Restless from math calculations using play money, the second-graders look relieved when their teacher instructs them to gather their lunches and line up. They're heading down a stairwell to the schoolyard when Reilly Reynolds, a sturdy 8-year-old with blond hair and a cherubic face, remembers a pre-lunch appointment. She turns around and bounds back upstairs to the nurse's office.
FOR THE RECORD:
Young diabetic: An article in the Oct. 26 Health section, about a young girl with diabetes, recounted an experience in which she felt shaky, tested her blood glucose, found it to be higher than normal and then took a glucose tablet. In fact, her blood glucose was lower than normal, not higher, resulting in the shaky feeling and the need for a glucose tablet. Such a tablet wouldn't be given for high blood glucose. —
This daily visit has been part of Reilly's school day at Mark Kepple Elementary School in Glendale since she was diagnosed with Type 1 diabetes a little over a year ago. Like the 15,000 children and adolescents in the U.S. diagnosed with the disease each year, she must check her blood sugar several times a day, getting insulin injections when it's too high or to cover the carbohydrates she eats. Some children with Type 2 diabetes -- about 3,700 are diagnosed each year -- will need insulin injections as well, though many are treated with diet, exercise and oral medications. For most kids, the diagnosis is strange and a little frightening, but the younger they are, the more resilient they seem to be, experts say, quickly adapting to a life of daily testing, insulin injections, rigid diets -- and compensatory actions if they've miscalculated food or activity levels. "Initially the kids are a lot better than their parents," said Mary McCarthy, a nurse and diabetes educator at Childrens Hospital Los Angeles. "The younger they are, the more it just becomes a part of their life." The care that such children get at school is crucial. Reilly, for instance, is monitored carefully (and will be until she can handle the task on her own, probably in middle or high school). With a chronic dearth of school funding, many California schools don't have full-time nurses, so they share a nurse, staggering the times diabetic students are seen. In schools where there is no nurse, parents must manage on their own; nonmedical personnel can't administer insulin. They can, however, give a glucagon shot in an emergency; this happens when blood sugar dips so low the child can't drink or eat.
A normal life
Despite the constant managing, calculating, testing and planning, most diabetic kids have normal lives. "It's a chronic illness, but these are robust, healthy, normal kids who can go about their lives and do everything they hope and dream," says Dr. Jamie Wood, staff physician for endocrinology, diabetes and metabolism at Childrens Hospital Los Angeles, and Reilly's doctor. "We try to have the parents, nurses and teachers do as much as they can so these kids can be kids. It really does take a village to care for a kid with diabetes." For Reilly, part of that village is school nurse Toni Triling. Triling must calculate the amount of insulin she gives Reilly based on the grams of carbohydrates in her lunch (the higher the carbohydrate count, the more insulin) and on her glucose reading before lunch. She also takes into consideration Reilly's level of activity. Reilly studies her hands, washes them at the sink, then casually picks up a lancet and pushes it into her finger, squeezing the tip until blood beads. Next, she takes a blood glucose meter, or glucometer, and places the blood on a test strip. She tests herself about eight to 10 times a day, the first time upon waking. She hands the glucometer to Triling, who reads it aloud. "156." Though that's a bit high for Reilly, whose normal range is 70 to 150 (established by Reilly's doctors at diagnosis), it's not alarming. Colleen Reynolds waits for the nurse's call at her office in downtown L.A., where she manages a pearl import and jewelry business. The two adults discuss Reilly's pre-lunch glucose level, the carbohydrates in her food and how much insulin she'll need to bring her blood glucose level down to the normal range after lunch. The insulin enables the body to convert the carbohydrates into fuel. Too much and her glucose level drops. Too little and her glucose level spikes. "Reilly knows that she has to eat her whole lunch whether she likes it or not because she has been given insulin," Reynolds says. Reilly checks in with her mom over the phone while Triling prepares a shot of insulin. She is worried about her little brother Griffin, 6, a first-grader, who protested wildly that morning about having to go to school. She hangs up the phone and pulls up her sleeve. Triling gives the shot with lightening speed. The shots, given with a small needle, never bothered Reilly, her mother says, but the glucose testing did. Now she takes that in stride too. Today, the girl is quickly out the door and bounding down the stairs. When asked what is most difficult about having Type 1 diabetes, she replies: "Well, you can't really sneak a lot of treats. My mom says only one at a time. Only one," she reiterates. "We listen to the rules. After finding out [I had Type 1 diabetes], I felt nervous because I thought I would be in pain all the time. But then I got used to it." At lunch, Reilly sits across the table from two classmates, chatting amiably. Lunch is a wheat roll with cottage cheese, green grapes, a granola bar and water. She eats everything.
When the bell rings, Reilly and her classmates go back to class. But soon, Reilly starts to feel shaky. She's sent to the office, where a medical clerk (the nurse has left to work at another school) tests her glucose. Reilly feels too shaky to do it. Her blood glucose is a bit higher than normal. The clerk calls Colleen Reynolds, who recommends a glucose tablet. Maintaining Reilly's glucose level is based on fairly precise calculation, but there are still unpredictable highs and lows due to variables like how active the girl is, something that can be hard to measure, or a brewing cold. Reilly's father, John, a musician and painter, picks up Reilly and her brother from school. He tests her immediately at home. (Her blood glucose is 300; the Reynoldses try to keep her as close to 100 as possible.) John Reynolds gives her an insulin shot. Reilly settles in for the afternoon with a couple of family cats and tackles some homework. As it turns out, her little brother Griffin was coming down with bronchitis. Such exposure could have meant a brewing infection for Reilly, so her parents decided to keep her at home for a while to watch her glucose levels more closely than would be possible at school. In a few days, Reilly has an appointment with her endocrinologist at Childrens Hospital Los Angeles. The Reynoldses and Reilly get good news at the appointment. They have successfully controlled her blood glucose level at the numbers the doctors consider ideal for Reilly's optimum health over a three-month period. This is no easy feat. "That is very good," said Colleen Reynolds, "and it means we are controlling her blood sugar really well." For the parents of a diabetic child, nothing could be better.