JUVENILE ONSET DIABETES

Meagan was a normal 10-year-old girl. She was in the fifth grade and was an A student. She enjoyed playing in PE and her favorite subject was math. She was the only child to two loving parents who tried to give her the best of everything. They just moved into a larger house six months before which had a larger backyard with a pool. Meagan was not a sickly child and had the usual colds in the wintertime but no other significant medical history.

For one month Meagan noticed she was feeling more tired than usual even after getting a good nights sleep. She had her own bedroom with a bathroom down the hallway. Gradually she noticed she was getting up more and more in the middle of the night to urinate. When she urinated it was in large amounts. She attributed that to drinking late at night before going to bed because she had been very thirsty. Meagan also noticed she was getting headaches at school which she never had before except when she had a bad head cold. She continued to go to school everyday and tried to be as active as possible although she was not running as hard as she did before. Meagan also noticed she was hungrier than normal. Her parents attributed that to being a growing child.

Meagan’s mother noticed her daughter was getting up five or six times every night to urinate. One night she ran into Meagan’s room after hearing her daughter cry. Meagan said she was thirsty and wanted to drink some cold water. Meagan was becoming thirstier, even in the middle of the night. It seemed with each night that past she was drinking larger amounts of water throughout the day and night. Meagan’s appetite had increased to eating three times the amount of food she usually ate. Megan’s mother was concerned her daughter may have something wrong with her. She was concerned her daughter was drinking and urinating more than she should for a 10-year-old girl. She made an appointment to the pediatrician office for the following day.

Meagan’s mother gave the history of nocturia (urinating at night), polyuria (excessive urination), polyphasia  (excessive hunger) and fatigue for one month. The NP student listened and documented what history Meagan’s mother gave her. She asked if there was any history of diabetes in the family. There was none. The NP student ordered an accu-check to determine Meagan’s blood sugar and a urine sample. Megan was glad to hear about the urine sample because she had to go to the bathroom very badly. Her mother had a worried look on her face and was supportive of her little girl

The urine sample was obtained and dipped. It had ketones, protein, and glucose. Glucose should not be in a urine sample. I knew Meagan’s blood glucose was probably high because she was spilling it in her urine. It was time to get the accu-check. This was a finger stick to get a drop of blood to see how much glucose was in Meagan’s blood. I explained the process to Meagan and told her it was a quick poke and it would be over before she realized she was stuck in the finger by a sharp needle. She looked at her mother and said it would be alright to stick her finger. Her finger was stuck by the medical assistant and the drop of blood was placed on the glucose strip. The accu-check machine started to work to give the answer everybody was waiting for.

Approximately thirty seconds later the result was on the display screen. Meagan’s blood sugar was 375. Normal glucose levels were between 70 and 110. Meagan’s glucose level was high. Meagan was a diabetic. Her mom was supportive of her daughter and told me she wanted to learn as much about diabetes as she could from the internet and going to medical libraries. She knew her daughter’s diet would have to change by what little she knew about diabetes. Meagan sat on the exam table and did not know what to say. She did not understand what diabetes was because she had never been around anybody who was a diabetic. Meagan and her mother were told we needed to get a blood test to determine what her electrolytes were as well as refer them to a pediatric endocrinologist. Her mother agreed while Meagan continued to stare straight ahead. She wondered if her life would change and if she could no longer do the things she loved to do. Especially running during PE.

Meagan’s blood was to determine if her electrolytes were within normal limits. There was a concern about her potassium level since it could climb to critical levels with an elevated glucose level. Luckily they were all within normal limits. Her venous glucose level was 372, potassium 4.5, sodium 139, chloride 101, and bicarb 22. An appointment was made to the pediatric endocrinologist for the following afternoon. He would determine what insulin Meagan would be started on and follow her during her adjustment through the new diagnosis of type I diabetes. 

Meagan saw the pediatric endocrinologist the following day. She would see him often until her glucose levels were regulated with insulin and diet. She was started on Lantus insulin once a day at bedtime and Humolog before each meal with a sliding scale. Diabetic education was extremely important to help Meagan and her family adjust to having a new diabetic in the house. Meagan and her mother were taught how and where she should give her insulin injections. Meagan did not like the thought of sticking herself with a needle, especially in the stomach. Her mother assured Meagan she would help with the daily injections. An appointment was made for them to talk with the diabetic educator two days later. Meagan was given her own One Touch glucose monitoring machine and taught how to test her blood sugars before each meal. She needed to keep a glucose diary so the endocrinologist could determine if the insulin dose needed to be adjusted. They were also taught what signs and symptoms to look for in case Meagan’s blood sugar dropped too low (hypoglycemia).

One week later Meagan felt better about giving herself injections and changing her lifestyle. Going to the diabetic educator helped her understand the disease process and what kind of things she needed to do to keep her blood glucose levels below 120. She would be able to participate in the activities she did before being diagnosed with type I diabetes. Her mother was serving healthier foods for the entire family so Meagan did not feel she was different. She went to the American Diabetic Association’s website and found some recipes to make for the family. Everybody thought the food was good and did not complain about the change. Meagan was getting a better attitude and was willing to do whatever she needed to be healthy. This was the beginning of a lifetime disease. Meagan knew making healthy changes now would hopefully prevent medical problems when she became an adult. She had her whole life ahead of her.