Hospitalization &T1DM diagnosis

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Someone who unknowingly has T1BM can be ill for a long term before she seeks help and is diagnosed. As blood sugar rises, the person becomes more and more thirsty and urinates frequently. She loses weight, feels very tired, and can have impaired vision.

This happened to Maja, aged 11. She explains: I was ill for about a month before I told anyone. I had blurred vision. I lost so much weight, I was very tired. I was anxious but I didn't tell anyone. I didn't want to believe that anything was wrong with me. I thought it would pass.

Blood sugar level

She became so worried she told her mother, who's a nurse. Maja says, My mom tested my blood sugar level in the morning before I had eaten anything. The level was very high so she took me to hospital.

Blood sugar measurement

Blood sugar testing

Mom helps her son inject insulin

Diabetes can cause eye damage

The last few days before she went into hospital were very difficult, Maja explains. I felt terrible. I kept drinking water but couldn't quench my thirst. At night I'd pee at least three times. I had no saliva in my mouth at all.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA), a severe case of high blood glucose and ketones in the blood, is present in 15 to 67 percent of cases of type 1 diabetes diagnosedin children in Europe and North America.

In the United States, about 20 percent of children with T1DM receive their diagnosis as a result of treatment for DKA.

Hospital treatment

Once in hospital, Maja stopped worrying: I wasn't worried at all because I didn't know what it was until they told me. Everyone else was worried so I figured I didn't need to worry; they were doing it for me.

She was given fluids intravenously. Maja says, They gave me an insulin drip. They tested my blood sugar level every hour. They also took blood tests to send to research institutes that are studying why children get diabetes. The nurses seemed to be taking tests all the time: blood, urine, blood pressure. They weighed me everyday too.

During a patient's hospital stay, the staff aim to:

• Replace lost fluids and restore them to a normal level
• Reduce the acid condition of the blood by eliminating ketones
• Restore substances such as potassium
• Return blood glucose to its normal range of 80 to 120mg/dl

Lab tests

The numerous tests that are taken serve a number of purposes. Scientifically speaking, tests are run to measure blood glucose, blood gases, serum electrolyte and creatinine concentrations, and serum osmolality, i.e. the concentration of substances such as sodium, chloride, potassium, urea, glucose, and other ions in blood.(Thanks to Anne Hekkala, Mikael Knip, and Riitta Veijola at Oulu University Hospital, Finland for this information.)

Also, at diagnosis, height and weight are measured, and relative weight for the child's height (in percent). Using this information, Oulu University Hospital found that at time of diagnosis, the mean estimated decrease in relative weight for height was 6.9 percent. The mean duration of T1DM symptoms before diagnosis was 20 days, (ranging up to 168 days at the extreme end.)

In the Oulu University Hospital Study, about one-third of the children were treated with intravenous insulin, while the others received insulin subcutaneously.

Some patients with mild DKA recieved insulin treatment after an initial observation period of one to two days.

The length of hospitalization varied from zero to 43 days

Two weeks in hospital

Maja stayed in hospital for two weeks. She even did her schoolwork there. After the nurses had taken a lot of tests, a doctor told me, 'It can't be anything other than diabetes but don't worry, you are going to be fine.' Actually, he had a good idea it was diabetes before all the tests results came out it, but he wanted to be absolutely sure before he told me.

After a while, she given glucose in the intravenous fluids. It can happen after the initial treatment with IV insulin that blood glucose may drop toward hypoglycemia, in which case glucose is given. Potassium can also be added to the IV if blood tests show its level has fallen too low.

Insulin treatment

Nurses and doctors explained to Maja that she would have to take insulin for the rest of her life. A nurse showed me how to self-inject by doing it on herself. She used saline solution, not insulin.

Maja did not mind injecting herself. It's quite simple and not painful. I was told I'd have to inject myself in the abdomen, in the belly, with fast-acting insulin before every meal. And I'd have to inject in my leg once a day with a long-acting insulin called Lantus.

During her hospital visit, she met with nurses, doctors, and a dietician, who explained type one diabetes to her, including what she and her family needed to do to make life as normal as possible.

Maja says, In the beginning it wasn't difficult or bothersome at all. My body was still producing insulin. Once in a while I could eat things without taking insulin. In the beginning, I felt special but it got more difficult after about a year. Then I became fed up with the injections and blood tests. I wished I could do something to get rid of the diabetes.

Honeymoon period

The honeymoon period, as they called it, when it was interesting and almost fun to have diabetes, lasted about six months. During that time, not all insulin-producing beta cells have been destroyed. In many cases, but not all, insulin treatment allows the beta cells to recover and produce some amount of insulin.

When the honeymoon period was over, explains Maja, I had to take more insulin and take more responsibility for myself because my body was not producing insulin anymore. I knew I needed to be as good as possible at looking after myself. I was the only one who would suffer if I didn't take my diabetes seriously.

By David Hay Jones, who interviewed his daughter Maja

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