Adeline Dreher was 6 months overdue for a wellness visit. She wasn’t sick or in pain. She was up to date on all her immunizations and she didn’t have any concerns to discuss with her pediatrician.
Because Adeline was a typical, healthy and active 8-year-old girl looking forward to the start of many summer adventures, a wellness visit wasn’t even on her mom’s radar.
“I didn’t realize we had missed her well visit this year until I had called the office this past June to refill Adeline’s asthma medication,” said Amanda Dreher, Adeline’s mom. “I’m so thankful it was brought to my attention. Adeline was on her way to ketoacidosis. I don’t even want to think what could have happened had we waited another 6 months. It saved her life.”
During a routine wellness visit, certified nurse practitioner Joyce McArdle of Akron Children’s Hospital Pediatrics, Ashland, discovered that Adeline had lost 3 pounds since her last appointment 6 months prior. Because it’s atypical for a growing young girl, Joyce dug a little deeper and discovered Adeline had in fact lost 6 pounds over the course of a year.
“I just passed it off because she’s a very picky eater, not to mention it was summertime,” said Amanda. “She’s very active and wasn’t showing any signs that something was wrong.”
Since Adeline was in the office, Joyce wanted to run a few quick tests on Adeline’s thyroid and glucose levels just to make sure nothing else was going on.
“It is unusual for a child to lose weight unless she has been ill,” said Joyce. “Anytime I see weight loss and the patient has not been ill recently, it warrants further evaluation.”
While waiting for the results, Amanda began searching her mind for answers. She recalled Adeline complaining of stomachaches and had been thirsty more often. She only recalled one time when Adeline got up in the middle of the night to use the restroom, but as they’re sitting there, Adeline admitted to her mom it was happening quite often.
Soon test results came back that Adeline’s blood sugar level was 452 mg/dL (milligrams per deciliter). A normal blood sugar level registers around 140 mg/dL.
In addition, ketones were found in Adeline’s urine. Ketones are a byproduct produced when muscle and fat tissue are used for energy because the body doesn’t have enough insulin to use the available glucose.
Lastly, Joyce found Adeline’s A1C was 10.6%. An A1C, which indicates a person’s average blood sugar level over the past few months, of 6.5% or higher indicates diabetes and below 5.7% is considered normal.
There was no doubt Adeline had Type 1 diabetes.
“Adeline could have been in danger if her diabetes had not been recognized,” said Joyce. “She could have developed diabetic ketoacidosis (DKA). It is a serious complication of diabetes when blood sugars are high and the body does not make enough insulin to move the sugar into the cells, where it is used for energy. If left untreated, DKA can cause a diabetic coma.”
Amanda was flabbergasted. Tears immediately came as she tried to think of every possible reason as to why it couldn’t be true.
“Adeline didn’t understand it at first,” said Amanda, who later discovered a family history of Type 1 diabetes on Adeline’s father’s side. “She cried and asked, ‘How did I get diabetes? How did this happen to me?’ She was scared and nervous.”
Because Adeline’s test results came back at dangerous levels, Joyce immediately jumped into action and instructed Amanda to take Adeline to Akron Children’s Emergency Room to get her blood sugar under control.
Once in the ER, all Amanda could think about was how can Adeline get poked with needles the rest of her life when she had to be pinned down to get a throat swab? Luckily, the doctors were “absolutely wonderful with her,” Amanda said.
“They used Disney ‘Frozen spray’ to numb her arm and a ‘buzzy bee’ strap that vibrated to distract her,” she explained. “They made her feel so comfortable while drawing her blood that she never even cried or flinched.
“When Type 1 diabetes was confirmed and they were walking us up to the [Endocrinology] floor to be admitted, I had a hard time holding it together,” she continued. “Everyone was just very compassionate, not only to her but myself, as well.”
Life now with Type 1 diabetes
Amanda and her 17-year-old daughter, Sydney, took diabetic training at Akron Children’s Center for Diabetes and Endocrinology to learn how to meet Adeline’s needs.
“At first, Adeline’s sugars were all over the place and she couldn’t tell a high from a low,” said Amanda. “She could be almost 500 and walking around like she’s fine, or 63 and I wouldn’t know it. That’s super scary. Luckily, Akron Children’s was by our side to help us make adjustments as needed to Adeline’s insulin.”
Adeline now has to take into account anything that goes into her mouth. She counts her carbohydrates and, with her care team, figures out how much insulin she needs to cover it. She is not on a specific diet plan, but she tries to keep carbs at a minimum.
Her blood sugar is checked in the morning, before lunch and dinnertime, and before and after activities. She takes a junior insulin pen at mealtimes and bedtime, depending on her blood sugar levels. She also takes a long-acting insulin medication at bedtime.
“It can be a pain and it’s not something you can ever forget,” said Amanda. “Our lives have changed drastically because there’s so much preparation. We’re just so thankful her diabetes was caught early and that Adeline has an amazing support system. We couldn’t do it without them.”
At Adeline’s recent 3-month checkup, her A1C had dropped to 8.5%. Adeline and her family are adjusting well, and she is comfortable now to check her own blood sugar.
Adeline started cheerleading this summer and remains active, riding her bike and jumping on the family’s trampoline. She started 3rd grade earlier this fall and is doing well managing her diabetes away from home.
“She’s living her best life; she doesn’t let anything hold her back,” said Amanda. “She gets out there and does it. Diabetes has made her stronger, and she now can find humor in it. She tells people (from the infamous Wilford Brimley commercials), ‘Yep. I’ve got the diabeetus. I’ve got the suga.’”