Diabetes: Children with Diabetes

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Guest: Dr. Deborah A. Bowlby - Pediatric Endocrinology

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Deborah Bowlby, who is a Pediatric Endocrinologist at the Medical University of South Carolina. Dr. Bowlby, any endocrinologist sees a lot of people with diabetes and certainly working with kids, you see that a lot. Is there a difference in how diabetes presents in kids versus adults?

Dr. Deborah A. Bowlby: The presentation of type 1 diabetes is much more common in children because it is an illness in children, so the things to watch for in your child would be if they start drinking more, if they have to go to the bathroom more, what you would might notice is that they wet their bed at night, and they previously had not been wetting their bed. They often get more hungry. They might also complain of some belly pain. Sometimes if it progresses enough, they even start throwing up.

Dr. Linda Austin: Now, you said they may be drinking more. All kids seem to always have a soft drink in their hand, how much is more -- too much drinking, when should you be concerned about that?

Dr. Deborah A. Bowlby: If they are drinking two to three times the amount that they normally would, but that’s also really hard to detect in the heat of Charleston in the middle of the summer, so if you really watch the amount of times they go to the washroom to pee, that will really tip you off.

Dr. Linda Austin: In an older child could you just ask the question like, do you feel like you are more thirsty than used to be and the child would be able to tell you that they are feeling kind of funny?

Dr. Deborah A. Bowlby: Definitely. So, if you notice that your child is drinking more, just ask them that simple question, are you thirsty and you might be able to get some of the answers is to what is going on with them.

Dr. Linda Austin: And likewise you can ask that they are feeling more hungry than usual?

Dr. Deborah A. Bowlby: Correct and you can even ask to your own child, are you getting up in the middle of the night to go to the bathroom because most parents are sleeping and they wouldn’t even may be realize that their child is getting up in the middle of the night.

Dr. Linda Austin: Are there any risk factors that might make a particular set of parents be extra concerned about their child or really on the lookout overtime for signs of diabetes?

Dr. Deborah A. Bowlby: Well, type 1 diabetes can run in families, so certainly if you already have a family member, who has type 1 diabetes, you would certainly want to watch out for the signs in your own children. There also could be other autoimmune conditions, specifically lupus or rheumatoid arthritis, Crohn disease, ulcerative colitis, certain autoimmune conditions that would also tip you off that your child might develop type 1 diabetes, which is an autoimmune condition.

Dr. Linda Austin: Autoimmune means what?

Dr. Deborah A. Bowlby: Autoimmune processes are where your own body produces substances that destroy a certain function in your body.

Dr. Linda Austin: For example, antibodies that normally you think of are being produced to attack germs or viruses or bacteria instead are now attacking the body itself.

Dr. Deborah A. Bowlby: Correct. So, that would be that the antibodies for diabetes attack, the islet cells, which are in the pancreas, which produce insulin.

Dr. Linda Austin: Let’s talk a little bit about the pancreas, what is the pancreas?

Dr. Deborah A. Bowlby: The pancreas is an organ in the body that has many functions. With regards to diabetes, it produces insulin. When you have diabetes, the pancreas shuts down and stops producing insulin.

Dr. Linda Austin: Now, that’s type 1 diabetes.

Dr. Deborah A. Bowlby: Correct.

Dr. Linda Austin: In particular, type 2 is a little bit different function, correct?

Dr. Deborah A. Bowlby: Correct. With type 2 diabetes, at the start of the disease process, your body still produces insulin and your body just can’t respond to it.

Dr. Linda Austin: So, to just walk this through then with type 1 is what’s going on that for whatever reason, may be a genetic reason, your body starts making antibodies as if they were for an agent and these antibodies attack the cells of pancreas and then those cells, the islet cells stop putting out insulin and what happens then if you don’t have insulin, what happens to your body?

Dr. Deborah A. Bowlby: So when your body doesn’t produce insulin, you are unable to use your body’s fuel sources, specifically sugar and your body’s amount of sugar builds up and gets too high.Dr. Linda Austin:In the blood.

Dr. Deborah A. Bowlby: Yes.

Dr. Linda Austin: Is that right?

Dr. Deborah A. Bowlby: Yes.

Dr. Linda Austin: So, then why do these kids get hungry, I mean if their blood sugar levels are high, why do they seem to stay so hungry?

Dr. Deborah A. Bowlby: Well, that’s what is the unique aspect of diabetes is that your blood sugar is really high, you have a lot of fuel, but you can’t use it, so your body is actually starving for fuel and that’s why the children feel that as hunger.

Dr. Linda Austin: I see almost like there is gas in the gas tank, but it can’t get to the engine.

Dr. Deborah A. Bowlby: Correct.

Dr. Linda Austin: And so the engine keeps crying out for more and more. So, what happens to the weight of these kids then in their early stages if before they have gotten diagnosed and treated?

Dr. Deborah A. Bowlby: What happens is because they have excess sugar in their blood, your body tries to be pretty smart and eliminate the excess sugar, so that comes out in the body in the child’s urine. What also then happens with that is you lose all these fuels and you lose weight.

Dr. Linda Austin: How dramatically might one lose weight?

Dr. Deborah A. Bowlby: You can lose up to 10% of your body mass at diagnosis.

Dr. Linda Austin: Over what period of time, Dr. Bowlby, do these symptoms emerge in a child?

Dr. Deborah A. Bowlby: In general, the development of symptoms occurs over two to four weeks.

Dr. Linda Austin: Really, pretty rapidly.

Dr. Deborah A. Bowlby: Yes.

Dr. Linda Austin: And when it reaches a crisis, what might a crisis look like?

Dr. Deborah A. Bowlby: A child who is initially being diagnosed with diabetes will complain of thirst and excess urination, but will also develop vomiting, could be very tired, and then might even go into a coma.

Dr. Linda Austin: So, it could be extremely dramatic.

Dr. Deborah A. Bowlby: Yes.

Dr. Linda Austin: Could it be fatal at first presentation, does that ever happen?

Dr. Deborah A. Bowlby: It can be; however, if you seek immediate medical care, your child can receive treatment and that can be prevented.

Dr. Linda Austin: So, that’s pretty unusual then is that right that first episode could be fatal?

Dr. Deborah A. Bowlby: It is unusual, but is certainly a risk.

Dr. Linda Austin: What a child then, let’s say, goes to a pediatrician outpatient with those symptoms, what would the doctor do to make the diagnosis?

Dr. Deborah A. Bowlby: It’s actually very simple for the regular pediatrician to simply check the urine of the child in the office and they can check for sugar being present. Other physicians can also check the blood sugar of the child in the office.

Dr. Linda Austin: So, you can make a diagnosis pretty quickly then.

Dr. Deborah A. Bowlby: Correct and that is often what happens here in Charleston that a child will go to the regular pediatrician’s office with the symptoms may be weight loss, drinking a lot, peeing a lot, and that primary care provider makes the diagnosis and then calls our office.

Dr. Linda Austin: And what happens then or let’s imagine that these folks are living in Charleston and your office isn’t there, does a child necessarily need to go in the hospital for that first episode?

Dr. Deborah A. Bowlby: Yes. When we get a phone call, most of the children are sent to their nearest emergency room and then are transferred to MUSC to receive the initial diabetes management and also to receive the diabetes education.

Dr. Linda Austin: Dr. Bowlby, in another Podcast, we will talk about that management and education, thanks so much.

Dr. Deborah A. Bowlby: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.

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