Moscow no exception to rise in juvenile diabetes

Families say more awareness is needed about Type 1 disease

Moscow School District nurse Julia Parker helps a student with his insulin shot at McDonald Elementary School in Moscow on Friday. Geoff Crimmins/Daily News

By Holly Bowen Daily News staff writer
Mar 10, 2012

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An emergency helicopter ride and a hospital stay aren't what Mary Silvernale Shook planned when her family visited Massachusetts last summer, but that fateful vacation may have been a lifesaver for her 10-year-old son.

Silvernale Shook assumed her son had been suffering from the flu, but he wasn't any getting better. One night in their hotel room, the boy got up five times during the night to use the restroom, and he was begging his mother for ice water.

"Ten-year-old boys don't send their mothers to the ice machine in the hotel," the Moscow woman said. "At 5 a.m., something came into my brain, and I Googled the signs of juvenile Type 1 diabetes."

The symptoms fit. Her son had lost weight, was constantly thirsty, needed frequent bathroom breaks and was having trouble seeing the blackboard at school.

Type 1 diabetes, known as juvenile diabetes, is mysteriously on the rise worldwide. Doctors and researchers don't know why. Genetics, environment and other factors may all play a role, but to what extent is still unknown.

Unlike Type 2 diabetes, Type 1 diabetes is an autoimmune disorder and isn't connected to poor diet and exercise habits. It can occur at any age but mostly arises in children.

"We were traveling with relatives for a family reunion, and my younger brother is Type 2," Silvernale Shook said.

Uncle Chuck used his blood glucose meter to check his nephew's blood sugar level - it was through the roof.

Her son was life-flighted from Salem, Mass., to Boston, where he spent 12 hours being stabilized in a pediatric intensive-care unit before coming home to Idaho.

Silvernale Shook said her son's symptoms set in over a period of two weeks, but his pancreas had likely been under attack for years.

In people with Type 1 diabetes, their pancreases don't produce enough insulin, a hormone that helps the body's cells use glucose for energy. Without enough insulin, the glucose stays in the blood and can cause deadly side effects.

People with Type 1 diabetes must monitor their blood glucose levels throughout the day and inject themselves with insulin accordingly. That presents extra challenges for young children who attend school.

School nurses

The Moscow School District is hiring a part-time nurse assistant to help care for an increasing number of young students who have Type 1 diabetes.

Julia Parker, the district's full-time nurse, is being stretched too thin between McDonald Elementary School, which has four diabetic students, and Lena Whitmore Elementary School, which has three. She can't be two places at once, hence the hiring of the nurse assistant.

At lunchtime Friday, Parker sat in the school office with a boy diagnosed with Type 1 diabetes about a month ago.

First she asked him whether he'd be eating school lunch that day, or if he had brought a sack lunch from home. School lunch.

So, she got a menu from the cafeteria and figured out the number of carbohydrates he would be eating.

The boy pricked his finger to test his own blood sugar with a meter. Parker took the number and entered it into a formula with the number of carbs. That told the boy how much insulin he needed to inject before eating.

Because it's a careful balance between injected insulin and blood glucose levels, it's imperative that juvenile diabetics be completely honest about what foods they plan to eat.

If they don't eat what they say they will, Parker said, "It only hurts them."

Living with diabetes

Silvernale Shook said her son was still in the ICU when the doctor started her family's diabetes education. They met with dietitians, pediatric endocrinologists and social workers, who all told them their lives would be different from then on.

"Diabetes is managed 24 hours a day," she said. "They told my husband and me that we had new jobs - 'You are your son's pancreas.' ... For 24 hours a day, we put diabetes on top of everything else we do."

Blood glucose monitoring and insulin shots are now part of family trips and sports participation, she said.

Jacki Riley's 11-year-old daughter was diagnosed with Type 1 diabetes when she was just 4 years old.

Riley said having a very young child with diabetes was a struggle. She said her daughter had to be retrained to eat.

"No more mindlessly eating," she said. "We had to know every little morsel of food that went into her mouth."

She said her daughter now checks her own blood sugar and wears an insulin pump that eliminates injections.

"It's like a little calculator that holds the insulin in it," Riley said. "A tube goes from the pump into her body. She'll put in how many carbs, then her blood glucose level. Then it calculates (insulin) for her based on the numbers we've preprogrammed."

Cindy Schneider's son was diagnosed on April Fool's Day 2008 when he was 3-and-a-half years old.

Schneider said at first it was difficult to determine whether her son's unquenchable thirst, frequent bathroom breaks and irritable mood were just part of being a toddler or if they were something more serious.

Schneider said the family had a steep learning curve for about six months, especially because her son wasn't yet able to verbalize his needs well.

"It kind of takes away your spontaneity and flexibility from your daily routine," she said. "You test up to eight to 10 times per day, then overnight. We still do."

She said her son injects insulin at breakfast, lunch, dinner and during special food-centric occasions, like birthday parties.

School parties challenge juvenile diabetics, but Parker said children can participate with some planning.

"These parents are good at being homeroom moms and attending parties," she said.

The children can take extra insulin if they know they'll be eating extra carbs, or they can take the sugary snacks home to eat with dinner.

Riley said juvenile diabetics can typically eat any kind of food as long as they dose their insulin accordingly.

Grateful for the help

Schneider said she and the other parents are thankful that the Moscow School District is hiring a nurse assistant to help Parker.

"It's definitely been a long time coming," she said.

Schneider, Silvernale Shook and Riley all said it's important that people remember that Type 1 diabetics didn't get their disease from poor health habits.

"The community in general needs to be more aware of what it is," Riley said, adding that family members have to deal with the stigma of people assuming their children had to be overweight to get the disease.

"I was in the same boat before (my son) was diagnosed," Schneider admitted. "I thought they were overweight, eat too much sugar and don't take care of themselves. For a family of a Type 1, that's a hard pill to swallow. None of those things is the reason why our child is a diabetic."

She said she doesn't think people are trying to be insensitive or not care - they just don't know any better.

Riley, who coordinates a local support group for families of Type 1 diabetics, said she's not sure exactly how many children in the area are affected by the disease because some families don't attend the group's meetings.

"Every couple of months has a new diagnosis in the area," she said. "Last month, there were two new diagnoses."

The Type 1 support group meets at 6:30 p.m. the first Monday of each month at Pullman Regional Hospital.

Riley also recommended the research and support of the Juvenile Diabetes Research Foundation at www.jdrf.org.