During the summer of 2017, 16-year-old Montgomery resident Jakob Iser felt like he couldn’t get enough to drink. On a weekend camping trip he’d gone through five bottles of water in about three hours.
He says, "It was summer, so I didn’t think too much of it." But in the days following that trip he became much drowsier than usual.
"He would nap for hours," says his mom, Lisa Giese, a certified medical assistant instructor and mother of three. She was concerned that diabetes or a kidney issue might be the problem.
The doctor who performed Iser’s sports physical ordered a urinalysis. The ketones and glucose in the urine did flag diabetes as the culprit. The doctor explained type 1 diabetes to Iser and told him and his mother that they needed to go to Edward Hospital’s ER.
Iser describes his reaction: "I was very emotional on the way to the hospital. It was rough and very surreal."
Type 1 diabetes (T1D) can occur in people of any age, but it’s much more common in children and teens. With T1D, the pancreas no longer produces insulin, the hormone that controls blood sugar levels. The condition can lead to serious complications and is potentially life-threatening. But with treatment, most people can lead full and active lives.
Besides excessive thirst and drowsiness, warning signs of T1D might include:
Type 2 diabetes can sometimes be controlled with diet, exercise and, in some cases, oral medication. But T1D is not lifestyle-related. People with this diagnosis need to take insulin via injection or insulin pump for the rest of their lives to minimize the chance of dangerously low or high blood glucose levels. They also need to be mindful of what they eat — including carbohydrate and protein counts — and frequently monitor their blood sugar levels.
It’s a lot to absorb, so it’s not surprising that education is a major part of the diabetic’s treatment plan. Iser is not alone in feeling overwhelmed.
"A new diabetes diagnosis is exhausting for the patient and their family — emotionally, physically and mentally," says Christine Yaeger, clinical nurse educator in Edward’s Pediatric Intensive Care Unit
(ICU). "We have a team of physicians, nurses, dietitians, a social worker and case manager available to newly diagnosed diabetics and their families, as needed."
After Iser arrived at the Edward ER with a blood sugar of 590 (normal for a 16-year-old is 90-150), he was admitted as an inpatient and spent three days in the Pediatric ICU. His day nurse, Claudine Yagoda, spent many hours educating Iser and Giese about diabetes management. She also gave them written materials and videos for reference.
Says Yaeger, "In the hospital we focus on basic education for surviving the first week at home. We show the parents and the older pediatric patients how to test for blood sugar, give an injection and deal with an emergency."
"The nurse was so good and so knowledgeable that I felt confident by the time I left the hospital," says Iser. "I said to myself, 'I can do this.'"
Iser, 17 and a junior at Oswego High School (during the 2017-18 school year), gives himself a long-term insulin injection called Lantus every night. At every meal time he injects Novolog, a short-term insulin. He can take additional Novolog if his blood sugar becomes elevated.
He tests himself every four hours for a blood sugar reading in order to corroborate the readings he’s getting every five minutes on his Dexcom continuous glucose monitor (CGM). This device includes a small sensor placed under the skin on Iser’s arm and a transmitter on his arm.
An app allows Iser, his mother and his pediatric endocrinologist, William Zeller, M.D., to access the glucose information from the CGM. Iser can access the information on his smart phone and smart watch.
He says the most challenging part of his "new normal" is eating.
"Before, if I felt like eating something at midnight, I just had to go get what I wanted," he says. "Now it’s more complicated. I have to do a count and take an injection (and know what’s in the food I’m looking at). But I feel good and I’m sleeping regularly, about eight hours [a night].
"I’d tell others who get this diagnosis to take things one step at a time. Otherwise, you’ll be overwhelmed. You will learn what you need to know and you can practice doing what you have to do. You’ll be fine."
Learn more about diabetes care at Edward-Elmhurst Health.
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