Diabetes and Children - Chapter 6

As many of my readers know, my son was diagnosed with Type I Diabetes a little over a year ago. Unfortunately, we again found ourselves back in the ER, which turned into a 4- day stay.

Again, what we thought was your basic 24-hour flu turned into pancreatitis. He was feeling fine the day before. He was brought home from school during the day. He had the usual symptoms of nausea, vomiting, and stomach pain, so the stomach flu was assumed to be the problem.

His sugar readings started to climb, which is expected with any illness, even colds. Keeping him hydrated was proving to be difficult, which also did not help his sugar readings. Corrections did not seem to be working, which started to cause concern. Also the pain was increasing in his stomach area, so we assumed that he might have appendicitis.

Once he arrived at the ER, he was immediately put on IV therapy for correction of his dehydration, as well as an insulin drip. The results of his blood work showed that his white count was high, which is why we assumed that maybe his appendix was acting up. He was also showing that he had ketones in his blood. Since the pain in his stomach was still very bad, we were sure that he was headed to surgery.

The doctors did CAT scans and x-rays to verify either a cranky appendix or possibly some sort of infection of his respiratory system. We were surprised when the results came back as negative. We assumed that he had just gotten a nasty case of the flu, and that the pain in his stomach, since it was below the rib cage, was from vomiting.

Since the hospital did not have a pediatric department, they insisted on sending him to Cleveland Clinic to continue fluid replenishment, correction of his sugar levels, and also to find the reason behind his high white count.

It is so hard to try not to show emotions. When the expected diagnosis of appendicitis did not come back as positive, we figured that he should be able to be re-hydrated at the local hospital, since it was probably just the flu. Their insistence of my son going to the Clinic showed that it was not just to re-hydrate, and I started to develop a feeling of dread. Keeping your fears in control is very important, so I told my son that it was just to make sure that his levels were brought into control.

When the transport ambulance arrived, the fear level increases. You are already exhausted at 2 AM, and now seeing all these monitors and a lot of hustle and bustle, the thoughts of what it could be can really take control if you let it.

The transport paramedics were awesome. They made my son feel very comfortable and even joked with him. They took him off the insulin because his numbers were starting to go toward the normal range. They then proceeded to explain that if his numbers dropped to quickly, he could have a brain hemorrhage. Just one more thing to have to worry about!

His father rode with him in the ambulance. Watching them close the ambulance doors on your child leaves a weird feeling in your gut. You are leaving your child in the hands of strangers, even though they are exactly the right ones to leave him with. Since they would be busy just getting him settled and re-hydrating him, I decided to return home and wait for any further information from the hospital.

Once I was out of sight of my son, the floodgates opened. Anger and fear take control. Why him? Why any child? Why can't things like this happen to bad people and leave the good ones alone?

One of the hardest things to do is to not get burnt out while going through hospital stays. Unless the child is critical, it is best if you can alternate between parents, so that you don't become ill from exhaustion. Also, some hospitals are not always parent friendly in the PICU, so there may only be room for one to stay overnight. So, even though it is hard to not be there 24-7, it is better for the child if you can keep your energy levels up by doing shifts.

Sleep was pretty sketchy, dozing off and waking every hour to make sure that the message light was not beeping and that yes, I had in fact made sure that the ringer was on. I called the next morning to see how he was doing and got the shock of my life. My son was diagnosed with pancreatitis, which is an inflammation of the pancreas. The more I thought about it, with him being a diabetic, the pancreas would be open to infections.

The funny thing is that even though it can become a very serious situation if not corrected, the cure for your basic level of this disease is so very simple: no liquids or food by mouth until certain measurables in his blood work is reached. While the pancreas is inflamed, any foods or liquids by mouth will irritate it and cause the extreme pain.

The pancreas secretes digestive enzymes into the small intestine, and helps digest fats, proteins and carbohydrates in food. Normally, the enzymes do not become active until they reach the intestines. If they become active in the pancreas, they will start to digest the pancreas! Acute pancreatitis, which is what my son had, will usually correct itself by resting the pancreas, which is done with no food or liquids and IV therapy.

It was such a relief to find out that no surgery was required and that he would be well soon. But he still had fluctuating sugar levels and ketones in his blood. He was very exhausted and also starting to get hungry.

Once his sugar levels were more in control, they moved my son to a regular room. He was still on IV therapy into the second day. It takes time for the enzyme numbers to lower. When he was finally able to have a small amount of clear liquids, he was questioned about stomach pain. If his stomach started to hurt after eating, then he had to stop the food intake again.

Luckily, there has been no return of stomach pain. The hard thing is that he has to stay on an extremely low fat diet of 30 grams for the next week or so. The average recommended for teenagers is around 60 grams. So, on top of watching his diet for sugar carbs, he now has to pay even more attention to the fat carbs. He can cover the sugar, but there is nothing to cover the fat!

Once again, there are some emotional issues when dealing with a child and more diet restrictions. To us adults, seven days is no big deal, but to a kid, that eliminates a lot of things that they like: pizza, McDonalds, and just about every food that tastes good! So, again you have to make sure that they get a strong reality check that if they do not do as instructed, they will end up back into the hospital, and the results will be more severe. A week of a low fat diet compared to a lifetime is definitely the better way to be. For kids his age, a lifetime concept is not understandable. All he knows right now is that he can't eat his favorite food right now, and that he can't be a "normal kid".

Even though my son is now basically healthy again, his father and I both watch him like a goldfish in a bowl. I now ask him once after eating if there is any stomach pain, and that is it.

We also decided not to send him on his field trip to Washington D.C. Besides the exhausting schedule, we were not sure what food options he would have. We were also concerned about if he had the will power to resist high fat foods. After hearing about what they had for food choices, we realize that we made a good decision. He probably would have landed back into the hospital again.

The experts say that even though this disease can happen in children, it is not that common, especially when the child already has diabetes. Also, we may never know what caused this to happen. We are waiting on the results of his blood work to see if this was caused by mononucleosis, since his stepbrother came down with this during exam time at school. Of course, we lightened the moment by teasing him about wanting to be special and that he should quit kissing his stepbrother!

How do you tell the difference between flu and another bout of pancreatitis? The main thing is that flu will give you body aches and the runs. Pancreatitis will not. Now, when he gets the basic flu, instead of letting it run its course, we may need to take him to the doctor.

The sad reality is that no matter how hard I try to keep my son healthy, we may have more visits to the hospital. Learning how to handle the fear and the exhaustion will make it a little easier, especially if you are no longer connected to the other parent, and have no support person. By taking care of yourself during this time, you can make better decisions and really help your child survive a bad situation.