Both my son's have Type 1 Diabetes and it seems more and more kids lately are developing this mystery disease. But what Is Type 1 Diabetes? According to the Junior Diabetes Research Foundation, they simply explain it this way:
"Type 1 diabetes (juvenile diabetes) can occur at any age, but most commonly is diagnosed from infancy to the late 30s. In this type of diabetes, a person's pancreas produces little or no insulin. Although the causes are not entirely known, scientists believe the body's own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes must inject insulin several times every day."
When our oldest, Russell, got sick, we had no idea what the symptoms where. Honestly, we thought he was going through a growth spurt. But is just wasn't right. He was thirsty all the time, soaked his bed every night, lethargic and eating more then normal but losing weight. I took him to the doctor and they did a simple urine test and checked his blood. At the time his brother was only 4 months old and sleeping in my arms. As soon as the tests came back, the Dr. told me I need to get him to the ER right away! I called my husband and we raced to Children's Hospital. He spent 1 night in the ICU as his blood sugar numbers where so high and out of control.
We felt guilty waiting so long to take him in, but honestly had no idea what was going on in his body. He spent 4 days total at the hospital (they did move him to a reg. room after the first day) so my husband and I could be educated on how to take care of him at home.
A few short years later, his little brother Brian was also diagnosed weeks before his 3rd birthday. He was showing the same symptoms for about a week or so and so we used his big brothers meter to check his blood sugar. Finally, while on Russell's 7th birthday, we decided to take Brian to Children's Hospital as the blood sugar meter kept saying "hi" (meaning his numbers where over 600). He spent 5 days at Children's Hospital because he also developed a viral infection.
So now we have two kids with Diabetes, two kits, two sets of insulin, meters, syringes, test strips, etc. All the tools of the trade to manage this mystery disease from home. But we do manage it. The kids have taken it on as normal as brushing their teeth.
Both my kids are on Lantus (long acting insulin) and Humalog (short acting). Every morning they each get a shot of Lantus, units are different for each child due to age and weight. The Humalog is given every time they eat food with carbohydrates that fall within a ratio of their target blood sugar. For example, at lunch, my youngest may eat food that ads up to 25 grams of carbs, so if his blood sugar is within its normal range before he eats, his shot will be 1 unit of Humalog. Same applies with his big brother, just a different dosage ratio.
How do we figure out their dosages for Lantus and Humalog? Every three months since the date of their diagnosis, we visit the Endocrine Clinic at Children's Hospital here in Seattle. Their Dr. takes a blood sample, much like their finger pokes and that will tell her their A1C levels (A1C is a test that measures a patient's blood glucose level over the previous three months that might also help predict serious health complications like heart attack and stroke).
They also download their blood glucose meters to get a readout of their average blood sugars over the last few months. With this information, she can decide where the peaks and lows are, and where the Lantus and Humalog may need adjusting. Their Dr also has a computer program on the hospital database that helps with the calculations as well as "cheat sheets" we use for each child. You see. They many times have different dosages for the Humalog for EACH meal during the day, for EACH child. A chart for Breakfast, Lunch and Dinner (if they eat a snack, for example, mid morning, I use the dosage for breakfast to treat it if necessary).
We've been very lucky with Children's Hospital, they've got the best Endocrine team there and have helped us weather many storms through both boys dealing with illness or simply not able to get their numbers under control.
This leads me to another thing we have to watch out for, ketones. Or as we like to tell our kids, we need to fight the "ketone monsters".
What are Ketones?
Ketones are due to not enough insulin being available to meet the body's needs. The 2 main causes are illness/infections (the body needs extra energy to fight off a virus or bad cold) or forgetting to take an insulin shot. There are other causes, but the primary ones we've had to deal with are the two mentioned. Another bugger, which is worse, is acidosis.
Now acidosis is the result of letting ketones get out of hand. Perhaps insulin isn't available due to an emergency situation, or the person is simply not taking care of their diabetic needs properly. See, it is not high blood sugar that causes ketones or acidosis; eating sugar does not cause acidosis. Ketones come from the breakdown of body fat. The role of insulin is to shut off fat breakdown. Now if the stress hormones are high or there simply isn't enough insulin, fat will begin to break down. And the side product of fat breakdown is ketones production. In the early stages, it can be tested with urine. But if left undetected, ketones can also build up in the blood and eventually in the body tissues. When it gets this far, it will result in acidosis (DKA).
For example, my youngest spent a week at Children's Hospital when he got the stomach flu last February. He was so sick; we couldn't get him to keep any food or liquid down. Because he wasn't eating, his blood sugar dropped low, and we couldn't give him insulin to deal with the heavy ketones because he wasn't eating. So in turn, he was on an IV drip to help rehydrate his little system as well as supply glucose for his body to work with. Even the smallest amount of long acting insulin dropped him low to the point the Glucagon wouldn't work (that is an emergency glucose administered through as a shot to help the body draw stores of sugar from the liver). But because we where able to get him in and on an IV drip, he never got as far as DKA.
Our oldest son has also developed ketones because of the flu and or a head cold. His body will have really high blood sugars (only a couple of times has he had heavy ketones and low blood sugars, luckily never needing to be admitted, but did have an ER visit). So we follow a sick day management regimen and different calculations according to how heavy his ketones are so we know how much extra insulin he needs to get his blood sugar under control. As with any illness, lots of fluids, especially water are a necessity but even more so with diabetics.
So anytime my kids come down with even just a sniffel, we're on them to check for ketones and watching their blood sugars closely. We have test strips that can be dipped in urine that show a color code to how light or heavy their ketones are. Staying on top of their sick day management has prevented many trips to the ER.
What can my kids eat?
Anything! What is so nice about the insulin they're on; they're not restricted to how much food or type of food they can eat. We do, however watch how much fat (limited "fast food" and "junk food") and salt intake because it raises blood pressure as well as threatens the circulatory system. The reason fat restriction is very important because high cholesterol and diabetes are two of the four risk factors for developing heart disease. (The other two for developing heart disease is smoking and family history).
So I make a lot of my own foods for home. I've posted many of our favorite recipes at The Poor Chef website. I also input the nutrition information on a program I use at home that gives me the carb amount on home recipes per serving (FitDay.com). Another great resource for food items, especially if you're eating out (most restaurants now supply nutrition info) is a pocket book from Calorie King. I keep a copy in the car just in case, trust me, having extra resources to go to in a snap is so handy.
What about school?
Again, we are very lucky to have a great school district who supplies a full time nurse. Nurse Alice is the best. We have a system down for my oldest son Russell. I make his lunch and provide all the carb info for what is packed. She just has to add up what he's eaten and is able to use the "cheat sheets" I've provided so she knows how much insulin to give him at lunch time. We talk almost every day about his numbers so I have a complete log for when it's time to go to the doctor. It's a team effort and I can use all the help I can get. Brian isn't quite ready for school yet, but I know he'll be well taken care of when it's time.
I can't say it's been an easy road and wouldn't wish it on anyone. But if you're reading this and have a loved one with Type 1 Diabetes, I hope the information has been of some help. It's an ongoing education and we're so grateful to live in a time where medical breakthroughs are happening all the time. Who knows, maybe by the time my kids are in high school, there may be a cure for Diabetes. Until then, we'll keep managing their care, not let it get us down or hold us back from living a happy and normal life.
For more information regarding Type 1 Diabetes, please visit:
"Understanding Diabetes, A Handbook for People Who Are Living with Diabetes", by H. Peter Chase, MD (aka: The Pink Panther Book)
This Article is Written by Kathleen Schmidt (c) 2009
Kathleen Schmidt:
Domestic Goddess and Work At Home Mom
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