Pediatric Endocrinologist, Katherine Vu-Boast, MD with UPMC Children’s Hospital of Pittsburgh discusses ways parents and families can help a child who’s living with type 1 or type 2 diabetes.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Both type 1 and type 2 diabetes can have a significant impact on your child’s health. So, what can you do to support them through the illness? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And, joining us right now is Dr. Katherine Vu-Boast. She’s a pediatric endocrinologist with UPMC Children’s Hospital. Thank you so much for joining us.
– Thanks for having me.
– So, if you are already dealing with a child that has this, you may know a lot of these things. But, for parents that have a child who is newly diagnosed, let’s really talk about some of the basics here. Begin with what’s the difference between type 1 and type 2 diabetes?
– That’s a very important question, and it all has to do with the way the body handles insulin, the hormone that our pancreas makes, which normally helps our body absorb the nutrients from our food and turn those sugars into energy, fuel for our daily activities. So, in type 1 diabetes, a child is genetically predisposed and gradually loses the ability of their pancreas to produce insulin at all, making them dependent afterward on insulin treatment. Whereas type 2 diabetes, the pancreas makes insulin just fine. In fact, it has to make more than the usual amount because the body has developed a resistance to the insulin.
– Let’s go into type 1 diabetes first. What are sort of the signs and symptoms, and how is this most likely diagnosed?
– Very oftentimes, a parent, or a teacher, or a friend notices that the child is more tired than usual, or losing weight, or having difficulty gaining weight, even though they’re eating a normal or even increased amounts of food. And, also, excessive urination and thirst are also warning signs.
– Do we know, you said maybe genetically predisposition. Do we have any idea what really causes type 1 diabetes?
– Well, it does seem to be an autoimmune process, meaning that our own immune system has started to see the pancreas as an unfriendly organ, and it starts to attack it the same way it would attack a germ that enters the body to make you sick. So, it’s this dysregulated immune response that causes the gradual deterioration of the pancreas cells.
– What does treatment look like?
– Well, if the body no longer has the ability to produce sufficient insulin, then the only treatment that will sustain life is to replace that insulin with insulin from outside the body. If the child’s very sick at diagnosis, this may take the form of IV insulin to begin with, but once the child is stabilized and able to transition to using insulin injections, then that’s what’s used.
– And, so, what does this mean? Obviously every child is different, but what does this mean for a child and a family in everyday life? At this point, insulin would be lifesaving. What does sort of like that dosage look like? How many times a day?
– Sure. So, in order to mimic what the body normally does, how it produces insulin, we give two types of insulin, usually: one that is longer-acting and lasts in the body for 24 hours. But, then, also, to take care of the sugar rises that happen with food and activity, we also give injections of insulin that are shorter-acting several times throughout the day. So, it is multiple injections a day of insulin that these families are taught to give their children.
– And what about food and diet? Are there foods, on type 1 diabetes, stay away from? What does that look like in the scope of a child’s life?
– Yeah, great question. A lot of families are very interested to know this when they’re diagnosed. So, overall, we suggest the same normal, healthy diet that most children should be eating anyway. You know, well-balanced proportions of carbs, fats, proteins, all the usual things. We do tell these kids not to do excessive sugar intake such as juice, soda, and candy. But, to be honest, as a pediatrician or a dentist, these are the same advice that you would give to children in any sense.
– And, so, from a parent’s standpoint, you spend so much time with parents and kids. What do you say to parents about the way to have the conversation with their child, and what sort of things should they be saying to their child who’s newly diagnosed?
– It can be a very scary and stressful time for the child and the parent. So, one of the first things I talk to the families about is the perspective to approach this. I make sure they understand it was nothing the child did or didn’t do that caused this to happen. There was nothing the family missed or did wrong that brought this upon their child. Really, we focus on how to help the kids take care of themselves and how we support them going through the years as they get older and learn to master their own diabetes, getting ready for a successful life as an adult with diabetes.
– Right. And, so, I would imagine parents say, “What does this mean long-term?” And, what can you say to them about what this means long-term?
– Sure. I kind of take a broad perspective. A hundred years ago, when insulin was discovered, you can imagine the life expectancy of affected individuals was rather limited. But, we’ve come so far since then. Better and better insulins have been developed. Newer ways to monitor sugars and deliver insulin to these children and adults once they grow up have been developed. So, our patients are living long lives, very productive lives. Oftentimes, they come back and work for us in our diabetes clinic, and it’s great to see how well they can do. And that’s what we want to support our families to help their children do.
– In general, would you say this is a condition that schools should know about, friends should know about, other parents should know about? And, why is it important that a family let people know that their child has type 1 diabetes?
– Right, well, it’s even more true in the case of diabetes, but it takes a village to raise a child. Your parents can’t always be there to look after you every moment of the day. So, it is important to recruit grandparents, extended family members, teachers and principals, your coaches to all look after you. The amount of information you give to friends and casual acquaintances, it’s completely personal, but we do work with schools. Our center works with a lot of school nurses to make sure that they have the knowledge and the comfort level to help our kids thrive.
– I would imagine, just as a little kid, no one likes to get a shot, everybody’s crying over an immunization. So, this whole idea of having to do an injection every day, can you talk a little bit about a good way for parents to make that happen at home? And, I would imagine the younger you are, probably the more difficult and strife-ridden it could be.
– Yeah, definitely. And I have to give so much credit to our endocrine nurses that work with these families for the few days that they’re diagnosed in the hospital when they’re undergoing the most intensive family education. We walk through it with the families, we train the families, we show them hands-on how to use soothing techniques to help their kids cope with this. With not just the physical injections, but the whole diagnosis as a whole. We walk the walk with them as much as we can, and we also, once they leave the hospital, we have psychology on-site to help any of our families who request that sort of support as well.
– Right. Is there one soothing method that you think is extremely valuable?
– For the younger kids, because it is age-dependent. I think for the younger ones, sometimes distraction or reward systems where you get a sticker or something like that can help many children. And, then, once they’re older, a lot of kids understand more than we think. So, reasoning with them, talking them through it, having them understand why this is happening, that goes a long way, too.
– What does the monitoring look like? And how should parents really explain to a child, if a child’s going to be off on school by themselves, what they need to look out for?
– Sure. So, picture 10 years ago, 15 years ago, a child was expected, or their parents were expected, to check their sugars using a finger poke, a lancet device, and a handheld meter six to 10 times a day, standard care. These days, we have continuous glucose monitors that the patient can wear that checks their sugar for them automatically every five minutes or so. And, these devices can even transmit the data wirelessly to the parent’s phone. So, while the parent’s at work, they can see how their child’s doing at school. And, also, you can set an alarm so that it lets you know if the sugar’s dropping too low or rising too high. This has been a game-changer for many of our families, especially the ones whose children are prone to having lows and they’ve been scared every single night since diagnosis that their child might not survive.
– And, so, moving on to type 2 diabetes: We talked about the difference in the beginning of the podcast. Remind us what type 2 diabetes is, and if we know the cause.
– Sure. So, this generally occurs a little bit later, mostly in adults, but also in adolescence. It’s where the body has developed a resistance to the effects of the hormone insulin. So, even though the body’s making insulin, it’s not working to put the sugar into the cells where it can be used for energy. The sugar just stays in the bloodstream.
– And what are some of the signs and symptoms of type 2 diabetes?
– It can look very similar to type 1 when it’s initially diagnosed, with fatigue, weight loss, and excessive thirst and urination.
– So, you said weight loss. And oftentimes people may think, oh, type 2 diabetes, there’s a conception out there that type 2 diabetes is related to weight and lifestyle. But, you said weight loss can also come along.
– Yeah, you’re not incorrect in saying that there is an association with weight gain. oftentimes. Don’t forget, also, that there are genetic factors and environmental factors that play in. So, I don’t wish to imply that overweight equals type 2 diabetes. But, in the moment when you are diagnosed, because of all the high sugar levels that are running around in your bloodstream, it can cause an acute weight loss, which can be an important clue that there’s diabetes happening.
– What does treatment for that look like?
– Depending on the severity of the diabetes at the time it’s diagnosed, it might be able to be controlled with oral medications or non-insulin medications, in addition, of course, to healthy diet and exercise. If the diabetes is more severe, we may start off with insulin injections similar to type 1 diabetes. And, then, the course of treatment afterwards will depend on how the patient is doing.
– Right. And, with that, what sort of conversation should parents be having with their children?
– It’s just as important in type 2 diabetes, I think, to make sure that the child doesn’t feel stigmatized for having diabetes. This is so common because of misconceptions out in the public about what diabetes is and where it comes from. No child chooses to have type 1 or type 2 diabetes. They would all give it up if they could. So, it’s really important to help our kids feel included, to have them not be singled out or left out. And those are some of the, I think, key factors in how well the kids do going long-term.
– Physical activity: How does that play into this? Is it restricted, made more difficult? Is it encouraged? What does that look like?
– Oh, we love it when our kids can get regular exercise. Whether type 1 or type 2, we really want them to feel included in all normal childhood activities, whether they be field trips, school events, birthday parties, sports activities. And, definitely, regular exercise helps overall health, including controlling your blood sugar levels.
– You already touched on this. Doing this as a family, do you often find that some families may try to put everyone on a healthier eating plan? What does that look like, and what sort of conversations should parents be thinking about?
– Yeah, I think it’s a great idea when they get everybody on board. It makes the child themselves so much more likely to be successful at maintaining healthy habits, as opposed to, say, watching brother eat a bag of potato chips while being told not to have any. It’s a great opportunity for everybody in the household to take a second look at the way they’re living. And we could all probably use improvements in our lifestyle, right?
– Right. Can you grow out of type 2 diabetes, or is that a myth? Or, reverse it?
– Yeah, yeah. I wouldn’t necessarily use the term “growing out of,” as if it just kind of passes over time. But, with careful care and attention to your lifestyle, and taking the medications you’ve been prescribed, you can improve your health to a point where your sugars may be under such good control, your doctor may deem it safe to wean down your medications, and, in some cases, eliminate the medications over time.
– Right. In both of these conditions, what are the risks if it’s not treated?
– If the sugar levels remain high in the long term, not only will it affect, you know, your school performance, and your abilities, your health in the moment, but also, because these are children, we’re looking years, decades down the line. We’re really interested in helping them to reduce the risk of eye, kidney, cardiovascular disease, things that oftentimes we hear about in the adult population, but we don’t think about when we look at our children. But we really want to prevent those, too.
– Right. And, you touched on this earlier. Tell me about your center. Tell me about the team that works there, and what is the official name of the center?
– We are the Pediatric Endocrinology, Diabetes, and Metabolism Division as part of the University of Pittsburgh and the Children’s Hospital of Pittsburgh. It’s a long name, but I’m very proud of the team that I work with. It’s a large team, comprising physicians, nurse practitioners, physician assistants. Those are the providers that see the patients in clinic every time. But, also, we have diabetes educators and dieticians, social workers, psychologists. We’re all trying to holistically approach every patient, helping them address integrating diabetes management into their normal lives. We serve about 2,500 families, not only in central and Western Pennsylvania, but in parts of five surrounding states. We are an ADA-certified center, meaning the American Diabetes Association certifies us. And we’re also ranked No. 6 nationally as a pediatric diabetes center. So, I’m very proud of what we try to do for our families.
– There’s also lots of research going on. And, let’s touch on that a little bit.
– Sure. Various people in our division have a longstanding interest in research in various areas of diabetes, both type 1 and type 2. For instance, TrialNet is a nationwide research program where families can elect to participate. If they have a first-degree family member who has type 1 diabetes, they may be eligible to enroll other family members to be monitored over time to identify the disease early, or to participate in research trials to understand what brings this on, how can we prevent it, what treatments can we develop that are better and better?
– There have been advances. Talk a little bit about those advances and then what you hope that means for down the road.
– It’s been so exciting, in the last couple of decades, seeing better and better insulins come out, the insulin pumps that we have for our patients to use, the continuous glucose monitors that they can choose to wear, replacing some of the older ways of monitoring and treating diabetes. I can only imagine where this is going in the next 10, 20 years.
– What would you say is the most important thing parents should keep in mind? If their child just received a diagnosis and they’re listening to this because they are Googling all the information that they can, what would you want them to keep in mind?
– I think one of the most important things is they’re not alone. There’s a whole community of us here eager to support them. They should give us a call at any time during the course of the disease. If they’re unsure, if they have questions, if they have issues, if they’re struggling, if their child is struggling, definitely speak to us, and we’re here to help.
– And how did you choose this as the area of medicine in which you wanted to practice?
– Well one of the most fun things I do is attend diabetes camp as medical staff. It’s a typical summer camp experience, but imagine everybody is checking their sugars together. Everybody is supporting each other. You know, especially the newly diagnosed patients, the older patients help them learn how to take care of themselves and feel good about it. It’s an uplifting experience for everybody. So, I’ve done that at several different camps through several different states that I’ve lived in over the years, and it’s so rewarding. It’s inspiring to see what these kids do, what their families do, and it continually renews my initial enthusiasm for helping them reach adulthood in a healthy way.
– What do you find most rewarding about your job?
– I think it’s when I see patients come back with a renewed spark or hope in their eyes that, “Oh, I can do this,” or when something I’ve said has connected with them and made them know that I care. That’s probably the best thing.
– Well, Dr. Katherine Vu-Boast, thank you so much for coming in and spending time with us today. Some really great information for families. We appreciate your time.
– Oh, thank you so much for doing this.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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