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A toddler's experience with Type 1 diabetes

Liam’s only 4 years old, but he already sets an example for other children by staying healthy and using blood glucose monitors and insulin pumps.
Liam’s only 4 years old, but he already sets an example for other children by staying healthy and using blood glucose monitors and insulin pumps.

With support from family and clinicians, this 4-year-old is learning to manage his blood glucose monitor and insulin pump.

Liam Dubno will be 5 this December, but he already has a cell phone, plans some of his own meals and helps with family food shopping. It’s all part of his life with Type 1 diabetes.

Liam seemed like a typical toddler last year. He was adjusting well to being the big brother to his new baby sister. His mother, Gloriamarie Tyrrell-Dubno, noticed one day that he was going to the bathroom more than usual. That night, she found him asleep in the family’s Merrick home, holding the water bottles she and her husband, Peter, kept by their bed. Liam had finished the water in both bottles.

“I thought, ‘This doesn’t seem right.’ But I didn’t think it was anything serious,” Ms. Tyrrell-Dubno said.

She thought she was just being cautious by taking Liam to the doctor, but Ms. Tyrrell-Dubno made the right call. The pediatrician performed a blood test and found that Liam’s blood sugar was about four times higher than normal.

‘Go to the Emergency Department right now’

“He sat me down and said, ‘Listen, Liam has diabetes,’” said Ms. Tyrrell-Dubno. “‘You have to go to the Emergency Department [ED] at Cohen Children’s Medical Center right now.’”

Phyllis Speiser, MD, chief of pediatric endocrinology, met them at the ED. “Liam was very dehydrated when he was admitted, and his blood glucose was very high,” she said. “Our job was to get him stabilized and educate his parents quickly about Type 1 diabetes and how to care for him.”

The Dubnos learned how to check Liam’s blood sugar and give him insulin and what to feed him to keep his blood sugar stable. The family also started building long-term relationships with Dr. Speiser and Cohen Children’s special diabetes nursing and nutrition teams.

“They really held our hands though the beginning, when we needed someone to care for us,” said Ms. Tyrrell-Dubno. “When we went home, we were nervous but felt really supported.”

Soon after the diagnosis, the Dubnos and Dr. Speiser decided that a continuous glucose monitor and insulin pump would be best for Liam, rather than finger-stick blood tests and insulin injections. The little boy thrives in the freedom that this technology allows. Liam is like other children his age —  going to school, playing with friends. He is also unique in unexpected ways.

“The first day of summer camp, he got on the bus and introduced himself to the driver,” Ms. Tyrrell-Dubno said. It was the first time he would ride the bus by himself. “He said, ‘My name is Liam and I’m diabetic. I have a cell phone because it connects to my glucose monitor and tells me if I’m low. I have gummy bears to eat if I need sugar, so please don’t take them away from me.’

“We didn’t tell him to do that. He’s just learned to self-advocate.”

Liam has already learned to make healthy choices, too. “He’ll tell me, ‘Mommy, this cookie doesn’t taste good enough to deal with the carbs. I don’t need it,’” his mother said.

Community connections

When Liam’s diagnosis was new, “I wished that we had someone local who knew first-hand what we were going through, but we didn’t,” Ms. Tyrrell-Dubno said. She stays current with clinical trials and research, and participates in online communities for parents to trade coping strategies and tips to help their children with Type 1 diabetes.

The Dubnos also connect locally to help parents with newly diagnosed kids. For example, they recently hosted a family to assist with their daughter’s new glucose monitor.

While the adults talked through technical details, Liam jumped in to help, too. “He was trying to train the little girl, that it just hurts a little bit and when you’re done, your mommy will tell you it’s all done and then you get a little prize,” Ms. Tyrrell-Dubno said. “He was trying to ease her into it. We are really proud of him.

“I wish he didn’t have diabetes. I wish I could change it,” she added. “But he’s learning to manage. And he’s constantly amazing us.”

Tools for freedom

Liam’s continuous glucose monitor (CGM) is a tiny implant that checks glucose levels every few minutes and sends the results to him and his mother via a mobile app. An insulin pump is a wearable device. A wireless controller signals the device to release insulin into the body whenever Liam needs it.

The CGM and insulin pump give kids with Type 1 diabetes the kind of freedom they couldn’t enjoy with tools of the past, according to Dr. Speiser.

“Children don’t want to have their fingers stuck for blood tests multiple times a day. They prefer not to pull out a pen device or syringe to inject insulin. And they don’t eat regular meals the way adults do,” she said. “It’s harder to control children’s blood glucose the traditional ways, and it’s more limiting for them. Continuous glucose monitoring and an insulin pump give children like Liam much more flexibility and normalcy.”

The tools “give us so much more control over Liam’s sugars than just testing him before meals,” said Ms. Dubno. “We know in an instant if he’s too high to too low, and can get him insulin or food to correct his levels.”

Get savvy about diabetes

Diabetes has many forms. Generally, it’s a chronic condition that affects how the pancreas works. 

Type 1 diabetes is very different from Type 2. Type 1 is an autoimmune disease that occurs when your pancreas stops producing insulin, the hormone that controls blood sugar levels. Warning signs often appear suddenly, according to JDRF, a nonprofit organization that provides research, advocacy and funding for Type 1 diabetes, and there’s no way to prevent the disease. Type 1 used to be called juvenile diabetes, but that name was misleading because it affects adults too.

 Type 2 develops very gradually and is unusual in children. When you have Type 2, your pancreas doesn’t produce enough insulin or cells that can use insulin properly. Family history, genetics and lifestyle all play a part in developing Type 2 diabetes. Carrying too much weight and consuming a lot of sweets are risk factors, but they don’t guarantee it.

The difference between Type 1 and Type 2 diabetes

Type 1: Type 2:
  • Often diagnosed in childhood, affects all ages
  • Not associated with excess body weight
  • Often associated with higher-than-normal ketone levels at diagnosis
  • Treated with insulin injections or insulin pump
  • Must be controlled with insulin for a lifetime
  • Usually diagnosed in adults over 30
  • Often associated with excess body weight
  • Often associated with high blood pressure and/or high cholesterol levels at diagnosis
  • Initial treatment doesn't usually include medication
  • Sometimes possible to stop taking medication