Coping with Diabetes
- JULY 2006
- Français
Above, from left, RN Janet Heywood checks six-year-old Catharine Lockhart's blood sugar levels at the Niagara Diabetes Centre, while mother Tamara looks on.
Sometimes, the patients are mere infants, with parents in a state of panic about how to cope with a condition they know will impact their child for the rest of his/her life. Often, the patients are adolescents, going through the turmoil of their teenage years only to find out they must make a major change in their lifestyle, whether they like it or not.
One Family's Experience
The Lockhart family in St. Catharines says that without the Niagara Diabetes Centre, they don't think they could have dealt with their daughter's diabetes. Catharine Lockhart, turning seven at the end of July, was diagnosed with diabetes at age five, and for her mother Tamara and father Chris, the revelation came as both a shock and a relief.
"We knew something wasn't right with her," Tamara recalls. "She was very thirsty, which we put down to the hot weather, and she had lost a little weight, but had grown two inches. We don't have a family doctor in Niagara, and we hadn't been able to get her to our doctor in Hamilton. Things came to a head at a pool party, when a guest who was a nurse took one look at Catharine and told us she needed to go to the Emergency Department right away." Within minutes, the ER staff had diagnosed Catharine with diabetes and because of her physical state, admitted her to hospital immediately.
"The first few months were very difficult for us to adjust," Tamara says. "We had a hard time dealing with it, and the Niagara Diabetes Centre was great. We met with them several times for the first month, and called them with our questions. They were very supportive."
Every day, the dedicated Paediatric Diabetes team at the NHS Niagara Diabetes Centre educates and provides diabetes management support to children and their caregivers on 'survival skills' for diabetes, teaching families how to monitor blood sugar levels, administer insulin and make healthy food choices. As well, the team discusses how to handle low and high blood sugars, and how to cope with the stress diabetes may have on the family home life.
Manager Cathy Lanteigne says their paediatric caseload averages about 120 patients from all corners of Niagara, who come to the Centre's location at Ontario Street Site in St. Catharines for care by a Registered Nurse, Dietitian, and Social Worker as well as access to a paediatrician in a clinic setting. "Our youngest patient was diagnosed with Type 1 diabetes at nine months," Cathy says. "We see them up to age 18 and continue to support them through the transition to the adult setting." The program was reorganized in 2001 so that a "critical mass" of patients is seen by a dedicated team with a very high skill-set in working with children and their families.
Type 1 and Type 2 Diabetes
Type 1 diabetes, formerly called juvenile diabetes, is when the body's pancreas is not producing insulin at all. Type 2 diabetes occurs when the body can produce insulin but is not absorbing it properly, explains RN Janet Heywood, who has been part of the team since 1991. "The treatment for Type 1 and Type 2 is vastly different, and there are considerable risks if a patient believes he/she has Type 1 and is injecting insulin every day, but may not require that treatment at all."
Typically, Type 2 diabetes is an adult condition. The Centre is seeing more Type 2's presenting in our children, partially due to the disturbing upward trend of adolescent obesity and sedentary lifestyle. Some ethnic groups, such as Natives, are at higher risk for Type 2 diabetes.
Having your child diagnosed with diabetes can cause enormous stress on a family, Cathy explains. "Our Dietitian and Social Worker play a significant part in helping the family. Our Social Worker works closely with the family to ensure the supports for the child are in place."
"As the Dietitian on the team, I educate the family about carbohydrate sources of food and its balance with insulin," says Carrie German. "We stress that all foods can fit into a healthy eating pattern for kids with diabetes." Visits are also made to the schools, so teachers are aware of the issues around diabetes. A little bit of education goes a long way to take the stigma away from diabetes.
Monitoring blood-sugar levels is an important component. Home blood-glucose monitoring kits involve a pinprick to fingers or other areas, such as the palm of the hand or arms or legs. The monitoring units are now free, with patients paying for the test strips.
Insulin Treatment
Most children will take insulin injections three to four times a day, usually in the abdomen, and these days, the needles are tiny (only about ¼ inch long) and very fine, so the pinprick is almost unnoticeable. "I get a needle before I eat," says little Catharine. "Sometimes it doesn't hurt at all and when my mommy comes to school to give it to me at lunch, all the other kids crowd around my desk to see, and I get to tell them about it."
The insulin pump, an alternate way of administering insulin, delivers a steady dose of insulin just like a healthy pancreas. The dosage can be adjusted easily, based on carbohydrate intake or physical activity, but these pumps are costly – about $6,500, plus the cost of supplies (about $200 per month).
Symptoms
Usually, children are diagnosed with diabetes when they come into an Emergency Department with some or all of the following symptoms:
- Extreme thirst
- Frequent urination
- Bed-wetting after they are fully toilet-trained
- Weight loss
- Stomach flu-like symptoms such as vomiting or abdominal tenderness
- A fruity smell to their breath.
"Our ER physicians usually make a fairly quick diagnosis, based on blood and urine testing, and our goal these days is not to admit the child into hospital unless he/she is medically unstable," Cathy says.
Whether the child goes home or is admitted to hospital, he/she will begin seeing the Paediatric Diabetes team within a day. "Our goal is to see the children and their families within 24 hours of their diagnosis, so we can start educating the whole family and teach them the survival skills for diabetes," Cathy explains. "Our team will see them frequently during the first month." Once the diabetes is being managed effectively, patients and their families come for an appointment with the team or to see the physician in the clinic every three months. Our ultimate goal is to educate and provide support to the child and their family so they feel they are in control of the diabetes rather than the diabetes controlling them."
The Niagara Diabetes Centre works closely with McMaster Children's Centre in Hamilton to ensure comprehensive care is in place.
How is little Catharine coping with diabetes today? "I have learned how to prick my finger to check my sugar levels," she says proudly. "I look at the numbers and if they are low, I need to have a snack, and if they are high, I need to exercise." Catharine is going to be just fine, her mother says proudly. "She's learning more now about the carb content in foods and making healthy choices. She's happy, healthy and very involved in managing her diabetes."
For more information on the Niagara Diabetes Centre and the Paediatric program, call 905-682-4200.
The Paediatric Diabetes team meets regularly with young patients and their families. Below, from left, are RN Janet Heywood; patient Catharine Lockhart with her mother Tamara and brother Iain; Social Worker Kathryn Pummell and Dietitian Carrie German.