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Health & Wellness: Children with diabetes use different strategies in fight for their lives

Leigh Ann Laube • Apr 28, 2010 at 12:00 AM

Growing up with three rough-and-tumble older brothers, 6-year-old Brittany Tate has to do what she can to get attention.A diagnosis of type 1 diabetes probably isn’t what she or her parents had in mind — but it’s worked.The petite Carters Valley Elementary School first-grader, who loves to read, now has to closely monitor her carbohydrate intake, have insulin shots four times a day, and check her blood sugar levels four times a day.Brittany’s mom, Julie, saw the warning signs in her daughter, and despite an extensive family history of type 2 diabetes, she didn’t want to believe her youngest was affected. Brittany was diagnosed in February.“Two weeks before, she had complained of stomach cramps and she was uncontrollably thirsty. Then she started wetting the bed, so drinks were cut out after 6 p.m.,” Julie said.The bed wetting continued, and Brittany’s teacher sent home a note saying she was asking to use the bathroom a lot during school.By the time the Tates took their daughter to the doctor, her blood sugar levels were critically high. She was hospitalized that night.Type 1 diabetes often develops in children, adolescents and young adults, so it’s sometimes called juvenile diabetes. It’s different from type 2 diabetes.“I knew nothing but type 2,” Julie said. “I had assumed [type 1] was just like type 2, except in a child.”In type 1 diabetes, the body can’t make insulin. Treatment includes taking insulin, making healthy food choices, being physically active and controlling blood pressure and cholesterol.According to the Juvenile Diabetes Research Foundation, type 2 diabetes is a metabolic disorder in which a person’s body does produce insulin but is unable to use it effectively. Type 2 is usually diagnosed in adulthood and does not always require insulin injections; however, the rate of children with type 2 diabetes has greatly increased during the last decade.“Twenty years ago, you never saw type 2 in children, but we are now,” said Gray pediatrician Stephen Combs. “People will say, ‘We think it’s this,’ but there’s no exact cause. There are lots of studies, lots of intimations. ... It’s a combination of things and doctors don’t know exactly what causes it and why that is.”Several years ago, Combs’ practice had some teens with type 2 diabetes, but those kids have moved on to adult doctors.“We’re keeping an eye on some kids right now. They don’t have type 2 yet, but there’s a family history, and you worry about those,” he said.Amanda Pearson, a fourth-grader at Powell Valley Primary in Big Stone Gap, Va., was diagnosed with type 2 diabetes on March 29.“She started gaining weight and wanting to drink a lot. Then she started getting a discolor around her neck. I didn’t recognize it [was diabetes],” said her mother Michelle Azbill. “It was just something that wasn’t right.”Amanda’s dad has diabetes, as do his parents. Her diagnosis has meant some changes in the family’s diet.“We’ve had to stop frying her food. We have to make it out in little portions. She is not allowed to have any sugar whatsoever. She sees other kids having candy and stuff like that, and she can’t have it. It’s a big change. I’ve got a 7-year-old, Etta, who’s trying to work with the program, but it’s hard,” Michelle said.Amanda, 9, admits that the change in diet has been difficult.“I’m getting there, but it’s kind of hard to do,” she said.“In the beginning, when we told her [about her diabetes], she was disappointed,” Michelle said. “She’s getting a little bit better at trying to watch. She still wants to sneak a little. That’s going to come with it when you’re used to a different routine.”Amanda gets adequate exercise at a nearby park, where she runs around with her friends, jumps rope or does jumping jacks.She takes Metformin (originally sold as glucophage) to help regulate her blood sugar, and those levels are checked three times a day.Etta isn’t showing any signs of developing diabetes. Michelle is going to get herself checked because she believes she’s at higher risk since she’s had gestational diabetes.In 2006, in response to the growing numbers of type 2 diabetes and the risk factors that lead to diabetes, Tennessee Gov. Phil Bredesen launched GetFitTN, a health and wellness awareness campaign to promote healthier, more active lifestyles among Tennesseans.The initiative is aimed at educating both adults and children that proper nutrition and physical fitness can prevent or significantly delay onset of the disease. For more information on GetFitTN, visit www.GetFitTN.com.Aside from Brittany’s four-a-day insulin shots, she manages her diabetes through close monitoring of her her diet.“It’s not really life-changing,” Julie said. “You just have to adapt. The major change is how we cook our meals. She’s on a regular diet, but she has to monitor her total carbohydrate intake. Vegetables and meats are free food, as long as it’s not breaded. We used to eat a lot of processed foods ... and now we buy lean meats. We don’t bread it at all, and we’ve started grilling. We’ve started buying different kinds of vegetables ... trying to eat healthier.”Having diabetes doesn’t mean the fun is over, Combs said.“It’s really more of a focus change. They can still do things they want. If I have a child with diabetes, I want them to exercise and eat right. That doesn’t mean there’s no sugar, no candy bars, no fun in life. .. It’s the same thing we all ought to be doing. We all ought to be exercising 30 minutes a day, making healthy choices.”Combs said he advises his diabetic patients to keep their blood sugar levels as close to normal as possible.“Then we look at how you do that. Number one, you make healthy food choices. You keep carb levels about the same at every meal,” he said.The Tates have developed a meal schedule to accommodate their youngest — 6:30 a.m. breakfast, 9:30 a.m. snack, 11:30 a.m. lunch, 2:30 p.m. snack, 5:30 p.m., dinner and 8:30 p.m., snack.“Before it was three meals and snacks whenever,” Julie said.The elementary school nurse gives Brittany her lunchtime insulin shot and makes sure she has the right carb count.“We’ve had to keep in close contact with the school nurse. The nurse and her teacher both have Walkie Talkies,” Julie said.Brittany is never to be left alone at school — even walking to the bathroom — because she shows no warning signs if her blood sugar level bottoms out.“If she’s high, she gets really, really hyper and hateful,” Julie said. Water and exercise bring her high blood sugar levels down.Brittany’s been taught to take good care of her feet — never going outside without shoes on, and checking her feet for cuts and bruises every night.“They said she could live a perfectly normal life as long as she monitors,” Julie said.Brittany is treated by a pediatric endocrinologist in Knoxville who has offered to have Brittany’s brothers — Andrew, 12; Jordan, 10; and Scotty, 8 — genetically tested. Julie knows that both she and husband Tim are carriers of a gene that predisposed Brittany to the disease.“Researchers don’t really understand why some kids get it and some kids don’t, even if they have similar risk factors,” Combs said.Being diagnosed at such a young age means that Brittany will grow up knowing how to control her diabetes.“She’s done remarkably well. She took it better than I did,” Julie said. “She loves the extra attention. She didn’t want to leave the hospital because she got to order room service.”Warning signs of type 1 diabetes can include extreme thirst; frequent urination; drowsiness and lethargy; sugar in urine; sudden vision changes; increased appetite; sudden weight loss; fruity, sweet or wine-like odor, or breath; heavy, labored breathing; and stupor and unconsciousness.Warning signs of type 2 diabetes can include frequent urination; unusual thirst; extreme hunger; extreme tiredness; irritability; slow healing of wounds or sores; tingling or numbness in hands or feet; itching; blurred vision; acanthosis nigricans (dark, velvety patches on the skin around the neck or in the armpits); and high blood pressure.

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