Romanne
Tan is five going on six and will be starting primary school next year. In
addition to learning to handle money and buy food, she has also started
learning how to prick her fingers to draw blood samples.
She
suffers from Type 1 diabetes, a condition where one's body is unable to produce
insulin, a hormone needed to regulate the amount of sugar in the blood. Several
times a day, she uses a pen-like device called a lancet to extract blood
samples.
Although
she does not know how to monitor her blood glucose levels using the samples or
inject herself with the correct dosage of insulin based on the glucose reading,
her mother wants her to start learning to care for herself.
Ms
Rosalind Goh, 37, worries that shy Romanne will not be able to tell her primary
school teachers when she feels hungry, a sign of low blood sugar that she
addresses by giving her daughter a glucose tablet or honey. If untreated, low
sugar levels can lead to fainting or seizures.
Romanne
also changes the disposable needles used for the injections.
Ms Goh, a
nurse, taught her daughter these two aspects of her diabetes care last month,
as a first step to preparing her for Primary 1 next year. She is hoping the
girl will be able to check her sugar levels and administer her own insulin by
the time she is 12.
For now,
either Ms Goh or the family's domestic helper uses a glucometer to monitor
Romanne's blood glucose levels. The five insulin jabs that Romanne, the younger
of two children, needs every day are mostly administered by either of the two
women. Her father, swimming coach Jimmy Tan, 37, pitches in sometimes when he
is not working.
Romanne
was diagnosed when she was three. Her mother says: "I'm now used to the
pinpricks and injections. Emotionally, I can take it. In the past, it was
heartache."
While she
still tears up when talking about Romanne's condition, she is also optimistic
about medical advancements, which have helped minimise the pain commonly linked
to jabs. Romanne has a small injection port attached to her body, which allows
her mum to inject insulin without having to puncture her skin for each shot.
The girl says the injection port is not as painful as the syringes she used.
A
demanding daily regimen such as hers is part and parcel of living with diabetes
as a child. It is a diagnosis that parents and children often struggle with.
Kids such as her face a lifetime of taking multiple daily doses of insulin.
Endocrinologist
Ben Ng, a vice- president of the Diabetic Society of Singapore, who has a
clinic at Mount Elizabeth Novena Hospital, says having a diabetic child can
cause "psychological stress and conflict" within families or between
parents.
He adds:
"It comes from love. Why is the child's sugar levels so high? Why are they
not taking the medication? The needs of other family members have to be met
too.
"In
Singapore, we're very good at the medical aspect of diabetes, less so the
social and psychological support."
Since
Health Minister Gan Kim Yong declared a "war on diabetes" last month,
the focus has largely been on Type 2 diabetes, by far the more common form of
the disease for Singapore's more than 400,000 diabetics.
Type 1
diabetes, an auto-immune condition which has no cure, is often hereditary,
whereas people who are overweight and inactive are more likely to develop Type
2 diabetes, in which the body cannot use insulin effectively.
Losing a
substantial amount of weight has been known to reverse Type 2 diabetes in some
cases.
Dr Daphne
Gardner, consultant at the Department of Endocrinology at Singapore General
Hospital, says Type 2 diabetes affects up to 90 per cent of those with
diabetes, while Type 1 diabetes is more often seen in childhood.
Although
Type 2 diabetes occurs more in older people, rising numbers of children and
teenagers are affected.
KK
Women's and Children's Hospital, for example, has seen an average of a 60 per
cent increase in paediatric patients with Type 2 diabetes in less than 20
years.
From 2000
to 2005, the hospital saw an average of 15 newly diagnosed paediatric patients
a year. Between 2011 and 2015, this yearly average was 24.
For Type
1 diabetes, the number of newly diagnosed paediatric patients remained fairly
constant at an average of 30 a year between 2000 and last year.
Two years
ago, when Romanne was drinking a lot of water, waking up at night to go to the
toilet and losing weight - all common symptoms of the illness - Ms Goh
suspected it was Type 1 diabetes because of her medical training.
Yet she
still found it hard to accept. "The first thing I thought was whether I
had been giving her too much sugary stuff," says Ms Goh, even though she
knew these were unfounded fears. There is no strong history of diabetes in her
or her husband's families.
Making
dietary adjustments was tough. She says: "It was difficult to explain to
her that because she has diabetes, if her friends give her sweets or
chocolates, she must tell them she cannot have them, she can have only
sugar-free ones. I have to keep reminding her."
The
amount of insulin measured out for each jab depends on the patient's blood
glucose levels, which can be affected by the type of food consumed and the
amount of physical activity.
Romanne
was at first upset, but now mostly accepts her dietary limitations. She eats
half a portion of cake at birthday parties and, instead of a scoop of ice
cream, she can have just five teaspoonfuls.
Dr
Gardner advises that the whole family be involved in making the lifestyle
changes necessary to controlling diabetes.
She says:
"Food choices would be better done in a family context rather than
singling out the individual for an 'exclusion diet'."
As Ms Goh
says: "I don't want Romanne to feel different from the family."
Together with Romanne, she, her husband and their son, Romulus, eight, all eat
white rice mixed with healthier oats or brown rice, and drink Coke Zero if they
want soda.
Dr Yvonne
Lim, associate consultant at National University Hospital's Division of
Paediatric Endocrinology, says: "Parents of young children with Type 1
diabetes must overcome their own fears and administer injections to their kids.
The other significant challenge is knowing when to allow the child to
self-manage his or her diabetes with confidence."
Housewife
Philomena Chew, 44, admits that her own fear of needles has influenced how she
views her son's Type 1 diabetes.
She gave
up work as an accounting executive to care for Raphael, 11, when he was
diagnosed at five. "He's growing up, putting on more weight. The hospital
staff kept telling me that he needed more jabs. I was not ready. I didn't want
him to have more pain," she says.
It was
only in November that she agreed it was time for her son to learn to inject
himself. This was because Raphael, who has a six- year-old brother, was
approaching adolescence. He is now in Primary 6. Until then, he had taken two
insulin injections a day. From late last year, he started taking three jabs,
and, last week, progressed to four.
Raphael,
who enjoys taekwondo and basketball, says his mother's concerns sometimes
"aggravate" any anxiety he might feel about needles.
However,
he has a practical approach. When he injects himself in school in the early
afternoon, he does not want people around, in case they brush against or
distract him. "The needle is very fine. I'm scared it will break," he
says. If low blood sugar levels make him hungry or uncomfortable, he addresses
it by quietly eating sweets.
Not every
young diabetic is level- headed like him. The teen years can be troubling for
diabetics who might also be grappling with adolescent self-consciousness.
For
example, convincing teens to exercise can be difficult, says Dr Ng from The
Diabetic Society of Singapore, whose services include health screenings,
diabetes management programmes and support groups.
For
adolescents, "it's the support of their peers that helps", he says.
"Those with Type 2 diabetes tend to be overweight. It's already a bit of a
stigma. It's one more problem for them to be told to lose weight."
He has
encountered girls as young as 13 who dangerously "manipulate" their
disease by withholding insulin injections to lose weight.
When Type
1 diabetics skip or reduce their insulin intake, they run the risk of coma or
even death, reports say. Blindness, amputations and kidney failure are some of
the possible long-term complications.
Dr
Gardner says parents can help their adolescents by "providing quiet and
non-overbearing support".
"If
someone would rather miss a dose of insulin to be out with friends, finding
practical ways for them to administer insulin subtly would probably be more
helpful than insisting they do it," she says.
Ms Nurul
Jannah Buang, 21, had some difficulty after being diagnosed with Type 1
diabetes as she had to cut down on chocolates and fast food, normal fare for
her teen peers then.
At 18,
while out for a pizza, she drank four bottled sugary drinks and a blended ice
drink, but these failed to quench her raging thirst, one of the symptoms that
prompted her to go to the hospital. She was found to have a potentially fatal
blood sugar reading of 40 millimoles a litre. The normal range is four to eight
millimoles a litre.
Today,
the preschool teacher has adjusted well. "I feel like I am just like other
people. I need to stay healthy and exercise. What makes us special is the daily
insulin."
Two types
of diabetes
The
symptoms of Type 1 and Type 2 diabetes are similar.
They are:
- Increased urination
- Sweet urine which attracts ants
- Blurred vision
- Fatigue or drowsiness
- Cuts or bruises which heal poorly
- Constant feeling of thirst
- Weight loss despite heavy eating (more applicable to Type 1)
- Nausea and vomiting
- Dry, itchy skin
- Loss of feeling in hands or feet
A blood
test can confirm if a person has diabetes.
Both Type
1 and 2 diabetes, or diabetes mellitus, have a hereditary and a lifestyle
component, but the contribution varies.
For Type
1 diabetes, the dominant predisposing factor is genetic. People with Type 1
diabetes need insulin injections to control their blood sugar level. It usually
occurs in young people.
For Type
2 diabetes, though there is a strong hereditary component, a sedentary
lifestyle with poor eating habits and excessive weight gain is a strong
predisposing factor.
These
diabetics can produce insulin, but their bodies do not use it effectively.
The
condition can be controlled by diet, exercise and medicine. If these fail,
insulin injections may be needed.
Sources:
The Diabetic Society of Singapore; Department of Paediatric Medicine, National
University Hospital
No comments:
Post a Comment