Diabetes and treatment in the life of a 5 year old
Starting with the facts
I have learned of new information about diabetes that is important for every one to know. There has been a 23% increase in diagnosed cases of Type 1 diabetes in people under age 20 from 2001 to 2009! What really makes that scary is that they don't know why!
According to an article on WebMD, titled 'Type 1 diabetes up 70% in kids, Study finds', ..."What isn't clear is what specifically is driving this increase. Numerous theories abound, but none has yet been proven."
There are theories that abound, but with no clear evidence and no cure, and no way to prevent it, diabetes is a condition that demands a cure.
Another disturbing fact, this one from the JDRF, "...The rate of T1D incidence among children under age 14 is estimated to increase by three percent annually worldwide."
Every day, by the numbers
So what exactly does it mean to have Type 1 diabetes? For parents of a small child, it can be easily misdiagnosed and lead to death. Some of the symptoms are: excessive thirst, cranky, and frequent urinating. Of course, with a baby, this is hard to detect. We wrote about our experience with this in a previous hub about discovering diabetes in our 14 month old. we almost lost him and it changed our lives. It's been 4 years and we want to share what the daily life is like.
The very first thing that comes after diagnosis is calculations. While still at the hospital, we were introduced to a couple formulas that would become something that we have to do multiple times daily. Unless there is a cure found, our son will do this every day of his life. The first is a corrective formula. The endocrinologist determines a 'target' blood sugar number based on age and weight. It goes like this...blood sugar-target number divided by corrective. For our son, an example might be:
255-150=105. Then 105/80=1.31
So, to correct his numbers, we then round to the nearest half, which in this case would be 1.50. This is the number of units of insulin we would have to dose him with to get him closer to a healthy number.
But, we aren't done yet. Each time he ingests carbohydrates, another formula is used. Again, based on age and weight factors, the endocrinologist determines an 'insulin sensitivity' number. After each meal, the number of carbs are calculated and divided by this number. For our son, he gets 1 unit of insulin for every 18 grams of carbs he ingests. Therefore, a typical lunch would be:
1 peanut butter and jelly sandwich with 4 ounces of milk= 51 grams. So we divide 51 by 18 and round to the nearest half. 51/18= 2.83, rounded is 3 units of insulin.
BUT, at meals, we take the corrective dose (CD) and the food dose (FD) and add them together for a total dose (TD). So for this lunch example, he would actually get 4 units of insulin.
A day in the life, from morning to night
From the time Gage wakes up, a critical life routine begins.
Wake up- poke finger and check blood sugar.
Inject daily long acting insulin dose.
If sugar is high, calculate corrective dose, eat breakfast, count carbs and calculate food dose. Then inject with total dose.
If sugar is low, dose with 15 grams fast acting sugar, ( we use strawberry syrup), and wait 15 minutes. Recheck. If still below 100, dose with another 15 grams and wait 15 minutes, if above 100, eat breakfast but don't calculate a corrective dose.
In 2 hours, recheck blood sugar. Insulin used for food dosing is a quick release and fades out in about 2 hours.
Repeat this process for each meal and any snack with carbs.
Bedtime, check blood sugar. If low, dose same as daytime process, but set alarm to recheck again around 1 or 2 am to make sure blood sugar doesn't go low again. If low, wake up long enough for a sugary dose of syrup and recheck every 15 minutes until above 150.
Wake up and start over.
Remember, everywhere we go, we always keep Gage's glucose tester and insulin with us. Also, we carry an emergency pen that will save Gage's life if he goes extremely low. Hopefully.
Ways to treat with insulin. Syringe, pump or pen
Diabetes has no cure. Therefore, it is treated with insulin. Insulin delivery systems are pretty much broken into 3 categories; syringe, pump, or pen.
The pen is the insulin delivery device we are currently using. This device offers the smallest needle available and is very discreet. The insulin is contained in a vial on the pen. Only the needle tip is changed every time it's used. The insulin vial in the pen is changed monthly. That's because Gage currently doesn't use very large doses yet. An adult may go through the vials more frequently. Regardless of how much insulin is left, the remaining insulin is thrown away because it's not as effective after 30 days.
To load the pen, a dial is turned to the amount needed for dosing. Then the pen is inserted into the skin and the same dial is pressed to complete delivery.
The pump creates a more hands free approach to insulin dosing. The inset is attatched to the body with a spring loaded device that inserts a tiny catheter under the skin. A tubing line runs from the insulin pump to the site. Inside the pump is a vial of insulin. The blood glucose meter used to test is also used to enter the amount of insulin to be dosed. The inset site needs to be moved every few days to reduce the likely hood of infection in the inset site.
The pump is the closest thing that the industry has to an artificial insulin delivery system. The problem is, that with a small child doesn't respond well to the removal and installation of the inset site. The adhesive on the site catheter sticks very aggressively so that it won't fall off. Removal is like the stickiest band aid ever being pulled off your skin. Then the installation is a spring loaded device with a needle that snaps the site into the skin, forcibly. For Gage, this became a little too traumatic. He would cry with the site removal, and cry even harder with the install. As parents, it broke our hearts. So we took him off of it.
Most adults find the pump the easiest way to go. It's discreet and easy. No needles and no vials. Also, paired with new continuous glucose monitoring systems, the device automatically responds to changing sugar levels detected in the skin. The draw back is, it's another device that has to be inserted into the skin and changed regularly.
The syringe is used in conjunction with a vial to provide insulin dosing. As mentioned earlier, a set of numbers is used to calculate the amount of insulin needed. Then, the correct amount of insulin is drawn into the syringe, inserted into the skin, and injected. This process has been around for the longest amount of time and is the delivery system one receives after being diagnosed. Gage started on this system originally, then, after our stint with the pump, we went back to it for a while before we went to the pen. It requires more steps, math and is a very visual process. It can cause a few funny looks at a restaurant as you insert the needle into a vial, tap the air bubbles out and draw up a shot.
Speaking of restaurants, getting accurate carb counts can be pretty challenging. Most have no clue how many carbs are in a dish. In light of this, we carry a dietary information book that has carb and calorie counts for most foods. We actually actually had a manager at a fast food chain get nervous when we asked for nutritional information. The manager stated that they had none printed and that they weren't legally obligated to. We stated that they could relax, we only asked because some do and it makes it easier than thumbing through our book.
The JDRF search for a cure
- JDRF Walk to Cure Diabetes: Welcome to the JDRF Walk to Cure Diabetes.
The JDRF Walk to Cure Diabetes raises funds for scientific research to better treat, prevent, and ultimately cure type 1 diabetes. Join the Walk today.
We are not alone and we will never give up!
Every year we participate in the Walk to Cure Diabetes program supported by the JDRF. They were the first to reach out to us at the hospital offering us hope and comfort. The JDRF also does the most to research better ways to treat and hopefully cure diabetes. If you know anyone with diabetes, or have the disease yourself, please encourage to connect with the JDRF in there area. There are branch location all across the United States and around the world. They are a get source of support.
Please donate to the JDRF and help us find a cure!
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