In four weeks time, Jenifer Byrd’s 8-year-old son lost 23 pounds. He started developing dark circles under his eyes, and his thirst was unquenchable.
On a child’s small frame, the weight loss “ripped me apart,” his mom said. “I knew something was wrong.”
Her job as an RN with Northern Michigan Regional Hospital and her bachelor’s of science degree complemented her mother’s intuition, and she made an appointment for her son with his pediatrician. In January of last year, he was diagnosed with type 1 diabetes.
“It presented so much like flu-like symptoms. Finally we said ‘Enough’s enough, something is seriously wrong,’” Byrd recalled. “When I took him to the pediatrician, they did a urine test and there was sugar present in the urine … the diagnosis hit me like a ton of bricks.”
Her son was admitted to the hospital immediately and started on a course of insulin to regulate his wildly fluctuating blood sugar levels. She chose to keep him at NMRH rather than LifeFlight-him to a downstate hospital, in order to remain close to the staff she knows, the one-on-one care available and her family.
“They did lab work and drew blood and everything started coming back showing how really critical he was at that point,” Byrd said.
For seven days, her son was on an insulin drip and eventually regained enough energy and stabilized so he could return home. “It was amazing how quickly, I’d say within months, he regained his strength from losing so much muscle,” she said.
While the diagnosis has meant a change in the family’s spontaneous lifestyle and daily activities, Byrd hopes other parents might be able to spot the health problem in their own children by sharing her story: The fact that her son could drink a half gallon of milk and not be quenched; that immediately after drinking something with sugar, he would vomit; weight loss; frequent urination; lingering flu-like symptoms that could be the sign of a deeper problem.
“I think it’s overwhelming when I hear about the number of type 1 cases just in our community,” Byrd said. “In a bigger metropolitan area, I wonder what they’re seeing.”
Today, her son wears an insulin pump and a glucose sensor, new technology that monitors blood sugar with fewer finger pokes. “We used to have to poke his fingers eight to 10 times a day,” Byrd said. “Now, (it’s) three times a day on a good day.”
“I’m blown away by his compliance,” she added. “I’m his biggest cheerleader. What I see as a nurse is that this is treatable, and if a parent equips themselves with knowledge, there is no reason their child can’t have a great life and avoid being hospitalized.”
‘It’s scary at the beginning’
Anyone under the age of 18 diagnosed with diabetes is deemed to have type 1, or juvenile diabetes, as opposed to type 2, which afflicts adults, mainly because of a poor diet, a sedentary lifestyle and other risk factors.
When sugar is present in a urine test of a child, like in Byrd’s son’s case, it means the body is not using glucose in the cells for energy because the hormone insulin is not present to make the process happen.
That is why type-1 diabetics require regular insulin throughout the day, every day. “There is no other option,” Byrd said.
Most Northern Michigan cases of juvenile diabetes are referred to DeVos Children’s Hospital in Grand Rapids, where specialists handle the individual needs of children like Byrd’s son and those of Reed Moore, a 10-year-old Petoskey boy recently diagnosed with type-1.
“It’s just something that they don’t know why it happened. It could’ve developed slowly and we didn’t know,” said his mom, Kim Moore. “It’s just one of those guessing games.”
Reed, one of a set of triplets in the Moore home, was put on prednisone for a lingering cough last summer that lasted three months. His mom said the type-1 diagnosis came following that course of treatment, in August, after she noticed his excessive thirst and frequent urination and consulted with a pediatrician.
An active child, Moore said Reed continues to pursue his activities but now must receive an insulin injection once a day; it’s a newer treatment that regulates blood sugar for a 24-hour period. “It’s right in the arm, and he’s really good about it,” Moore said.
The family will undergo training in Traverse City, hosted by staff from DeVos, in the next several months, when Reed will be fitted with an insulin pump for the regular injections he’ll need at that point.
The insulin pump is a pager-sized device that delivers insulin regularly through a plastic tube. The tube is permanently in place in the skin, inserted with a plastic needle usually on the fatty part of the upper buttocks or the abdomen. The pump dispenser is worn around the waist like a belt buckle. The pump is used for daily, continuous insulin delivery, 24 hours a day. Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level and sleep.
Kim and husband, Scott, also must monitor everything Reed consumes, recording carbohydrates, and they’ve enrolled him in ski school to keep his activity level high in the winter.
“It’s scary at the beginning, of course, but in the long run, it’s really not that bad,” Moore said. “This is treatable, as long as you are educated and the child is educated and you keep on top if it.”
Diabetic children in the classroom
Moore was certain to the note important role of Ottawa Elementary School aides and staff in keeping her constantly informed about Reed’s blood sugar levels and how he’s feeling through the course of the day. “That’s my sanity,” she said with a laugh.
Indeed, the rising numbers of diabetes cases is presenting new challenges for school districts, which must train staff to administer insulin. Staff must also learn the signs of low- and high-blood sugar in their young charges and more.
Byrd is not only a mother of a diabetic son, but she also works with type-1 and type-2 diabetics through her RN job at the hospital. And, she also works as an independent trainer on diabetes care for Petoskey school district staff. “It’s hard enough to just deal with what the schools have to deal with; there’s a lot the schools have to be aware of,” Byrd said. “Diabetes is not black or white. It’s extremely unique for each child.
“And it can be so frustrating for a child, because they have to stay within these parameters. They just want to be a kid, they want to go to gym class, and they don’t want to have to stop and do a finger poke.”
It’s a reality, however, for a number of students throughout the Charlevoix-Emmet Intermediate School District.
Cal Prins, principal at East Jordan Elementary School, and Marcia Foster, health assistant for the East Jordan Public School system, said they’ve seen an increase in students diagnosed with juvenile diabetes.
“I have dealt with four students, age 6 and under, in the last four years who are insulin-dependent diabetics. Prior to that time, I had none. I’m talking at least in the last 10 years, I had none,” said Foster, who is not a licensed nurse but who provides a variety of health care needs to students districtwide.
Foster said when a student has diabetes, she works with parents, local pediatricians and often the care plan devised by medical staff at DeVos to ensure the child’s daily needs are met.
“I have to record all the carbs that the child eats while they’re at school, and they need to eat not only at lunch, but two hours after lunch, and they need a snack before physical education,” she offered. “When they have their snacks, I have to add up their carbs, take their blood sugar and then determine the dose of insulin that I need to inject them with.”
One girl under Foster’s care has been living with the diagnosis since age 1. Now a 6-year-old, her blood sugar swings can be difficult to manage, but she is more aware of what’s happening with her body. “When she feels shaky or is acting lethargic, she’ll automatically come and see me,” Foster said. “But we’ve had a really hard time keeping her diabetes under control.”
Prins said Foster’s assistance with the diabetic students has been indispensable.
“It’s a very big job. Just dealing with students who are only diabetic would be one thing, but we’re seeing lots of things associated with it,” Prins added. “ … I think the biggest thing we look at is developing a strong working relationship with the parents, the trust that takes, and that takes time.”
Foster put the situation into clear perspective at the end of the interview: “From the minute they get off the bus to the minute they get back on the bus, the school is responsible for their life.”
Diabetes by the numbers
Millions of Americans suffer from both type 1 and type 2 diabetes. Stats from 2007 show, all ages:
Total diabetics: 23.6 million people, 7.8 percent of the population.
Diagnosed: 17.9 million people
Undiagnosed: 5.7 million people
About 186,300 people younger than 20 years have diabetes, type 1 or type 2. This represents 0.2 percent of all people in this age group.
Each year, approximately 30,000 Americans are diagnosed with type 1 diabetes; over 15,000 are children. That’s 35 children each day.
Sources: National Diabetes Information Clearinghouse, Juvenile Diabetes Research Foundation International
What is juvenile diabetes?
Type 1 diabetes is also known as juvenile diabetes, and is distinguished from type 2 mainly because type-1 diabetics are insulin-dependent and the cause is most often genetic or environmental rather than spurred by lifestyle factors.
Juvenile diabetes occurs when the body’s immune system attacks and destroys certain cells in the pancreas. These beta cells normally produce insulin, which helps the body move the glucose (sugar) contained in food into cells throughout the body to use for energy.
When the beta cells are destroyed, no insulin can be produced, and the glucose stays in the blood instead, where it can cause serious damage to all the organ systems of the body. For this reason, people with type 1 diabetes must take insulin in order to stay alive. This means undergoing multiple injections daily, or having insulin delivered through an insulin pump, and testing their blood sugar by pricking their fingers six or more times a day.
People with diabetes must also carefully balance their food intake and their exercise to regulate their blood sugar levels, in an attempt to avoid hypoglycemic (low blood sugar) and hyperglycemic (high blood sugar) reactions, which can be life threatening.
From the Juvenile Diabetes Research Foundation International
Type 1 warning signs
Parents should be aware of the warning signs of juvenile diabetes. They include: extreme thirst, frequent urination, drowsiness or lethargy, sugar in urine, sudden vision changes, increased appetite, sudden weight loss, fruity, sweet, or wine-like odor on breath, heavy, labored breathing, stupor and unconsciousness.
