Diabetes Program
I watched my daughter, three-year-old Miranda Speirs, play with the toys in the pediatrician's waiting room...both of us oblivious to the news we were about to receive and how our family's life was about to drastically change. The doctor came back into the room with a look I had never seen before. This was Dr. Widelitz, a jovial, warm and very funny man usually, but that afternoon in March 2009 he knew the extent of the news he was about to divulge. He simply said that Miranda had ketones in her urine and that usually meant a diagnosis of diabetes. He was going to make the necessary call to have a bed ready for her at Miller Children’s Hospital Long Beach and we had to go home and pack. I really didn’t know what to think - I was all ready to leave with a prescription for a urine infection. But looking at his face brought me back to earth. Diabetes, I rationalized – OK, we can do this. After we get out of the hospital we can just give Miranda her medication and all will be okay…simple, right? Oh how wrong I was.
We drove to the hospital about an hour later, trying to explain something to Miranda to which my wife and I had no clue about either. After five days of round-the-clock blood work, glucose testing, insulin injections and other activities - all of which Miranda was absolutely terrified of and had to be held down half the time for - we finally said our goodbyes to our team of excellent nurses, dieticians, counselors, doctors and friends.
That’s right - in five days some of her care team made such an impact on us that Miranda still asks about them. It was unnerving to leave the security of the hospital but we had to try to get back to our normal routine. It took many months and lots of tears for us to gain Miranda’s trust about the strict regime of finger pricking and injections, never mind the fact that her diet changed drastically and was continually monitored. She could no longer just eat what she wanted to, whenever it suited her. She has to continually interrupt her play, her schooling, her just being, to make sure her blood sugar is in check.
Looking back now I knew absolutely nothing about diabetes. Still to this day it’s very hard to make another person who is not part of the world of diabetes, understand how much work is involved with this particular condition. (I prefer to call it a condition and not a disease). Miranda has recently progressed to an insulin pump and this has made life a little easier, but diabetes is still there, every day and every night requiring continual testing and strict diet control.
If you met Miranda, now 5 years old, you would never know she had diabetes unless she told you herself. She often lets other people know and doesn’t seem to be embarrassed or shy about it. That may change as she becomes older and more self conscious, but with the correct education and support I think she will be a far stronger teenager than she would have been diagnosis free. I look forward to a time where technology and human ingenuity may give Miranda her true freedom back.
Gerry Speirs is a pastry chef and stay-at-home dad to 5-year-old Miranda and 8-month-old Quinn. Follow his family’s journey of food and life at onedadandhisblog.blogspot.com
 The diabetes program at Miller Children’s Endocrine, Diabetes and Metabolic Center provides diagnostic evaluation, acute treatment, long-term management and follow-up care for children with diabetes. The diabetes program helps children, adolescents and their parents learn how to manage type 1 or type 2 diabetes, to reduce the risk of associated complications. The key to a successful life with diabetes, is to balance diabetes management with a healthy lifestyle.
Diabetes Diagnosis
A child may be referred to the Endocrine & Diabetes Center because their primary care physician is concerned about signs or symptoms of diabetes or have an acute illness associated with diabetes. Diabetes occurs when the body is no longer able to produce insulin (type 1 diabetes) or the patient’s body is resistant to the insulin that it is producing (type 2 diabetes). This leads to an increase in the amount of glucose or sugar in the bloodstream, which leads to an increase in urination and fluid intake. This may also lead to weight loss. Laboratory evaluation is necessary to make the diagnosis.
Diabetes Management
In most cases, once a child is diagnosed with diabetes, he/she is admitted to the hospital for the initiation of insulin and/or other medication(s) and for family education on diabetic care and management. This includes consultation with physicians as well as nurses, dietitians, physical therapists and social workers.
Diabetes Treatment
There is is currently no cure for type 1 diabetes. However, with proper management, children can lead very long, happy, and healthy lives. Primary treatment for type 1 diabetes includes monitoring the blood sugar, meal planning, insulin dosing, regular physical activity, and routine healthcare. Treatment of diabetes is an ongoing process of education and management that includes not only the child with diabetes, but also the family, caregivers, and school personnel.
Often, type 2 diabetes can be controlled through weight loss, an appropriate exercise program, and improved nutrition. However, sometimes these are not enough and either medications by mouth and/or insulin must be used with blood sugar monitoring to obtain optimal blood sugar control.
Diabetes Testing
Routine blood sugar checks are fundamental to good diabetes control. The blood sugar checks provide the necessary information about how well the insulin, medication, or other therapies are working. The goal of treatment is to maintain the blood sugar within an optimal range. A laboratory blood test called Hemoglobin A1c (HbA1c or A1c) obtained every three months provides an average of the blood sugar level for the previous three months. This result gives a measure of how well the blood sugar is controlled. The A1c may also show how well the diabetes treatment plan has been working.
Insulin Pen
An insulin pen is a device for administering insulin. The insulin pen provides portability and is easy to use compared with the insulin vial and syringe. The pen has an insulin cartridge, along with a dial to measure the dosage of insulin needed. Disposable pen needles are used to inject the insulin under the skin.
Insulin Pump
An insulin pump is a delivery device that provides flexibility in dosing insulin. The pump allows for different amounts of insulin to be administered at different times of the day or night depending on the patient’s lifestyle needs.
Insulin pumps deliver rapid- or short-acting insulin 24-hours a day through a small plastic placed under the skin. Insulin doses are separated into:
- Basal rates as a 24 hour continuous unfusion
- Bolus doses to cover carbohydrates in meals or snacks
- Correction or supplemental doses for high blood sugar
Continuous Glucose Monitoring System
The continuous glucose monitoring system is a sensor that detects the level of sugar at very close time intervals, even up to minute to minute intervals. A small plastic tube is placed under the skin and is attached to a sensor that detects the sugar in the tissue. This allows for the patient, family and care team to monitor the trend in sugar. This may help to provide tighter blood sugar control.
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