Taking Control

Learning to Manage Diabetes

Jamie Nyberg, Minocqua

Sweet 16 – it's a great time in life. You can drive and have a summer job. You can be with friends, join school sports, eat fun foods and sleep late.

If you have diabetes, it's also a time to start taking control of your health and managing the disease – yourself.

Jamie Nyberg, Minocqua, is experiencing the joys of being 16 and is learning to manage her diabetes, a condition she has lived with most of her life.

Type 1 diabetes

Nyberg was diagnosed with type 1 diabetes when she was 18 months old.

With type 1 diabetes, the pancreas makes little or no insulin, the hormone that helps your body convert blood sugar from what you eat into energy. "Diabetes is not something you can run away from," said Nyberg. "You can never stop checking your blood sugar. What I'm learning now is that I have to put my health first." Not an easy goal, when you're a busy teenager.

Her mother, Diane, recalls the experience she and Jamie's father, Alan, had before their daughter's diagnosis. "Jamie would look flushed and sweaty even after she'd had a bath," said Diane. "She was often thirsty and had on and off flu-like symptoms. She didn't seem to play or laugh. Something was just not right."

A trip to the emergency room at Howard Young Medical Center in August 1995 was the turning point. Jamie's breathing had become labored, and Diane was unable to wake her.

Joanna Gudel, M.D., Marshfield Clinic Minocqua Center pediatrician, was on call and met the Nybergs at the hospital.

A blood test revealed their daughter's blood sugar elevated to a critical level. She was airlifted by helicopter to Ministry Saint Joseph's Hospital in Marshfield in need of critical pediatric care.

After several weeks in the hospital, the Nyberg family returned home.

Her parents had to learn how to give Jamie as many as six insulin shots a day. Jamie had to relearn how to walk.

Their family has come a long way since that time. "In a toddler or young child, Type 1 diabetes can happen rather rapidly," said Dr. Gudel.

Vague signs

The disease can appear vague at first.

The child just doesn't feel good, may have flu symptoms, such as vomiting and diarrhea, or may go to the bathroom often, she explained. "Breathing can become labored or consciousness may be lost. If it is not diagnosed soon enough, the child could die."

Today Jamie is working to manage her disease using an insulin pump with the help and support of a health care team that includes Dr. Gudel, Afshan Chaudhry, M.D., Marshfield Clinic pediatric endocrinologist; and diabetes educators. "Your body normally regulates blood sugar with insulin from the pancreas," said Dr. Gudel. "With type 1 diabetes the pancreas is not working as it should, so the insulin pump mimics the delivery of insulin normally done by the pancreas. This is called a basal dose."

When Jamie eats, she then supplements the basal dose with a bolus dose to correct a high blood sugar, Dr. Gudel added.

Wearing the pump doesn't take Jamie away from activities she enjoys, such as competitive dancing, riding horses, snowmobiling or keeping stats for the high school baseball team. "With the pump, I can choose to take it off for certain activities," said Nyberg. "I just have to make sure I keep control with insulin shots to cover the time I'm without it."

Managing diabetes

Removing the pump and losing control of her blood sugar has been an occasional problem, Nyberg admits. "It's not an uncommon problem for teens during puberty," said Dr. Gudel.

Puberty presents challenges of its own when managing diabetes. "Teens begin to want more control, and they may be more apt to listen to their friends than their parents or doctor," Dr. Gudel said.

Taking insulin can cause weight gain, which bothers some teens. "With the pump, I can tell if the diabetes is under control or not. What the patient is doing is all recorded by the pump."

It helps to involve the child in diabetes treatment and decision-making early, Dr. Gudel said.

By age 12, 13 or 14, patients may think they know better. "If they get a lot of good emotional and educational support, that's the time they have better control of the disease. Then as they grow older, they begin to accept that it will not go away and that they need to take care of themselves."

"The biggest hurdle for me is when I get tired of the disease," said Nyberg. "Diabetes has its highs and lows, and I'm not just referring to blood sugar. I can really talk with Dr. Gudel when I need to. I am here today because of her."

Nyberg hopes she will always have a provider from whom she can seek advice and support when she is grown and away at school or off in the world of work. Her doctor's support has been inspirational, she said.

Nyberg plans to become a child psychologist specializing in children with diabetes.

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