by Robert Bernstein

Created on: November 12, 2008   Last Updated: December 18, 2008

Just one month after my second child was born, my first child (then 17 months) awoke one morning in a drenched diaper and crib. My wife and I were both resident physicians. We chuckled at this and said, "maybe we should dip the diaper (with a urine glucose test strip)." The next night, the same thing happened. Again, we chuckled (a little less) and said, "maybe we should dip the diaper." The third morning, I walked across the street to the emergency room and brought back a urine glucose dip stick and stuck it into the diaper; the reading was high glucose and ketones. So started our journey and education into juvenile diabetes.

We brought our daughter into the emergency room at the local children's hospital where I worked. Blood was drawn, labs were sent, an IV was started. Her pH was 7.34 (normal is 7.4), indicating that we had caught this extremely early and she was minimally acidotic. When there is no insulin to help transport glucose into the cells, the body begins to starve and breaks down fat into ketones that release hydrogen ions, dropping the body's pH, known as ketoacidosis. If it drops too low (becomes too acidotic), the patient becomes severely ill as proteins denature and cease to function, resulting in tissue damage and even death.

She received IV fluids and IV insulin and had multiples blood tests throughout the night to monitor her blood sugar. After 2 hours and 3 IVs, I was notified by a resident that the pharmacy had mixed the insulin incorrectly, and she had received 10 times the amount of insulin she was supposed to get. The IV fluid was changed to include glucose, the insulin dose was corrected, and her sugars came down appropriately. All night long I held her on my stomach, holding her. Each time her IV failed and the resident had to insert another, she would stick out her arm and say "OK, OK."I cried.

Over the next week we learned about the different types of insulin. She was on a regimen of Regular and NPH. Regular takes effect after about 30 minutes from the time of injection, and works for about 4-5 hours. NPH is slower, peaking in a few hours and lasting 12-16 hours. This seems pretty easy, except that 17 month old children don't eat consistently. You give the insulin, and then find yourself begging the child to eat because you can't "undo" the insulin you have given. Imagine sitting in the parking lot of your local restaurant, giving the insulin in the car (because you have to give it about 30 minutes before the child eats), only to

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