Diabetes Maintenance (ER Story)

“Adolescents is a particularly difficult time and children with chronic medical illness…and many times their disease gets way out of control, because they don’t want to be different, they don’t want to have a special diet, they don’t want to have to poke their finger three times a day, they don’t want to have to give their insulin shots.”

– David Goo, emergency pediatrics, Children’s Healthcare of Atlanta

It’s not easy for people with diabetes to keep track of blood sugar levels and to take the right amount of insulin almost hour by hour. And for a child, it can be especially difficult.

That’s the case for eleven-year-old Taja. She has diabetes, which for most of her life has been under control-but not lately.

“She woke up in the middle of the night and she was low- she was about 67, was it Taj? Yep, she was about 67. In the morning, when she got up, she was 400,” her mom recalls.

Normal blood sugar is around 150, but that wasn’t her only problem. “She was in what we call diabetic ketoacidosis,” explains Dr. David Goo, “that means that the acid in her blood sugar was building up because she wasn’t getting enough nutrition from her sugar.”

And without insulin to turn food into energy, she was weak and nauseous. In fact, ketoacidosis can be life threatening. But for Taja, what was the cause?

“It’s kind of a puzzle, really, at this point to me cause either you’re too low or you’re too high,” says Dr. Goo.

He says it could be from an infection or stress, hormones or forgetting to take medication. To find out, Taja was admitted to the hospital.

“I talked to the doctors yesterday,” says Goo, “and they said that over the weekend you were sleeping over somewhere else and you might not have gotten your insulin. Is that what happened?” Taja nods yes.

Diabetic children like Taja have to check their blood sugar and give themselves shots of insulin three and four times a day. “That’s a lot of work and a lot of pain and a lot of trouble for a young child,” says Dr. Goo.

“I think it’s hard to remember taking your medicine all the time,” he sympathizes with Taja, “And especially if you’re not at home where everything is, where it’s all reminding you. It’s easy to forget, and you know, you figure, it doesn’t matter if I miss one or two doses, right? Well, now you know better, don’t you?”

Taja will go home with a lesson learned- there is no question, she must take her insulin regularly.

According to recent estimates, more than 150,000 people under the age of 20 have diabetes, which translates to approximately 19 percent of all people in this age group. In addition, approximately one in 500 children suffers from type 1 diabetes (juvenile diabetes), which occurs when a person’s immune system destroys the cells of the pancreas that normally secrete insulin – a hormone essential for digesting sugar.

The American Diabetes Association (ADA) says that type 1 diabetes is usually diagnosed in children and young adults. Because a type 1 diabetic’s body cannot produce insulin to digest sugar, the sugar builds up in the blood instead of going into cells. This starves the diabetic’s cells of much-needed energy, and over time it can result in tissue damage. According to the Juvenile Diabetes Research Foundation (JDRF), the risk of developing type 1 diabetes is influenced by autoimmune, genetic and environmental factors.

PaHow can you determine if your child suffers from type 1 diabetes? The Centers for Disease Control and Prevention (CDC) and the JDRF suggest parents look for the following warning signs:

• Extreme thirst
• Frequent urination
• Drowsiness or lethargy
• Increased appetite
• Unexplained weight loss for no reason
• Sudden vision changes
• Fruity odor on breath
• Tingling or numbness in hands or feet
• Sores that are slow to heal

The CDC says that type 1 diabetes is particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections. Most people today administer insulin with a needle and syringe, according to the National Institute of Diabetes & Digestive & Kidney Diseases , but other devices are also available:

• Insulin pen – This device looks like a pen with a cartridge. Some pens use replaceable cartridges of insulin; other pen models are totally disposable. A fine, short needle, similar to the needle on an insulin syringe, is on the tip of the pen. Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin.
• Insulin jet injector – This device sends a fine spray of insulin through the skin by a high-pressure air mechanism instead of needles.
• External insulin pump – The pump connects to narrow, flexible plastic tubing that ends with a needle inserted just under the skin near the abdomen. The insulin pump is about the size of a deck of cards, weighs about three ounces, and can be worn on a belt or in a pocket. Users set the pump to give a steady trickle of insulin continuously throughout the day.

If your child has type 1 diabetes, his or her best defense against complications is keeping his or her blood sugar levels near the normal range. The ADA warns parents to be aware of the following problems associated with type 1 diabetes:

• High blood sugar (hyperglycemia) – This occurs when your child’s body has too little, or not enough, insulin or when his or her body can’t use insulin properly. Often, your child can lower his or her blood sugar level by exercising. However, if his or her blood sugar is above 240 mg/dl, check the urine for ketones. If ketones are present, don’t allow your child to exercise. Cutting down on the amount of food your child eats might also help. It’s important to treat hyperglycemia as soon as it is detected – failure to treat will lead to a condition called ketoacidosis (diabetic coma).
• Low blood sugar (hypoglycemia) – This occurs when your child’s body has an abnormal decrease of sugar in the blood. The quickest way to raise your child’s blood sugar is with some form of sugar, such as three glucose tablets, half a cup of fruit juice, or five to six pieces of hard candy. It’s important to treat hypoglycemia quickly because it can get worse and your child could pass out. If your child passes out, seek IMMEDIATE treatment, such as an injection of glucagons, calling 911 or visiting a hospital’s emergency room.

If diabetes is not treated properly, your child could suffer serious health complications including heart disease, blindness, kidney failure, nerve damage and lower-extremity amputation.

Just because your child is diagnosed with type 1 diabetes doesn’t mean that he or she cannot live a long and healthy life. The American Academy of Family Physicians suggests these tips for helping your child cope with diabetes:

• Learn all you can about diabetes. The more you know, the more you can help. Encourage your child to learn about diabetes, too.
• Be sympathetic. It can be scary at first for your child to find out he or she has diabetes. Offer your child the emotional support he or she needs.
• Try to eat the same foods your child must eat because of his or her diabetic diet. Avoid buying foods he or she isn’t supposed to eat. People with diabetes should generally follow the same advice for healthy eating that everyone else should follow: Eat less fat and fewer sugary foods. Instead, choose a variety of fresh fruits, vegetables, whole grains, lean meats and fish.
• Encourage your child to exercise. You might even want to make exercising a family affair.