completed two hours before bedtime.
• Avoid alcohol before or immediately after exercise.
• Avoid hot tubs, saunas, and steam rooms directly after exercise. Otherwise, your heart rate will remain elevated longer, and your blood glucose may continue to drop.
• Check with your doctor about the length, intensity, and duration of your planned exercise program.
• Check your blood glucose immediately after exercise to prevent low blood glucose from occurring hours after exercise. It may also be necessary to check your blood glucose more often for two to four hours after exercise. Intense exercise may cause your blood glucose to drop for the next 24 hours.

What should you do if you find your blood glucose is less than 100 mg/dl immediately after exercise?

• Follow post-exercise snack guidelines. If you are not scheduled for a snack or a meal for 30 to 60 minutes after exercise, 15 grams of carbohydrate should be sufficient to prevent a low blood glucose. If no meal or snack is scheduled for more than one hour, take 15 grams of carbohydrate and 7 to 8 grams of protein.
• Increase carbohydrate intake before exercise.
• Decrease the dose of active insulin for the next exercise session.
• Consider decreasing the insulin dosage following exercise.
• If your blood glucose at bedtime is still less than 100 mg/dl, double your bedtime snack, or—if possible—decrease your bedtime insulin dose.

How They Knew Something Was Wrong

Jacob was a normal 6 year old but then in the Spring of 2009 he started to act really strange. He was hungry and thirsty all the time yet he was losing a lot of weight. I remember being young and saying that he looked like a skeleton. He also had to urinate a lot more than a kid usually would. My mom told me a story of how we were all at the zoo one day and he asked to go to the bathroom 5 times in less than 1 hour. My parents knew something had to be wrong. They took him to the doctor and got his urine tested. His ketone levels were extremely high and he had to be taken to the hospital immediately. That is when they diagnosed him with Type 1 Diabetes. Here are 2 pictures of him in the hospital.On the top he is with our dad and on the bottom he is with his room mate who almost died from a burst appendix.

What is Type 1 Diabetes?
According to The American Diabetes Association, Type 1 Diabetes is when the body does not produce insulin. It was previously known as juvenile diabetes because it is most common in children, however adults can develop this type also. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. People without this disease produce insulin in their pancreas  however type 1 diabetics need to take insulin shots to maintain healthy glucose levels in their blood.

Symptoms of Type 1 Diabetes
I searched on the Juvenile Diabetes Research Foundation International website and found that there are many warning signs for Type 1 Diabetes. They include:

• Extreme thirst
• Frequent urination
• Sudden vision changes
• Sugar in urine
• Fruity, sweet, or wine-like odor on breath

• Increased appetite

• Sudden weight loss
• Drowsiness, lethargy
• Heavy breathing
• Stupor

All About Jacob

My brother's name is Jacob Curtin. He is 18 years old and has just graduated from Riverside Brookfield High School. He will be attending the Illinois Institute of Art for Visual Communications in the fall. Some of his hobbies include painting, drawing, photography, cross country, and skate boarding. The reason I chose him to interview for this project is because he currently has Type 1 Diabetes and Attention Deficit Disorder. He was diagnosed with Type 1 Diabetes in kindergarten but was not diagnosed with ADD until the summer before senior year of high school when he was 18 years old. I thought it was interesting that while he was growing up and had trouble in school, the doctors thought it was because of problems with his diabetes. I will explain more about this in a different post. The picture to the right is of Jacob and I before his senior prom.