Siobhan Bailey’s 8-year-old daughter, Georgia, seemed lazy. She struggled to get out of bed in the morning, dragged herself up the stairs to her bedroom at night and rarely had the energy to exercise. One day, Siobhan noticed that Georgia seemed short of breath and, thinking she might have pneumonia, took her to the pediatrician. The doctor determined that acidosis due to juvenile onset diabetes was causing her shortness of breath, and Georgia was rushed to the ICU at Mobile’s Children’s Hospital.
A mother’s greatest fear is the illness of her child. Juvenile-onset diabetes strikes without warning and is a lifelong disability that requires both patient and parent to adjust their lifestyles. Understanding the disease and treatment will set the stage for a near-normal life, always with heightened awareness of the occasional bad times.
The human body maintains its sugar level through a complex regulation system involving hormones, keeping the bloodstream concentration within the narrow range of 60-140 milligrams per deciliter. Created in the pancreas, insulin grabs sugar out of the bloodstream and stores it in the liver or fat cells. Diabetes occurs when this process fails, and the body’s sugar level goes too high. In juvenile diabetes, scientists believe this happens because the body’s immune system mistakenly kills the cells in the pancreas that make the insulin.
Signs of diabetes can be subtle. Although the bloodstream is overloaded with glucose, without insulin taking it into the brain, the child will be constantly hungry yet lose weight. Siobhan had noted that Georgia had been losing weight and her ribs were showing. When the pediatrician weighed her, they discovered the child had lost 17 percent of her body weight since the last visit.
In diabetes, the kidneys try to get rid of the excess sugar, creating the classic symptoms of constant thirst and marked increase in urine output. Often the child can’t take in enough fluids to compensate for the kidney’s output, and she’ll become dehydrated. Nevertheless, this can be subtle, and Siobhan says even in retrospect, she hadn’t noticed these symptoms.
The extremely high levels of glucose in the bloodstream interfere with the body’s ability to maintain electrolyte and acid/ base balance. The body feels itself starving and starts breaking down muscles in hopes of capturing sugar from there, creating ketones that further poison the system. If not treated in time, this cascade can create diabetic ketoacidosis, a crisis involving brain swelling, which is the leading cause of death in children with DKA.
In the old days, doctors diagnosed diabetes by tasting the urine, which would be sugary sweet. Diabetic breath smells ketotic, having a sickly, sweet odor. Nowadays, of course, we have blood tests that give exact levels of glucose in the blood. Anyone can buy a sugar-level testing machine (glucometer) without a prescription. Once your child is diagnosed with juvenile onset diabetes, you and your child will learn how to use them with finger stick droplets.
There’s a huge difference between diabetic treatment for juvenile onset versus adult diabetes. In adults, insulin levels are low because the pancreas is wearing out. Pills can generally give the pancreas a kick or help the body absorb the insulin that is around. However, since the problem in juvenile onset is total lack of insulin, pills rarely work, and insulin shots are required.
Siobhan and Georgia spent a week at Children’s Hospital learning dietary rules and the process of giving insulin. Mom reports it took one week after discharge before Georgia took over giving herself all the shots. Nowadays, indwelling insulin pumps can work like artificial pancreases, making life much easier for mother and child. The Baileys have a device called Dexcom; inserted into the skin it gives continuous sugar level readouts to help control Georgia’s diabetes.
It’s extremely important for diabetics to keep their sugar levels under strict control. Besides the danger of DKA mentioned previously, high sugar levels make infections more common and harder to treat. For example, diabetics often have urine or skin infections. Parents must be constantly alert when their child is ill or has a fever, keeping a lower threshold for taking her to the doctor. Even a stomach virus can cause sufficient vomiting to send a child into DKA, an event that happened to Georgia last year.
Besides infections, other life changes affect the sugar levels. Siobhan reports Georgia’s reaching puberty has created swings in her sugar levels. During pregnancy, diabetes can cause complications both in self-regulation and in the growth of the baby. High sugar levels can cause retinal problems, kidney failure and heart issues. However, keeping the sugar levels near normal seems to bring all these risks nearly down to non-diabetic levels.
Children with diabetes must mature quickly, realizing they can’t eat the candy or drink the colas their siblings consume. They must learn how to test their sugar levels daily and be rigorous about taking their insulin. A parent’s love and patience will help the child learn these techniques and guide her onto a full and happy life. Siobhan is happy to report that Georgia is now as active and full of energy as a teenager should be.
Dr. Philip L. Levin is a retired emergency medicine specialist in Gulfport. Learn more or contact him at www.Doctors-Dreams.com.
