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Early Diabetes (ER)

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Wednesday, May 20th, 2009 | CWK Producer

“Sometimes we see children, by the time it’s picked up, by the time it’s figured out, they’re really, really sick.”

– Lonnie King, M.D., Emergency Pediatrics

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Renee’s mother brought her to the hospital. She was a strong, healthy girl – until about three weeks ago.

“She’s an eight-year-old girl whose mother had noticed she’d had several weeks of increased urination, increased thirst and some weight loss,” says Dr. Lonnie King with Children’s Healthcare of Atlanta.

The doctor’s diagnosis: diabetes. Her body can’t produce or properly use insulin – the hormone needed to change food into energy.

 When Renee’s blood sugar level is tested, it is over 360.  “Normally a person’s blood sugar should only be about 120 [at] most, even after a big meal, says Dr. Robert Schultz, an endocrinologist who examines Renee. “So 361 is fairly high.”

Renee is admitted to the hospital. Starting tomorrow, she and her family will begin a two-day crash course on diabetes and its treatment.

“Education is paramount,” says Dr. King. “She has to learn how to know how much she’s eating, what her activity is and translate that into how much insulin she should give herself.”

He says it was good that Renee’s mother recognized something was wrong – and then acted.

“Sometimes we see children, by the time it’s picked up, by the time it’s figured out, they’re really, really sick,” he tells Renee’s mom, “and she’s not. So that’s good that you got her in quickly with all of this.”

Renee will now begin a lifetime of insulin injections. But if she eats right and takes care of herself, she has every chance of leading a long and normal life.

Today, diabetes has no cure – at least, not yet.

“There’s a lot of hope for a cure,” says Dr. King. “There’s a lot of research going on, trying to find a cure or find a prevention.”

What We Need To Know

According to recent estimates, nearly 200,000 people under the age of 20 have diabetes.  Another two million are pre-diabetic.  In addition, approximately one in 500 children suffers from type 1 diabetes (juvenile diabetes), which occurs when a person’s immune system destroys the cells of the pancreas that normally secrete insulin – a hormone essential for digesting sugar.

The American Diabetes Association says that type 1 diabetes is usually diagnosed in children and young adults. Because a type 1 diabetic’s body cannot produce insulin to digest sugar, the sugar builds up in the blood instead of going into cells. This starves the diabetic’s cells of much-needed energy and over time results in tissue damage. According to the Juvenile Diabetes Research Foundation (JDRF), the risk of developing type 1 diabetes is influenced by autoimmune, genetic and environmental factors.

Many people with diabetes are unaware that they have it.  Knowing the symptoms is important to diagnosing the condition early. The Mayo Clinic recommends watching for the following signs:

  • Flu-like symptoms. Diabetes can sometimes feel like a viral illness, with fatigue, weakness and loss of appetite. Sugar is your body’s main fuel, and when it does not reach your cells, you may feel tired and weak.
  • Weight gain or loss. Because your body is trying to compensate for lost fluids and sugar, you may eat more than usual and gain weight. The opposite can also occur. You may eat more than normal but still lose weight because your muscle tissues do not get enough glucose to generate growth and energy.
  • Blurred vision. High levels of blood sugar pull fluid out of the tissues in your body, including the lens tissues of your eyes. This affects your ability to focus. Once the diabetes is treated and your blood sugar levels drop, vision improves.
  • Slow-healing sores or frequent infections. Diabetes affects your body’s ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.
  • Nerve damage (neuropathy). Excess sugar in your blood can damage the blood vessels to your nerves, leading to a number of symptoms. The most common are tingling and loss of sensation in your hands and feet. You may also experience burning pain in your legs, feet, arms and hands.
  • Red, swollen, tender gums. Diabetes increases the risk of infection in your gums and in the bones that hold your teeth in place. Your gums may pull away from your teeth. Your teeth may become loose or you may develop sores or pockets of pus in your gums.

If you suspect diabetes, it is important to see a physician who can diagnose the disease. If you are diagnosed, or have been diagnosed in the past, there are certain lifestyle changes you can make to help control your glucose levels.  By controlling the disease, you will feel healthier, better and prevent further diabetes complications. New Mexico State University recommends the following for controlling diabetes:

  • A healthy diet – Choosing a balanced diet low in fat and high in fiber helps control blood glucose and provides the nutrients your body needs to stay healthy. Diabetics must pay special attention to the amount of fats and carbohydrates (sugars) – the body’s two primary sources of energy.  See your dietitian for a meal plan that fits your lifestyle and eating habits.
  • Exercise – Daily physical activity helps control weight and blood glucose and reduces your risks for other chronic diseases like heart disease. And remember, physical activity adds up. Several short periods of physical activity throughout the day can be just as beneficial as one longer period of activity.
  • Monitoring – Monitoring blood glucose is an essential tool for controlling diabetes. Just as a car’s speedometer shows how fast or slow you are traveling, a blood glucose monitor tells you how well you are controlling your blood sugar levels and your diabetes.  Diabetics monitor their day-to-day blood glucose with a glucose meter. Monitoring helps you make decisions about food choices, exercise, medications, and stress. Long-term blood glucose control is measured by a hemoglobin A1c test done by your doctor.
  • Medications – Many people with diabetes need to take medications to control blood glucose. Medications should be taken daily as prescribed by your health care provider. Changes in diet, physical activity level, or blood glucose control may require changes in your medications. Visit your doctor often, especially if you have any changes in your lifestyle or blood glucose levels.
  • Skin/foot care – Diabetes causes changes in nerves and blood circulation, particularly in the lower legs. Amputations, a major diabetes complication, can be prevented. Daily foot care should include looking for sores or cuts, wearing comfortable shoes and socks, and taking care of your skin to prevent blisters, calluses and cracks.

Resources

  • American Diabetes Association
  • Juvenile Diabetes Research Foundation
  • Mayo Clinic
  • New Mexico State University

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