Diabetes, Education, Health, Parenting, T1D

4 Mothers, 4 Questions (Part 2)

4 Mothers, 4 Questions (Part 2)

Continuing this 4 part series, today we meet Jenni Cipriani, a full-time mother (a.k.a. Superhero Jack of all Trades) from Thornbury, near Bristol in the UK. She shares the story of when her son, Bradley, was diagnosed with Diabetes mellitus Type 1 at just 14 months old and what we can do to improve the current diagnosis process.

Jenni&Bradley
Jenni and Bradley

What is your child’s diagnosis story?

It was 18th September 2010, when Bradley was diagnosed with Type 1 Diabetes. He was just 14 months old. Leading up to that day, I had noticed that Bradley was losing weight, sleeping in longer in the mornings and suddenly napping during the day for hours (when he wouldn’t normally nap at all). He was raiding the cupboards for food straight after I had fed him but he wasn’t gaining any weight at all, he was also very constipated. Looking back, I know now that the most obvious sign was how much he was drinking, he would gulp down beakers and beakers of water. In the mornings he would wake up absolutely drenched in his own urine; his nappy full to the brim and his pyjamas soaking wet. At the time, it was very easy to find an explanation for everything: he’s tired because he has just learnt to walk, he’s hungry and thirsty because he is more active and that must be why he is losing weight, his nappies are wet through because of his increased thirst etc.

But on the morning of 18th September 2010, Bradley’s health deteriorated. His breathing had become very laboured, he was drifting in and out of consciousness and he had a sweet smell to his breath. My Dad and I couldn’t wait any longer for the call back from our GP so we took Bradley directly to our local A&E department at the hospital. There we explained his symptoms and sat down to wait, but within 5 minutes someone came to get us. Bradley was ushered into a room where they tested his blood glucose levels straight away. The results came back: 29 mmol/L (a non-diabetic person is between 4.0 to 6.0 mmol/L), and that was when they told us he was a Type 1 Diabetic. Subsequent testing discovered that his ketone level test was around 7 mmol/L, whereas a normal person will be under 0.6 mmol/L (above 3.0 mmol/L is ‘a dangerous level of ketones which will require immediate medical care’). At which point we were rushed to Bristol Children’s Hospital in an ambulance where we stayed for 4 nights.

Bradley_diagnosis (1) copy

How did you feel when you heard the diagnosis ‘type 1 diabetes’?

I am embarrassed to say that I was relieved upon hearing he had T1D. Not because it was a good thing, but because I had no idea what it entailed and I was just relieved I had an answer as to why he was so poorly. I remember a couple of children (back when I was in school myself) who were T1D but all I really saw was that they carried extra food like biscuits. I also knew they had injections but to what extent, I was clueless. Once we got to Bristol Children’s Hospital and the doctors and nurses started talking to me in detail about Diabetes mellitus Type 1 (T1D) it was then that it really hit home, and it hit me very hard. I could not believe that this was going to be my son’s life from now on. I struggled to accept he would need 4 or more injections a day, bi-hourly blood glucose testing or an emergency box kit in our fridge door containing glucagon just in case he fell unconscious from a hypo. All I wanted to do was wake up from this nightmare, but that couldn’t happen, this was our new reality, this was his life now. Instead, I put my fears aside and tried to take it all in; I listened in great detail to everything the doctors and the diabetes specialist nurses told me. When they asked if I wanted to try and do the first injection I said ‘yes’ and just got on with it for the sake of my son, I knew I needed to be strong for him.

In your opinion, how could improvements be made to the diagnosis process in future?

Whilst some parents end up visiting a GP before the symptoms deteriorate, many don’t. This is largely because the symptoms come and go over a fairly long period of time, and they don’t all present themselves together until right at the critical point. So, like many other parents, I did not have any contact with a GP about Bradley or my concerns until the day we ended up in A&E. That means the actual diagnosis process for us was very quick. That said, the A&E nurse knew to take a blood glucose test immediately and I do think that more routine tests in GP’s when children present with at least one of the ‘4 T Symptoms’ (tired, toilet, thirst and thinner) would be an ideal way to stop misdiagnosis and catch it earlier and thus not once the person is in Diabetic Ketoacidosis (DKA).

Bradley
Bradley (2017)

If you could share one piece of advice to other parents around the world, what would it be?

Make yourself aware of the symptoms of TD1, the 4 T’s (tired, toilet, thirst and thinner). If I had known these then I would have taken Bradley to the doctors a lot sooner. He had slowly been losing weight over a period of about 2 months and he would not have been as poorly as he was at diagnosis. It was heart breaking for me to see him so ill and if I could have prevented that by knowing the symptoms then I would have. Nowadays, it’s something that I try and make people aware of in my network.

#weneedacure

Diabetes, Education, Health, Parenting, T1D

When ‘I’ is replaced by ‘we’…

“When ‘I’ is replaced by ‘we’…

…even Illness becomes Wellness”. I came across this quote from Malcom X and find it rather fitting for this blog post. This week is Diabetes Awareness Week in the UK and today I wish to share with you a brief and personal view on the clinical team who treat our son Noah. I have discussed previously some of the challenges Kasper and I faced during our early training. I want to emphasize again that without these professionals our child’s life expectancy would be much shorter and his daily physical struggle would be so much harder. When Noah was diagnosed, we didn’t realise how privileged we were to have access to this expert team. I have since learnt that even in research-intensive countries, like the US or the UK, access to similar resources coupled with high quality care varies substantially. It is for these reasons that shining a light on the magnificent work that takes place behind the scenes is, for me, a no-brainer.

Angels in disguise
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Dr. Els van Straaten

Let me take you back to the day Noah was diagnosed in September 2015. We left the hospital carrying this new bomb shell, with the promise that someone was going to call us and tell us what to do next. Dr. Els van Straaten telephoned that evening; earlier that day Noah had received his inaugural boost of chemical insulin and she needed to advise us on getting Noah through his first night. The following day, puffy-eyed, bewildered and deeply confused, we arrived at the DiaBoss clinic located in OLVG West Hospital, Amsterdam, The Netherlands. The clinic quickly became our home from home. Over the next two weeks, Kasper and I underwent intensive training on the what, how, why etc. of treating a child with T1D. One of the first things Dr. Els van Straaten said to us that morning was ‘I may have worked with diabetic children for over 25 years but in 12 months time, YOU will be the experts in your son’s diabetes‘. That sounded totally alien to me at the time; I was struggling to understand the simple stuff like why we count carbohydrate units and not sugar units in food, or how many times a day he would need his blood tested, but I never forgot it. What she failed to mention, however, in that unforgettable moment, was how this metamorphosis from ‘ignorant to expert’ would only take place because of the incredible work, dedication, expertise and patience exhibited by herself and the team around her. We were not alone.

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Marion Tillman

Meet Marion, Noah’s diabetes nurse. Marion is really special. Our daily/weekly contact always starts with Marion; never has her patience faltered nor was she too tired or too busy to extend her unyielding care to Noah. What many of us often forget, or underestimate, is the emotional trauma that a T1D child suffers following diagnosis. For some this lasts a few months and for others it takes years to overcome. We all remark on how small children are tougher than they look, and it is very true; but still they suffer deep trauma. Noah exhibited the impact of his trauma when he became selective mute at school and shut down completely in front of everyone, except his family, over an extended period of time. The reason I am telling you this is because he didn’t shut down for Marion. She had gained his trust like a family member, he knew he was safe with her, he knew she cared for and helped him. That, together with her exceptional experience, is why she is a true angle in disguise.

Taking control back

ninjas-37770_1280Kasper and I have been working with the clinical team at ‘DiaBoss’ (based on the concept of being the ‘boss’ of your own diabetes, and not the other way round) for almost two years now. From our perspective, they operate an unequivocally effective triage of priorities. Firstly, they have built a team of highly skilled pediatricians, nurses, dietitians, child psychologists and administrators; all specialised in treating T1D in young children and juveniles. In short, they are the ninjas when it comes to fighting diabetes. Included in this, is their fight to push the boundaries and further improve health insurance coverage for T1D treatment here in The Netherlands. Secondly, these ninjas not only work with the latest treatment techniques and technology, they also actively seek input from world class experts when new questions or puzzles arise. And thirdly, they bring a superhero level of PMA (positive mental attitude) in delivering tailor-made care; not only for the patient but for the whole family. They put the ‘we’ into everything they do so families like us and kids like Noah don’t feel so alone in the struggle to learn to live with this disease.

Side by side

I am always touched by the interminable enthusiasm the DiaBoss team extend when asked for help in non-clinical matters. They understand how extremely important the parent’s coaching role is in the child’s long-term health. This understanding lays the foundation for their support also within the child’s environment. When Noah started school, Marion visited his school, spoke to his teachers, provided them with information and further support when they needed it. That level of care and attention for one child is mind-blowing when you give it some deeper thought. How many visits must they make each week or month? And yet, these resource-intensive initiatives are exactly what guarantee The Netherlands can truly acknowledge they lead the way in juvenile T1D care.

Here is my list of highlights where I believe DiaBoss prove they turn adequate care into phenomenal care:

  • They hug you when you cry; they completely understand how bewildered and terrified you feel. They are a clinical team who operate like human beings.
  • The DiaBoss helpline is open 24 hours a day, 7 days a week; we can always speak to an on-call diabetes pediatrician who knows everything about our son’s specific case.
  • A few months ago Noah got really sick: he had classic stomach bug symptoms. We had no idea he was suffering from his first diabetic ketoacidosis. His nurse, Marion, distinguished the difference over the telephone and made sure we got to the hospital on time.
  • They never run out of patience when you accidentally get a correction bolus wrong, forget to change a cannula or misunderstand anything they tell you. Since I often converse in a foreign language with them, this happens to me frequently 🙂

#weneedacure