Parenting a Diabetic Child
When her daughter, Melissa, was 4, Ellen Hagarty started noticing splashes of urine around the base of her toilet. Over the next few weeks she detected that Melissa was developing an unquenchable thirst and when she began to wet her pants, Hagarty warned her to cut back on the liquids.
But the night that Melissa became hysterical in the car because she needed to pee and insisted she could not wait the five minutes it would take to get home, Hagarty knew that something was wrong. "I immediately pulled into a Taco Bell and let her go," says Hagarty. "I was hysterical at that point. I could no longer rationalize what was going on." A trip to the pediatrician confirmed what Hagarty had begun to fear – her daughter had diabetes.
Today, Melissa is a happy, active 9-year-old. Other than the six blood tests and a minimum of two insulin injections she endures each day, she is just like any other fourth-grader.
The kind of diabetes Melissa has is referred to as type 1, juvenile-onset or insulin-dependent diabetes. In type 1, the body completely stops producing insulin, a hormone that enables the body to convert sugar into energy. Unable to do its job, sugar accumulates in the bloodstream, causing the blood sugar level to rise.
According to the Juvenile Diabetes Foundation, more than 13,000 children each year – 35 children a day – are diagnosed with type 1 diabetes.
The most commonly recognized symptom is probably excessive thirst, which is often accompanied by an urgent need to urinate. But what constitutes "excessive" and "urgent"?
According to Dr. Linda Siminerio, executive director of the University of Pittsburgh Medical Center's Diabetes Institute, parents should "have their antennae up" if they notice children making several trips to the bathroom during the night, asking to stop the car every 10 minutes to use a bathroom or drinking a liter of liquid at a sitting and being thirsty again soon afterward.
Other warning signs include:
- Extreme fatigue
- Constant hunger
- Sudden weight loss
- Rapid, hard breathing
- Sudden vision changes or blurry vision
- Fruity odor on the breath
- Skin infections
- Wounds that won't heal
But 5-year-old Zachary seemed perfectly healthy when his mom, Lashawn Goin, brought him to the pediatrician last April for the routine checkup and shots he needed to enter kindergarten. When the doctor found sugar in Zach's urine, he was immediately admitted to the hospital and diagnosed with type 1 diabetes.
Goin recalls her biggest fear at first was wondering how she would ever be able to poke her own child with a needle, especially since she is terrified of needles herself. But as it turns out, these days Mom isn't the one doing most of the poking. Six-year-old Zach insists on giving his own injections. "He rarely will allow me to give him his insulin shot," says Goin. "I still have to measure his dosage and pull up the skin in his tummy or leg, wherever he chooses for his injection."
"There's no magic age when children should start taking charge of their own treatment," says Dr. Siminerio. "I tell parents it's just like a baby giving up the bottle. It happens at different ages. It's very individual."
Like Zachary, Melissa takes an active part in treating her diabetes. "She injects the insulin herself," says Hagarty. "And she does all finger pokes except for the one in the middle of the night."
Two of Melissa's blood tests happen during her school day. Melissa leaves her classroom and goes downstairs to the nurse's office to test. Although she has the option of performing the test in the classroom, she prefers to use the nurse's office. "She told me that she enjoys the attention she receives from the nurse and the secretary in the office," says Hagarty.
Since Zach is in a half-day kindergarten, he is only required to get his blood tested once during school, right before his class's snack time. Goin encourages Zach to eat snacks with his classmates, believing that this is an important social time for him. "I am a stickler for making sure my child has the most normal routine possible," says Goin.
Besides monitoring blood sugar levels and injecting insulin, people with diabetes must orchestrate their food intake with care and learn what effect different foods have on their blood sugar. Since the body converts all carbohydrates to sugar, eating too much rice, pasta, bread and fruit, as well as the usual sugar-laden troublemakers like cake and candy, will increase the blood sugar level.
The amount of carbohydrates consumed at each meal can be adjusted based on the child's pre-meal blood sugar reading. Depending on the reading, more or less carbohydrates may be eaten. Calculating "carbs" also allows the child to adjust the amount of insulin injected based on what he or she wants to eat.
"Zach has learned to count carbs, so he is pretty good about knowing what he can have or can't have," says Goin. While Zach is still allowed to indulge in cake and ice cream on special occasions, these treats must be compensated for with much higher doses of insulin.
Since physical activity can lower the blood sugar and improve the body's ability to use glucose, exercise is an important component in treating diabetes. Melissa almost always indulges her sweet tooth at parties. "Most of the time the parties include a form of exercise such as roller skating, so Melissa is able to work the additional sugar in quite nicely," says Hagarty.
While it's true that most children do not engage in a regimented daily exercise routine, a raucous game of tag or a couple of spins around the block on a bicycle can do the trick. However, the tendency toward sedentary pastimes like Nintendo and its ilk has put a damper on many children's activity levels. "We used to get lots of calls after Christmas that children's blood sugar was low because they were all out sledding," says Dr. Siminerio. "That doesn't happen much anymore."
Avoiding Common Complications
When Melissa was first diagnosed five years ago, her then 7-year-old brother, Eric, wanted to know if having "die-abetes" meant Melissa was going to die. According to the Juvenile Diabetes Foundation, life expectancy of people with diabetes averages 15 years less than people who don't have it.
But while serious, long-term complications like blindness, kidney failure and nerve damage lurk in the minds of any parent of a diabetic child, a recent nationwide study completed over a 10-year period shows that if people keep their blood sugars as close to normal as possible, they can reduce their risk of developing some of these complications by 50 percent or more.
In the end, parents of children with diabetes have the same basic goal as any other parent. As Goin puts it, "I am working really hard at making sure my child has the love for himself that will make him always want to take care of himself even when he is a grown man."