As many as 3 million Americans have type 1 diabetes, according to the JDRF, and it is frequently diagnosed in children.
Listen in as Dr. David Repaske discusses what causes type 1 diabetes, how it differs from type 2 diabetes and about available treatments from a UVA expert in pediatric endocrinology.
Helping Kids with Type 1 Diabetes
Featured Speaker:
Learn more about UVA Children’s Hospital
Dr. David Repaske
Dr. David Repaske is board certified in pediatric endocrinology whose specialties including caring for children with diabetes.Learn more about UVA Children’s Hospital
Transcription:
Helping Kids with Type 1 Diabetes
Melanie Cole (Host): As many as three million Americans have Type 1 diabetes, according to the JDRF, and it’s frequently diagnosed in children. What causes it and how does it differ from Type 2 diabetes? That’s what we’re talking about today. My guest is Dr. David Repaske. He’s board certified pediatric endocrinologist at UVA Health Systems. Welcome to the show, Dr. Repaske. Tell us, what is Type 1 diabetes and how is it different from what we’ve been hearing a lot about Type 2 diabetes?
Dr. David Repaske (Guest): Hello, glad to be here. The hormone insulin moves sugar or glucose from the blood into the cells of the body where it’s burned for energy. In diabetes, there is not enough insulin to move the glucose. In fact, the definition of diabetes is a fasting blood sugar greater than 126 mg/dL. Now, in Type 1 diabetes, the problem is the body’s ability to make insulin decreases. That’s different than Type 2 diabetes where you can make lots and lots of insulin, but the body becomes very insensitive to insulin and you need more and more and more until you can’t make it enough to supply the needs.
Melanie: What symptoms would a parent notice in their child that would send them to a pediatric endocrinologist to get checked and have their blood sugars checked?
Dr. Repaske: Well, Type 1 diabetes can kind of be a masquerader. It can look like flu, but the things that set it apart are: lots of urine, so the child is going to the bathroom much more frequently than normal; a child can also be tired, lethargic, can be losing weight which is sort of unusual for a growing child. I think those are the highlights you can look out for.
Melanie: Then, when they take them in, how do you check for diabetes? What’s the first line of treatment when you discover that this is what a child has?
Dr. Repaske: Well, it’s really that blood sugar level. If the child comes in and has the symptoms of peeing a lot and drinking a lot and losing weight, we’ll check the blood sugar and find that it’s exceedingly high, that pretty much makes the diagnosis. The treatment is giving insulin. There’s an insulin deficiency. Really the only treatment is replacing what’s missing, giving insulin back.
Melanie: What does that involve? Is this something that children eventually learn to do by themselves? We’ve heard about kids carrying their needles around and parents having to show them how to do it. Speak about this insulin that they have to have and now it becomes a lifelong thing, correct?
Dr. Repaske: That’s right. At least at this moment, there is no real cure. You can just replace the insulin that the body is no longer making. It’s complicated because you need to match the amount of insulin to what the child is eating, the exercise level, and during other illness, you also need more insulin. It’s a very fine game of providing just the right amount of insulin. If you give too much, then the blood sugar will drop. If you don’t give enough, then the blood sugar rises and both of those are dangerous.
Melanie: Doctor, because exercise has an insulin-like effect, we encourage our children to be active and run around in gym and recess and such, do you have to be a type A personality as a family to really get this, as you say, this delicate balance? How do we work with kids that way?
Dr. Repaske: Unfortunately, it is a delicate balance. With time, every family learns the amount of insulin and the amount of glucose that a child needs to prevent highs and lows and we work with the family to customize the dose and to come up with strategies to keep the blood sugar normal during exercise. In some children, it may require giving a little less insulin. In some, it may require giving some extra carbohydrate or glucose, some form of sugar to keep the blood sugar from dropping during exercise. That’s the role of the pediatric endocrinologist, to work with the family to overcome these challenges.
Melanie: What about nutritionally, Dr. Repaske? Are there any limits to what a child can eat as they grow? And as they go into teen and adulthood, are there things you want them to really steer clear off that could exacerbate their Type 1 diabetes?
Dr. Repaske: You know, in the old days, we had many, many limits on what a child with Type 1 diabetes can eat. These days, you have to be reasonable. Eating a pound of sugar wouldn’t be such a great idea, but within reasonable limits and eating a relatively healthy diet, we can pretty much give the amount of insulin that anybody would need. Basically, you don’t really have to change your diet. We’re at a point where we have fancy insulin – some work quickly, some work slowly – that can match just about anything in the diet. I don’t want to give the wrong impression. A healthy diet is important for everybody, but especially for somebody with Type 1 diabetes.
Melanie: Talk about the horizon a little bit. What’s on the horizon for curative or treatments for Type 1 diabetes?
Dr. Repaske: Well, I think the thing that’s coming closer and closer and is quite exciting is an artificial pancreas. We have currently insulin pumps that deliver insulin under the skin continuously and then we also have continuous glucose sensors which check your blood sugar almost continuously. If the two of those could work together so that the blood sugar is constantly being checked, then that controls the pumps. If the blood sugar is rising, it signals the pump to deliver a little bit more insulin and decrease the blood sugar down to a normal level. Or if the blood sugar drops, then the sensor would tell the pump to back off in the amount of insulin that’s being given at that moment. That is what the pancreas does. That would be artificial pancreas, but then you wouldn’t have to worry so much about trying to match the insulin to what you’re eating and exercising; it would happen automatically. I think that is really coming pretty close, and here at University of Virginia, we are involved with designing those artificial pancreas instruments. I think another thing that’s coming along is islet cell transplantation where you put back the islets that have been destroyed by the immune system in Type 1 diabetes. A problem there that still has to get overcome is that the new islets are also going to be attacked by the immune system, and so we’ve got to regulate the immune system so it doesn’t pick on those new cells. Ultimately, there’ll be a cure. It’s hard to predict when it’s going to happen, but I think the cure is likely to involve a new mechanism for turning off the immune system so it stops picking on those beta cells, and if they can regenerate themselves and the immune system isn’t attacking them as they do so, then perhaps the beta cells will come back and be able to produce insulin again.
Melanie: In just the last minute, doctor, why should children with Type 1 diabetes receive their care at UVA Children’s Hospital?
Dr. Repaske: Well, our program has really dramatically expanded in the recent past. We now have six physicians and four nurse practitioners and we’re very shortly going to extend our clinic from two days a week to five days per week. We have all the latest technology, the pumps and the sensors that I have been talking about. We are involved in cutting edge research and offer patients an opportunity to participate. Last but not least, we have moved our diabetes clinic into that beautiful, new children’s hospital building on the UVA campus. We are really enthusiastic to welcome new patients into our practice and we promise to take excellent care of the whole family that’s affected by diabetes.
Melanie: Thank you so much. That’s wonderful information. For more information on UVA Children’s Hospital, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening and have a great day.
Helping Kids with Type 1 Diabetes
Melanie Cole (Host): As many as three million Americans have Type 1 diabetes, according to the JDRF, and it’s frequently diagnosed in children. What causes it and how does it differ from Type 2 diabetes? That’s what we’re talking about today. My guest is Dr. David Repaske. He’s board certified pediatric endocrinologist at UVA Health Systems. Welcome to the show, Dr. Repaske. Tell us, what is Type 1 diabetes and how is it different from what we’ve been hearing a lot about Type 2 diabetes?
Dr. David Repaske (Guest): Hello, glad to be here. The hormone insulin moves sugar or glucose from the blood into the cells of the body where it’s burned for energy. In diabetes, there is not enough insulin to move the glucose. In fact, the definition of diabetes is a fasting blood sugar greater than 126 mg/dL. Now, in Type 1 diabetes, the problem is the body’s ability to make insulin decreases. That’s different than Type 2 diabetes where you can make lots and lots of insulin, but the body becomes very insensitive to insulin and you need more and more and more until you can’t make it enough to supply the needs.
Melanie: What symptoms would a parent notice in their child that would send them to a pediatric endocrinologist to get checked and have their blood sugars checked?
Dr. Repaske: Well, Type 1 diabetes can kind of be a masquerader. It can look like flu, but the things that set it apart are: lots of urine, so the child is going to the bathroom much more frequently than normal; a child can also be tired, lethargic, can be losing weight which is sort of unusual for a growing child. I think those are the highlights you can look out for.
Melanie: Then, when they take them in, how do you check for diabetes? What’s the first line of treatment when you discover that this is what a child has?
Dr. Repaske: Well, it’s really that blood sugar level. If the child comes in and has the symptoms of peeing a lot and drinking a lot and losing weight, we’ll check the blood sugar and find that it’s exceedingly high, that pretty much makes the diagnosis. The treatment is giving insulin. There’s an insulin deficiency. Really the only treatment is replacing what’s missing, giving insulin back.
Melanie: What does that involve? Is this something that children eventually learn to do by themselves? We’ve heard about kids carrying their needles around and parents having to show them how to do it. Speak about this insulin that they have to have and now it becomes a lifelong thing, correct?
Dr. Repaske: That’s right. At least at this moment, there is no real cure. You can just replace the insulin that the body is no longer making. It’s complicated because you need to match the amount of insulin to what the child is eating, the exercise level, and during other illness, you also need more insulin. It’s a very fine game of providing just the right amount of insulin. If you give too much, then the blood sugar will drop. If you don’t give enough, then the blood sugar rises and both of those are dangerous.
Melanie: Doctor, because exercise has an insulin-like effect, we encourage our children to be active and run around in gym and recess and such, do you have to be a type A personality as a family to really get this, as you say, this delicate balance? How do we work with kids that way?
Dr. Repaske: Unfortunately, it is a delicate balance. With time, every family learns the amount of insulin and the amount of glucose that a child needs to prevent highs and lows and we work with the family to customize the dose and to come up with strategies to keep the blood sugar normal during exercise. In some children, it may require giving a little less insulin. In some, it may require giving some extra carbohydrate or glucose, some form of sugar to keep the blood sugar from dropping during exercise. That’s the role of the pediatric endocrinologist, to work with the family to overcome these challenges.
Melanie: What about nutritionally, Dr. Repaske? Are there any limits to what a child can eat as they grow? And as they go into teen and adulthood, are there things you want them to really steer clear off that could exacerbate their Type 1 diabetes?
Dr. Repaske: You know, in the old days, we had many, many limits on what a child with Type 1 diabetes can eat. These days, you have to be reasonable. Eating a pound of sugar wouldn’t be such a great idea, but within reasonable limits and eating a relatively healthy diet, we can pretty much give the amount of insulin that anybody would need. Basically, you don’t really have to change your diet. We’re at a point where we have fancy insulin – some work quickly, some work slowly – that can match just about anything in the diet. I don’t want to give the wrong impression. A healthy diet is important for everybody, but especially for somebody with Type 1 diabetes.
Melanie: Talk about the horizon a little bit. What’s on the horizon for curative or treatments for Type 1 diabetes?
Dr. Repaske: Well, I think the thing that’s coming closer and closer and is quite exciting is an artificial pancreas. We have currently insulin pumps that deliver insulin under the skin continuously and then we also have continuous glucose sensors which check your blood sugar almost continuously. If the two of those could work together so that the blood sugar is constantly being checked, then that controls the pumps. If the blood sugar is rising, it signals the pump to deliver a little bit more insulin and decrease the blood sugar down to a normal level. Or if the blood sugar drops, then the sensor would tell the pump to back off in the amount of insulin that’s being given at that moment. That is what the pancreas does. That would be artificial pancreas, but then you wouldn’t have to worry so much about trying to match the insulin to what you’re eating and exercising; it would happen automatically. I think that is really coming pretty close, and here at University of Virginia, we are involved with designing those artificial pancreas instruments. I think another thing that’s coming along is islet cell transplantation where you put back the islets that have been destroyed by the immune system in Type 1 diabetes. A problem there that still has to get overcome is that the new islets are also going to be attacked by the immune system, and so we’ve got to regulate the immune system so it doesn’t pick on those new cells. Ultimately, there’ll be a cure. It’s hard to predict when it’s going to happen, but I think the cure is likely to involve a new mechanism for turning off the immune system so it stops picking on those beta cells, and if they can regenerate themselves and the immune system isn’t attacking them as they do so, then perhaps the beta cells will come back and be able to produce insulin again.
Melanie: In just the last minute, doctor, why should children with Type 1 diabetes receive their care at UVA Children’s Hospital?
Dr. Repaske: Well, our program has really dramatically expanded in the recent past. We now have six physicians and four nurse practitioners and we’re very shortly going to extend our clinic from two days a week to five days per week. We have all the latest technology, the pumps and the sensors that I have been talking about. We are involved in cutting edge research and offer patients an opportunity to participate. Last but not least, we have moved our diabetes clinic into that beautiful, new children’s hospital building on the UVA campus. We are really enthusiastic to welcome new patients into our practice and we promise to take excellent care of the whole family that’s affected by diabetes.
Melanie: Thank you so much. That’s wonderful information. For more information on UVA Children’s Hospital, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening and have a great day.