Kids and Diabetes

BY JOHN SNYDER
http://www.gazettenet.com/story.cfm?id_no=12290062

Monday, December 29, 2003 -- SAMANTHA Willis loves to dance. She's graceful
and clear-eyed, with an oval face, medium-length brown hair kept back by a
headband, a slender build and a friendly if nervous smile. She competes in
tap, jazz, lyrical, ballet and acrobatic routines, and dreams of performing
on Broadway.

Samantha, 13, has been a dancer since she was 3. Now an eighth-grader at JFK
Middle School in Northampton, she puts in 3? hours of practice every Monday,
Wednesday and Friday. Tuesdays and Thursdays she trains for an hour,
knocking off on the weekends to rest and spend time with friends.

She describes her grades as pretty good, especially in English and math, her
favorite classes. She teaches younger dancers and baby-sits on the side, and
looks forward to playing field hockey when she starts high school next year.

Diabetes hasn't slowed her down a bit.

''I was diagnosed with Type 1 diabetes on July 19, 2001. It was during a
dance program ensemble at Cape Cod, and I'd been drinking a lot of water and
going to the bathroom a lot. I told my mom, and we thought it might be a
bladder infection,'' Samantha recalls.

''We went to the doctor not expecting anything [unusual], and they found a
lot of sugar in my urine. They did a blood test and they told my mom, 'Your
daughter has diabetes and needs insulin right away.' ''

Samantha says she remembers ''jumping away'' from a nurse brandishing a
syringe.

The next three days were packed: each an eight-hour crash course for the
Willis family at Baystate Medical Center in Springfield on how to give
Samantha insulin shots, how to prick her fingers and use a monitor to test
the blood for excess sugar, how to care for her when she becomes sick, and
how to plan meals and snacks and analyze her diet for carbohydrates.

Samantha now administers her own fingerprick tests (five times a day) and
insulin injections - one long-acting shot of insulin to start the day, and
one quick boost every time she eats.

''My math skills are up tremendously,'' Samantha says. ''For every 15 grams
of carbohydrate I eat, I take one unit of insulin. I'm always counting
carbs. I'm a diabetes pro.''

Samantha is one of a rising number of children to develop diabetes, which
comes in two types:

Type 1 diabetes used to be known as juvenile diabetes because it most often
occurs in childhood. The disease stems from a poorly understood autoimmune
attack that causes the pancreas to produce little or no insulin.

Type 2 diabetes used to be known as adult-onset diabetes. Risk factors
include obesity and poor physical fitness - problems seen in increasing
numbers of children. Here, the pancreas continues to manufacture insulin,
but the body resists its effects.

Diabetes symptoms include increased thirst and urination, hunger,
unexplained weight loss and fatigue.

The American Diabetes Association estimates 18.2 million Americans - 6.3
percent of the population - have diabetes. While an estimated 13 million
people have been diagnosed, 5.2 million, or nearly one-third, are unaware
that they have the disease, the association says.

The ADA also estimates that 5 percent to 10 percent of Americans who are
diagnosed with diabetes have Type 1 diabetes, a figure that includes
approximately one in every 400 to 500 children and adolescents.

For diabetics, controlling blood sugar levels is essential in warding off
complications such as heart disease, kidney failure and retina damage.

Here's why doctors are alarmed: According to the federal Centers for Disease
Control and Prevention, the prevalence of diabetes rose from 4.9 percent in
1990 to 6.5 percent in 1998, an increase of 33 percent. The CDC reported
increases in both sexes, all ages, all ethnic groups, all education levels
and nearly all states, and says the increases correlate to the rise in
obesity for all Americans.

Caring for kids

According to Holley Allen, chief of pediatric endocrinology at Baystate
Medical Center, 600 kids from western Massachusetts and parts of New York
state and southern Vermont are under her department's long-term care.

Baystate specializes in pediatric diabetes. Most regional pediatricians
refer their Type 1 diabetic patients there, says Allen, adding that most of
her patients stay with Baystate ''from babies through college.''

Allen's youngest patient was 2 weeks old when diagnosed, a victim of
permanent neonatal diabetes mellitus, a rare genetic disorder that occurs in
about one in 400,000 live births.

Speaking by phone while on rounds, Allen said her staff sees 50 to 60 new
patients per year. That's double the load since she started there nine years
ago. She is quick to point out that the rise in Baystate admissions with
Type 1 diabetes doesn't necessarily mean the incidence has doubled; the
trend could reflect issues having to do with referral and early detection,
she says.

''But it does correlate to the national increase,'' Allen says.

What it's like

''At diagnosis, about a third of these kids are fairly sick, requiring
hospitalization and stabilization,'' Allen says. The rest just need insulin
and coaching.

Baystate also helps kids learn how to manage Type 1 diabetes while at school
and on vacations, and maintains a 24-hour beeper service for after-hours
concerns.

'Not couch potatoes'

''The important distinction about Type 1 diabetes is that diet and lifestyle
aren't to blame,'' Allen says.

''Kids who develop Type 1 are not overweight and are not couch potatoes,''
she says. ''Type 2 certainly is influenced dramatically by obesity and
lifestyle, and we are seeing in kids an increase in Type 2.''

Allen says approximately 10 percent to 15 percent of her 600 pediatric cases
are Type 2, and speculates she isn't seeing more of those patients because
family physicians likely aren't referring them her way.

''Type 2 is less complex to take care of,'' Allen says, because of the way
children develop. ''But it's also on the rise nationally and locally.''

Getting the word out

According to Allen, increased funding and programs that teach kids and
families about a healthy lifestyle and good nutrition would help,
particularly as budget cuts compel schools to cut back on physical education
programs.

''I think cutting physical education is giving the wrong message. Not that
you can change the lifestyles in the school, but if we start giving the
message that it's not important to move the body, we're just going to see
this epidemic worsen,'' she says.

Close to home

Allen's colleagues at Cooley Dickinson Hospital in Northampton couldn't
agree more. The hospital has pitched in with the Northampton public schools
to develop a program to bring positive messages about health, exercise and
media literacy to children at the city's four public elementary schools and
JFK Middle School, all in an effort to stanch the rise in Type 2 diabetes,
which is diet- and exercise-related.

The pilot program, a tested curriculum sponsored by the Volunteers Hospital
of America Health Foundation, was first put into practice to improve the
health of Hispanic and Native American youth nationwide, according to
Marilyn Richards, CDH external programs coordinator.

Richards says the VHA worked with 25 hospital and school partnerships around
the country to reach 5,500 students and families in 2002.

The program was shown to be effective in raising awareness and keeping kids
healthier, Richards says.

With that in mind, Richards, along with Cindy Dourmashkin, director of
health services for Northampton schools, and Ellen Hirschberg, PTO
president, met in mid-December to brainstorm ways to tailor the program to
Northampton students, their families and the community at large.

They've dubbed the project ''Type 2 - We're On To You!'' and are exploring
ways to introduce the curriculum locally in the spring of 2004.

''We want to provide students and their parents with up-to-date information
about diabetes, and to provide materials and activities to be presented in
classrooms and in larger groups such as parent groups and student
assemblies,'' Dourmashkin says.

''We hope to reinforce strong, positive messages about how important it is
to make healthy food choices, decrease the intake of high-fat and high-sugar
foods, get enough exercise, and think about fast-food advertisements
critically.''

To that end, the team is targeting students in the fifth- through
eighth-grade age range, but for logistical purposes is particularly
interested in working with the fifth grade, as these students stay with one
teacher all day.

Because the curriculum has already been developed, and Cooley Dickinson
Hospital will provide much of the materials and staff, the program would be
free to families.

''CDH has significant resources of staff, educators and dietitians they are
willing to commit. It's a very encouraging partnership,'' Dourmashkin says.

Approximately 1,000 Northampton students are in the target age group,
according to Dourmashkin.

In addition to the class activities, the program encourages a community-wide
kickoff event that celebrates healthy eating, physical activity and family
and community involvement in keeping kids healthy, Dourmashkin says.

The nature of the event - a fair has been suggested - is to be determined.

The group will meet again in mid-January to refine the plan. In the
meantime, Dourmashkin says she's letting school principals know of the
opportunity and hopes to identify a school or schools interested in pursuing
it.

''Then we'll see where it leads,'' she says.

'What we're doing isn't enough'

''We are seeing a tremendous increase in Type 2 among everybody - not just
middle-aged groups, say 40 and over. Now it's children, too, all over the
country, and that's very alarming. So whatever is going on in terms of
education and awareness isn't enough,'' Dourmashkin says.

''We're looking to expand on our toolbox to address this issue and find ways
to consistently address it, and have it resonate in health, science,
physical education and any activities that have food involved.''

Ultimately, she says, ''Type 2 - We're On To You!'' will help schools and
the hospital tackle the initial part of the problem, which she described as
the most important and most effective part: prevention.

''You really don't want to be putting most of your efforts and your dollars
into intervention,'' she says. ''By then, it's too late.''


John Snyder is a freelance writer living in Shelburne Falls. He can be
reached at jsnyder@gazettenet.com.