Children adapt to Type 1 diabetes

Restless from math calculations using play money, thesecond-graders look relieved when their teacher instructs them togather their lunches and line up. They're heading down a stairwellto the schoolyard when Reilly Reynolds, a sturdy 8-year-old withblond hair and a cherubic face, remembers a pre-lunch appointment.She turns around and bounds back upstairs to the nurse's office.

Young diabetic: An article in the Oct. 26 Health section, about a young girl with diabetes, recounted an experience in which she felt shaky, tested her blood glucose, found it to be higher than normal and then took a glucose tablet. In fact, her blood glucose was lower than normal, not higher, resulting in the shaky feeling and the need for a glucose tablet. Such a tablet wouldn't be given for high blood glucose. —

This daily visit has been part of Reilly's school day at MarkKepple Elementary School in Glendale since she was diagnosed withType 1 diabetes a little over a year ago. Like the 15,000 childrenand adolescents in the U.S. diagnosed with the disease each year,she must check her blood sugar several times a day, getting insulininjections when it's too high or to cover the carbohydrates sheeats. Some children with Type 2 diabetes -- about 3,700 arediagnosed each year -- will need insulin injections as well, thoughmany are treated with diet, exercise and oral medications. For mostkids, the diagnosis is strange and a little frightening, but theyounger they are, the more resilient they seem to be, experts say,quickly adapting to a life of daily testing, insulin injections,rigid diets -- and compensatory actions if they've miscalculatedfood or activity levels. "Initially the kids are a lot better thantheir parents," said Mary McCarthy, a nurse and diabetes educatorat Childrens Hospital Los Angeles. "The younger they are, the moreit just becomes a part of their life." The care that such childrenget at school is crucial. Reilly, for instance, is monitoredcarefully (and will be until she can handle the task on her own,probably in middle or high school). With a chronic dearth of schoolfunding, many California schools don't have full-time nurses, sothey share a nurse, staggering the times diabetic students areseen. In schools where there is no nurse, parents must manage ontheir own; nonmedical personnel can't administer insulin. They can,however, give a glucagon shot in an emergency; this happens whenblood sugar dips so low the child can't drink or eat. A normal life Despite the constant managing, calculating, testing andplanning, most diabetic kids have normal lives. "It's a chronicillness, but these are robust, healthy, normal kids who can goabout their lives and do everything they hope and dream," says Dr.Jamie Wood, staff physician for endocrinology, diabetes andmetabolism at Childrens Hospital Los Angeles, and Reilly's doctor."We try to have the parents, nurses and teachers do as much as theycan so these kids can be kids. It really does take a village tocare for a kid with diabetes." For Reilly, part of that village isschool nurse Toni Triling. Triling must calculate the amount ofinsulin she gives Reilly based on the grams of carbohydrates in herlunch (the higher the carbohydrate count, the more insulin) and onher glucose reading before lunch. She also takes into considerationReilly's level of activity. Reilly studies her hands, washes themat the sink, then casually picks up a lancet and pushes it into herfinger, squeezing the tip until blood beads. Next, she takes ablood glucose meter, or glucometer, and places the blood on a teststrip. She tests herself about eight to 10 times a day, the firsttime upon waking. She hands the glucometer to Triling, who reads italoud. "156." Though that's a bit high for Reilly, whose normalrange is 70 to 150 (established by Reilly's doctors at diagnosis),it's not alarming. Colleen Reynolds waits for the nurse's call ather office in downtown L.A., where she manages a pearl import andjewelry business. The two adults discuss Reilly's pre-lunch glucoselevel, the carbohydrates in her food and how much insulin she'llneed to bring her blood glucose level down to the normal rangeafter lunch. The insulin enables the body to convert thecarbohydrates into fuel. Too much and her glucose level drops. Toolittle and her glucose level spikes. "Reilly knows that she has toeat her whole lunch whether she likes it or not because she hasbeen given insulin," Reynolds says. Reilly checks in with her momover the phone while Triling prepares a shot of insulin. She isworried about her little brother Griffin, 6, a first-grader, whoprotested wildly that morning about having to go to school. Shehangs up the phone and pulls up her sleeve. Triling gives the shotwith lightening speed. The shots, given with a small needle, neverbothered Reilly, her mother says, but the glucose testing did. Nowshe takes that in stride too. Today, the girl is quickly out thedoor and bounding down the stairs. When asked what is mostdifficult about having Type 1 diabetes, she replies: "Well, youcan't really sneak a lot of treats. My mom says only one at a time.Only one," she reiterates. "We listen to the rules. After findingout [I had Type 1 diabetes], I felt nervous because I thought Iwould be in pain all the time. But then I got used to it." Atlunch, Reilly sits across the table from two classmates, chattingamiably. Lunch is a wheat roll with cottage cheese, green grapes, agranola bar and water. She eats everything. Feeling shakyWhen the bell rings, Reilly and her classmates go back to class.But soon, Reilly starts to feel shaky. She's sent to the office,where a medical clerk (the nurse has left to work at anotherschool) tests her glucose. Reilly feels too shaky to do it. Herblood glucose is a bit higher than normal. The clerk calls ColleenReynolds, who recommends a glucose tablet. Maintaining Reilly'sglucose level is based on fairly precise calculation, but there arestill unpredictable highs and lows due to variables like how activethe girl is, something that can be hard to measure, or a brewingcold. Reilly's father, John, a musician and painter, picks upReilly and her brother from school. He tests her immediately athome. (Her blood glucose is 300; the Reynoldses try to keep her asclose to 100 as possible.) John Reynolds gives her an insulin shot.Reilly settles in for the afternoon with a couple of family catsand tackles some homework. As it turns out, her little brotherGriffin was coming down with bronchitis. Such exposure could havemeant a brewing infection for Reilly, so her parents decided tokeep her at home for a while to watch her glucose levels moreclosely than would be possible at school. In a few days, Reilly hasan appointment with her endocrinologist at Childrens Hospital LosAngeles. The Reynoldses and Reilly get good news at theappointment. They have successfully controlled her blood glucoselevel at the numbers the doctors consider ideal for Reilly'soptimum health over a three-month period. This is no easy feat."That is very good," said Colleen Reynolds, "and it means we arecontrolling her blood sugar really well." For the parents of adiabetic child, nothing could be better.

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