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Teacher’s notes

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This clip shows 12-year-old James Jarvis, who suffers from diabetes, having a hypoglycaemic or low-blood-sugar attack. It shows James in a disoriented state, resisting as his mother struggles to inject him with glucagon, a substance that raises blood-sugar levels. He calms down after she administers the glucagon. In the next sequence, James is shown about to inject himself with insulin. The clip includes James’s voice-over narration, in which he reflects that his blood-sugar levels have been ‘all over the place’.

Educational value points

• No More Needles Please follows 12-year-old James Jarvis, who suffers from type 1 diabetes, as he tries to find out why a cure has not been found for diabetes. Since the age of 2, James has required two daily injections of insulin to keep him alive. The clip tracks aspects of James’s daily struggle with diabetes and the effects it has on those around him, and makes it clear that insulin, while life saving, is not a cure. The documentary, co-directed by James’s mother Catherine Jarvis, makes use of a hand-held camera to follow James and includes his voice-over, which gives the sense that the story is being told from his perspective.

• James suffers from type 1, or insulin-dependent, diabetes. This is an autoimmune condition in which the immune system destroys the cells in the pancreas that produce insulin. Ten per cent of people with diabetes have type 1, the majority of whom are children or young adults. The cause of type 1 diabetes is not known, but it is believed that sufferers have a genetic predisposition to the condition, which may be set off by a viral infection or an environmental factor such as a reaction to a toxin.

• James’s irrational state in the clip is due to hypoglycaemia. This condition occurs when glucose levels in the blood become too low. The condition can cause anxiety, shakiness, faintness, headaches and blurred vision, but may also produce behavioural changes, including moodiness and irrationality. If untreated, hypoglycaemia can lead to unconsciousness and eventually a coma. People with diabetes can become hypoglycaemic if they delay or miss a meal, exercise or otherwise increase their physical activity without eating extra food, or inject too much insulin. Hypoglycaemia can be treated by taking some form of sugar that raises the blood glucose level such as a glucose tablet or lollies, or in severe cases by a glucagon injection.

• Treatment of type 1 diabetes includes two to four injections of insulin a day as well as regular exercise and a well-balanced diet. Type 2 diabetes can often be managed by lifestyle changes such as maintenance of a healthy weight and a balanced diet, and regular exercise. However, the condition may also require treatment with insulin or with medication that either helps the pancreas to produce more insulin or helps the body make more effective use of the insulin that is being produced by the pancreas.

• Insulin medication has to be injected because it is a peptide hormone, a type of protein, and if taken in an oral form would be destroyed by the digestive juices in the stomach before it could enter the bloodstream. Insulin medication, which became available in 1922, was initially made from animal insulin but in 1978 scientists genetically engineered a synthetic form of human insulin using recombinant DNA techniques. This involved placing the human insulin gene in simple cells such as those of bacteria or baker’s yeast, which then reproduced insulin for use as a drug.

• Diabetes Australia has estimated that more than 1 million Australians suffer one of the two main forms of diabetes, type 1 and type 2, but only about half have been diagnosed due to a lack of awareness of the disease and its symptoms. Diabetes is the fastest growing chronic disease in Australia and the seventh-highest cause of death. It is associated with an increased risk of cardiovascular disease, including heart attack and stroke, as well as high blood pressure, visual impairment, nerve damage and kidney disease or failure.

This clip starts approximately 38 minutes into the documentary.

James is rollerblading on a Parisian street.
James Jarvis, a 12-year-old diabetic Paris is a really cool place. I wouldn’t mind living here. I think I’ve lost Mum, and I’m feeling a bit weird.

The scene changes to inside what looks like a hotel room. James is crying and struggling with and pushing his mother away from him as she tries to administer some glucagon in a needle.
Catherine Jarvis, James’s mother James, you’ll feel better as soon as you have it. It’s just that you’re going low. I have to give you some … I have to give you some glucagon. James – here. Come here. Give me your arm.
James No! Mum! No! Mum! Get that away from me!
Catherine injects James. They both appear emotionally drained.
Catherine Come on, sit down.
James lies down on the floor.
Catherine You feeling better?
James Yeah.

James is now on a train, the French countryside whizzing past. He is self-administering glucagon.
James That low last night was one of the worst I’ve ever had. My sugar levels have been all over the place.