You Must Become Your Own Pancreas

Excerpt from Diabesity, by Dr. Francine Kaufman

Dr. Francine Kaufman's book, Diabesity, shows the growing link between diabetes and obesity. The book includes stories from her practice at Children's Hospital, Los Angeles. Dr. Kaufman meets Jaime, a twelve-year-old boy, when he's referred by his school nurse to her clinic for a possible hormone problem. The nurse describes him as "filthy" and "obese." Dr. Kaufman discovers that he has diabetes, and his skin looks discolored because his body's cells are not responding properly to insulin-a condition called acanthosis nigricans.

Jaime—the twelve-year-old patient I described earlier, who was referred by a school nurse who thought he was filthy—was diagnosed with diabetes in late December, during school vacation. Over the next week, the clinic nurses and nutritionists worked with him and his parents to establish new routines and new habits.

Since blood tests would tell us if he could control his diabetes adequately without medication, we told Jaime that he had to check his blood sugar four times a day for at least the next three month. At first he was reluctant to stick his finger, fearing that it would hurt. His mother offered to do it for him, but we pointed out that she couldn't be with Jaime during school and at all the other times when he needed to test his blood. We gave him a pen-like lancet device that performs the finger stick quickly and relatively painlessly. Jaime tried it, and—greatly relieved at how easy the procedure was—pronounced it "cool!"

Some diseases are worse than diabetes. But none requires such a complex balancing act, where patients must do so much themselves.

A social worker arranged for Jaime to join the local YMCA, and he went to basketball clinic every afternoon. As I had promised, we helped him develop a routine to tame his body odor. He showered before exercising, using a strong antiseptic wash. The he applied an antiperspirant combined with a deodorant. During the halftime break, he went to the locker room and refreshed his deodorant. After exercise he showered again if necessary.

When school resumed in January, Jaime brought his diabetes healthcare plan to the same school nurse who had referred him to me. The plan I'd written stated that Jaime needed to check his blood sugar before lunch, right after his math class. He'd keep an extra glucose meter and lancer pen in his math teacher's desk, along with a special container for used lancets and glucose strips. He would stick his finger, put the blood on a glucose strip, and wait for the glucose meter to tell him the results. Then he'd record the number in his glucose diary. All this would only take a minute or two, then he could go off to lunch.

Jaime's math teacher agreed to the plan. Since the testing equipment and container of used supplies would be locked in her desk, out of reach of the other children, there was no risk that anyone could get stuck or exposed to Jaime's blood. But the school nurse insisted that Jaime needed to test his blood in the health aide's office, on the other side of the school. Jaime either would have to leave math class fifteen minutes early to get there or else miss fifteen minutes of his lunch period, which was only twenty-two minutes long.

His father called me for advice. "Which would be better?" he asked. "This is his advanced math class, so it's important for him to be there. But I'm afraid that if he's so late for lunch, he won't time for a healthy meal and he might just grab a candy bar."

I had fought this issue many times in the past. Each time, I was amazed and frustrated that a school would place insurmountable barriers before a child who was trying to maintain both health and academic success. "He shouldn't miss either!" I said to Jaime's father. "Your son has the right under the Americans with Disabilities Act to take care of his diabetes in the least restrictive environment and with optimal access to educational opportunities, just like everyone else."

I sent Jaime's father to the Web page that the National Diabetes Education Programhas set up for school nurses. The page—called "Helping the Student with Diabetes Succeed"—explains the rights of children with diabetes in the school. I told Jaime's father to show this to the school nurse, the principal, and anyone else in the school who was not aware of the law. I suggested he contact the American Diabetes Association, if the problem was not resolved. If necessary, ADA would advise him, and might even assist with legal action to allow Jaime equal access to education and to take care of his health in school.

A few days later—after considerable back-and-forth among me, the school nurse, the principal, and Jaime's father—Jaime was checking his blood sugar levels after math class, so he missed none of his class and still had time to eat a healthy lunch. Three months after his diagnosis, Jaime had lost 15 pounds and his blood sugar was under excellent control. His ananthosis nigricans had faded considerably, and his body odor was acceptable. The school nurse never apologized. She simply told me, "I guess things are good. He isn't filthy anymore."

Some diseases are worse than diabetes. But none requires such a complex balancing act, where patients must do so much themselves. When you're diagnosed with diabetes, the disease infiltrates every moment and clouds the future.

An international authority on diabetes and obesity, Dr. Francine Kaufman heads the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles. She's developed innovative programs for overweight and diabetic children and their families.

© 2005 KCET, Tavis Smiley Productions and PBS.

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Published: September 15, 2005