Duncan Stone starts his day by pricking his finger to check his blood sugar level. Then, the 12-year-old mixes two kinds of insulin to give himself a shot.

He follows that with a breakfast that is well planned to make sure his body gets the right amount of carbohydrates and protein. No quick bowls of cereal for this Bend seventh-grader.

Once at school, he interrupts his daily learning for a couple blood sugar checks. If his blood sugar level is too low, he needs a snack or a glass of juice right away.

Back at home, it’s time for more insulin before dinner, followed by more blood sugar checks.

At the age of 6, Duncan was diagnosed with Type 1 juvenile diabetes, a disease in which a person’s pancreas stops producing insulin because the body’s own immune system attacks and destroys insulin-producing cells. Managing the disease is just a part of his daily routine, but it used to bother him to be different from his friends at school.

”I just felt weird,” said Duncan, who is active in football, wrestling and basketball at High Desert Middle School. ”I just felt like some total different person.”

Duncan is among a rising number of students in Central Oregon schools who have diabetes and need special accommodations such as being allowed to check their blood sugar levels or eat snacks during class time. The Bend-La Pine School District, for example, reports 46 children with diabetes including three new cases identified just in the last week, says lead school nurse Marylou Paterson.

That compares to 32 children with diabetes last year.

Until now, the state health division has never kept track of the prevalence of juvenile diabetes to help secure funding for research and resources to help these children.

But a new state law, which goes into effect Jan. 1, will require doctors and schools to report the number of kids with juvenile diabetes to the state so health officials can begin a diabetes database. Called Grace’s Law, it is said to be the first of its kind.

”To my knowledge, there isn’t a single state in the country that does this yet,” said Katherine Cowan, a spokeswoman for the Juvenile Diabetes Research Foundation International. ”I do hope Oregon is a trendsetter in this regard.”

The anecdotal evidence, according to local and state experts, is that the Pacific Northwest has a higher rate of juvenile diabetes than other areas in the country.

”For unclear reasons, the Northwest seems to be a hot spot,” said Dr. James Hansen, a pediatric endocrinologist with Legacy Emanuel Children’s Diabetes and Endocrine Center in Portland. His clinic treats children from Central Oregon in Portland and occasionally brings doctors to Bend for special clinics.

Most cases of juvenile diabetes are the Type 1 form, an autoimmune disorder that scientists believe is caused by a combination of environmental and genetic factors. However, doctors also are starting to see obese children develop Type 2 diabetes, which is more typically seen in adults over 40 and is related to poor diet and lack of sufficient exercise.

Hansen estimates that 1 in 300 children in Oregon have diabetes and the number is increasing. The clinic used to see about 75 children when he started with Emanuel in the early 1990s. Now, the patient load is up to 1,000, and kids are diagnosed at younger ages.

”What we need are really good objective numbers to confirm what we all suspect that diabetes is on the rise,” he said.

It’s hard to keep track without the disease being reportable because many children around the state do not see endocrinologists due to a shortage of the specialists. Children end up seeing family physicians or regular pediatricians, so it is hard to judge the number of cases based on the patient load of the endocrinologists.

The wait to get into specialists in Portland is about six months, said Rita Shearer, diabetes educator for Central Oregon Community Hospital who works with diabetic children.

”This condition has become so prevalent,” Shearer said. ”Numbers have skyrocketed.”

Bend has no endocrinologist practicing here, although the Bend Memorial Clinic has actively recruited for one for more than a year. Dr. Michael Harris said the clinic is continuing its search for a specialist, but he said it is difficult because endocrinologists are scarce.

Indeed, Hansen said fewer doctors are entering the specialty because it requires three more years of school and the pay is less than other specialities. Even medical centers in larger areas are struggling to offer the specialty.

Keeping track of diabetes cases through Grace’s Law should help doctors and scientists better understand the disease and work toward a cure. In addition, the law should also help convince people of the need for more medical and school resources to help kids with diabetes.

”If we see a cluster of kids develop diabetes at the same time, we’d like to be able to go back and see if there’s a common thread,” Hansen said.

Doctors need a better understanding of what environmental factors could be causing the onset of the disease, and whether particular pockets in the state are experiencing a larger number of cases and need more resources, he said.

It is suspected that people of Scandinavian descent may be of higher risk of diabetes, but the numbers will help health officials understand it that’s true, he added.

Locally, families with diabetic children and those who work with their kids hope the law will provide for better resources to help educate the public about the disease and to provide more services.

Robin Stone, Duncan’s mother, has become a local advocate for families faced with diabetes. Families need more help, said Stone, who remembers feeling overwhelmed when her son was diagnosed.

”Forty-five minutes after we went to the doctor, our whole lives changed,” she said. ”They try to teach you in a couple of days what nurses and doctors take years to learn.”

Stone said the schools also need more help in educating teachers and other staff about kids with diabetes. She has had to fight over the years so her son could eat when he needed to at school or on the bus. Stone also has made sure he gets the proper nutrition with his school lunch and that he is allowed to check his blood sugars when needed.

”I think education is critical for schools,” said her husband, Larry Stone.

Many people don’t understand what is involved with caring for diabetes, and the school’s nurses are stretched thin, Robin Stone said. Oftentimes, it’s the school secretaries or teachers, who receive training, that are managing a child’s diabetic care.

”I’m hoping out of this will come more school nurses,” she said.

Paterson, the lead school nurse, said the Bend-La Pine School District has only five full-time nurses and one part-time nurse to work with 13,000 students. The nurses are funded to care for special education children, but children with diabetes are not considered special education students unless they have another condition.

Still, the nurses are dedicated to helping diabetic children set up a care plan to help them while they are at school.

”There isn’t a nurse in the district who will say ‘Sorry,’ ” Paterson said.

The problem is each nurse visits several schools on a given day and can’t be there as often as they would like to help each child, she said.

Paterson said she hopes Grace’s Law can help schools find another source of funding that would provide for nurses who could spend more time working with diabetic children. Along with asthma and seizures, diabetes is one of the most complex health problem nurses deal with at local schools, she said. If diabetic children do not have the right balance of food, insulin and exercise, they can become shaky and confused, which interferes with learning.

Schools are making strides in improving services for diabetic children. For example, the Bend-La Pine and Redmond school districts recently approved the use of Glucagon, a medicine that can be given to diabetic children in emergency situations. Representatives from different schools are now being trained to use it.

A community coalition also is working to improve services here. Anne Hildreth, who heads the Deschutes County Diabetes Coalition, said the group is working on a resource guide to help families.

Shearer, the diabetes educator at Central Oregon Community Hospital, said she hopes increased awareness about the disease will help physicians and their patients learn about new technology that is available to help diabetics. For example, some diabetic children are using an insulin pump that gives them a constant supply of insulin in smaller doses than their injections. And Shearer is working with a physician in Redmond so that children can be fitted with the pumps without having to travel to Portland.

Most importantly, Shearer and others say, people need to understand the challenges children with diabetes face and what they can do to help those kids, whether at school, on a sports field or at a restaurant.

”Our whole goal is to keep these kids in school and let them be regular kids,” Shearer said. ”We ask these kids to do an awful lot to stay healthy, and we need to do something to make it easier for them.”