Kids with diabetes: Families learn to control blood sugar to avoid complications

Published: Monday, July 28 2008 12:00 a.m. MDT

WEST JORDAN — Since Joshua Black, 6, was diagnosed with type 1 diabetes three years ago, he has been poked in the fingers 8,500-plus times. His parents have also repositioned the needle to his insulin pump on his torso more than 350 times. And he's "kind of tired" of all of it.

But type 1 diabetes is not something that a little boy can wish away. So, his parents, Carrie and Jeffrey Black, are determined to help him control the disease to prevent serious complications and even premature death.

People with type 1 don't produce insulin, a hormone that converts blood glucose into energy. Without insulin, the glucose accumulates and that high blood sugar can cause a serious condition called ketoacidosis, according to the

Juvenile Diabetes Research Foundation. Left uncontrolled long enough, type 1 diabetes can lead to coma and death. To counter the disease, a diabetic must inject insulin, calibrated to factors such as what they're consuming, their activity levels and more.

The incidence of type 1 diabetes is growing worldwide, according to Dr. Mary Murray, medical director of the diabetes program at Primary Children's Medical Center. Utah is no exception.

"We don't know why; there's not a good explanation," Murray says. "There are a variety of theories that are helping to direct research activities."

While type 1 diabetes can occur at any time, child to adult, there are a couple of peaks around ages 5-7 and in adolescence. Recently, though, "the most frightening thing that pretty much everybody is seeing nationally is the incidence in young children under age 5 seems to be increasing more than any other age," Murray says.

Joshua fell into that category, diagnosed before he was 3. He wasn't potty trained yet and he was wetting constantly, which the Blacks knew were symptomatic of diabetes. He was always thirsty, another sign.

He was hospitalized for three days and they began a journey of education, learning about a disease that did not run in their family and what they must do to control it. By that time, Joshua had a baby brother, Jordan, not yet 1.

Some type 2 diabetes can be controlled without medication. Sometimes, it even goes away. Type 1 is forever, Murray says. "Once insulin therapy has begun, it may wax and wane a bit." She describes a honeymoon period after diagnosis when blood sugar can be controlled with little or no insulin, but notes it doesn't last forever. "It will increase again and insulin is required. There is no other therapy, except insulin, which must be injected."

Attempts to develop an inhaled insulin have so far yielded less than idea results, she says. The dosing is hard and so much depends on technique. As millions of asthma sufferers have found, inhalers are difficult to master. Many have "terrible or variable" technique, Murray says.

Joshua gets five shots a day and eats on a schedule. He came home from the hospital on a strict diet, his mom remembers.

While Murray says doctors don't require as tight control with kids as with adults, standards are still high because there are so many long-term complications, from eye damage to heart disease or kidney failure associated with diabetes.

Even with good control, there are no guarantees, she says. "You may still have some of the side effects. Or you can do everything horribly and avoid the side effects, if you have the right genetic background." Statistically, though, improved control decreases the rate of complications significantly.

Carrie Black says many things can throw off the delicate balance they've achieved with Joshua. Stress, virus, bacteria — "it can all toss things out of whack." So can medicines for other things.

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