In the last couple of days, I have seen so many reactions to a mother’s viral post about her child’s untimely demise. Long story short, she has exhibited symptoms typical of diabetes mellitus (DM). Unfortunately, it remained undiagnosed. This was despite seeing the doctor. Also, they went to the emergency room (ER) several times a few days before she died. Due to the fact that she was a minor, I will refrain from naming her in my post. Let’s just instead call her Angel, as she was that in her young life.

Angel, according to her mother, was a typical preschooler. She was an energetic and happy child, although a little picky about the food that she ate. Her weakness and weight loss were attributed to this fact. Her parents took her to the doctor who prescribed vitamin supplements. She did take them. Nevertheless, she remained weak and extremely thirsty.

Alarmed, her parents took her to the ER where they collected urine and blood specimen. She was discharged after being in the emergency room for a good number of hours. Her mother pointed out that she was starting to have difficulty in breathing, but that was brushed aside. Another ER visit later, she was accurately diagnosed with diabetes mellitus (DM) Type 1. Sadly, it was too late. She was already in diabetic ketoacidosis and she succumbed shortly.

My PICU Patient

As a pediatric nurse, I didn’t see Juvenile Diabetes (JD) or Type 1 DM often. One patient that I remembered was 11 years old. He was showing typical diabetic symptoms: increased thirst, increased appetite, irritability, and weight loss, among others. When we checked his blood sugar level, it was more than 1000mg/dl. As a point of reference, a normal blood sugar level is 99mg/dl or lower.

Aside from checking his hourly blood sugar, we had to start him on an insulin drip. His mother, a pediatric nurse herself, was beating herself up for how she didn’t notice the symptoms from a clinician’s perspective. After a couple of days spent in the Pediatric Intensive Care Unit (PICU), he learned how to check his own blood sugar and administer his own insulin daily.

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Type 1 Diabetes – What is it?

This is different than the typical adult-onset DM. Type 1, which is often diagnosed in childhood, basically means that the patient’s pancreas does not make enough insulin for the body’s consumption. Insulin, according to my nursing school professor before, is the key that opens the cells. This facilitates the proper utilization of blood glucose by the cells. Without it, blood sugar level builds up in the bloodstream to dangerous levels that may cause long-term complications, even death. That is the reason why kids have to administer insulin to themselves for the rest of their lives.

Type 1 DM cannot be controlled by diet alone or even oral medications.  Kids may have to give themselves insulin shots or may use insulin pumps, as indicated by their doctors. If uncontrolled, their blood sugar levels can either be too high or too low. This goes without saying, of course, that parents should be intimately involved in planning the appropriate care for these children.

Why is it Often Undiagnosed?

We often hear about Type 2 DM in adults. Type 1, however, only accounts for about 5-10% of all DM cases. Since its etiology is often unknown, or due to an autoimmune reaction, nobody knows how to prevent it from occurring. Children, especially younger ones, who exhibit some of the symptoms may be mistakenly diagnosed with failure to thrive for sudden weight loss, for example.

This may be the reason why the providers prescribed vitamin supplements and maybe even appetite stimulants, to some kids just like in Angel’s case. Sadly, a simple blood test could have determined that it was Type 1 DM in the first place. Ketones in the urine test may have signified impending diabetic ketoacidosis.

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Managing DM in Children

As I mentioned earlier, older kids are taught how to check their blood sugar levels regularly. They are also informed on how to calculate how much insulin they administer to themselves. This is based on their blood sugar level and the amount of carbohydrates they consume for a meal.

Kids have to go through lifestyle changes, just like adults with DM do. Physical activity is a must. They have to visit the doctor regularly. They are made aware of what signs and symptoms warrant emergent attention. Seeing the eye and foot doctors is often part of the care plan.

Needless to say, parents, especially of younger children, have to be educated regarding the importance of all the medical plans. Sometimes, it is challenging for clinicians when parents don’t fully understand the importance of their role in managing DM.

We had a three-year-old patient before who was in and out of the hospital because her parents didn’t know how to properly take care of her at home.

Conclusion

Clinicians, patients, and parents all play important roles in managing Type 1 diabetes. While the literature is available out there, awareness is lacking. For that reason, children exhibiting symptoms go undiagnosed until it is too late.

As Angel’s mother appealed, let us spread awareness in our own little way. Maybe a young child’s life can be spared because of sharing a post.

Are you up to taking on that challenge?