About 40% of juvenile diabetes cases are diagnosed only when children reach a state of acidosis that can be life-threatening and may cause irreversible damage. A new test developed at the Schneider’s Children’s Medical Center in Petah Tikvah near Tel Aviv will try to prevent this dangerous medical situation with an early diagnosis.
A groundbreaking study from Schneider’s discovered that using a standard finger blood test can predict in babies aged nine- to 18-months an 85% chance that certain children will develop juvenile (Type 1) diabetes.
The importance of this finding is in the possibility of preventing diagnosis of the disease only when it’s reached a critical point, which is a state of metabolic acidosis. In addition, an application has recently been submitted to the US Food and Drug Administration for approval of a drug that inhibits the onset of diabetes, which can give those found to be carriers a better quality of life for an additional period of time.
Diabetes is usually diagnosed when a child suddenly falls seriously ill, and is a life-threatening situation. It can be a truly traumatic event for the family as well as for the young patients. One case is 8-year-old Ziv Kemar from Kfar Saba, who was diagnosed with diabetes in early April, after the Maccabi Health Services children's clinic referred her to the emergency room at Schneider’s.
Ziv’s mom, Rona, said that this happened several days after her daughter started feeling sick. She vomited, felt weak and her stomach hurt. She also stopped eating, but kept asking to drink. Rona initially didn't attach much importance to this, but Ziv continued to deteriorate and could barely function.
Late, almost too late
Ziv's symptoms caused her parents to think she had coronavirus, so they took her to be examined.
After a negative result came and the situation only got worse, the pediatrician advised Ziv's parents to take her to the local health clinic. The nurse weighed Ziv and the number on the scale was significantly lower than the last weigh-in done at school six months previously.
"At that moment it hit me, I realized something was really wrong, and then the nurse did a blood test for Ziv, which showed that her sugar level was 350, a number which is extremely high, especially for a young girl,” Rona said. “The doctor said to me: 'I'm sorry to tell you that she has diabetes, go to the hospital now.' I was in shock and remembered that recently Ziv had been going to the bathroom several times a night. Suddenly I put one and one together, only it was already too late, almost too late.”
Upon reaching Schneider’s, Ziv continued to vomit and her sugar level had already risen to 470 with a severely abnormal level of acidity. The emergency room doctors tried to balance Ziv without success, and only after a few hours during which she was transferred to the intensive care unit did her condition start to improve.
One of the doctors who treated Ziv explained to Rona that the state she was in could cause her brain to swell.
"At that moment I almost fainted.” Rona recalled. “So, I started to realize how really serious the situation was and I just wanted her condition not to be life-threatening.”
They explained to Rona that her critical condition was a result of the worsening of her diabetes that had been developing for a long time. Ziv was in a really difficult situation physically and mentally, she kept shouting and crying.
It was a terrible sight. These were the scariest hours of my life,” said Rona.
It is hard to imagine a baby needing insulin injections
One-year-old Tahel from Petah Tikvah is currently marking three months since she was diagnosed as diabetic.
At the age of only 9 months, she was taken to Schneider’s in critical condition, after her mother Sarit noticed that she was blue.
Sarit tells of several days in which Tahel couldn’t calm down and was in a state of considerable restlessness, how she often cried, vomited and also drank a lot of water.
Sarit recounted that when a baby pees a lot and fills diapers, it's hard to think that the source is a physical problem. She was changing Tahel’s diaper every 15 minutes and didn’t think it was really normal, but she states that when you're inside a situation like this, the last thing you think of is a serious medical condition.
On the morning of the diagnosis, little Tahel kept crying and Sarit, who was helpless, tried to calm her down and get her to nap.
She gave her Tylenol liquid and put her to bed. With her last few breaths, Tahel, fortunately, continued to cry and only thanks to that, Sarit realized that something was really wrong.
When she picked Tahel up she noticed a change in face color which immediately lit a bright red light and sent them to the hospital. Upon arrival at the emergency room, sugar tests were immediately taken to determine that it was diabetes. Tahel's sugar levels in the diagnosis shot up to 800, which is practically fatal. Tahel's small body was fighting, with its systems on the verge of collapse. She was urgently brought to intensive care, where she was hooked up to life-saving devices and given a first insulin shot.
"A baby who gets insulin injections is something you can’t think of,” Tahel’s mother said. “To see her so small attached to devices, helpless, it's the biggest nightmare I couldn’t contemplate.
“At this age, to talk about what is allowed and forbidden to give her, when she is exclusively fed from milk formula, it’s inconceivable. We’re still adjusting to this new situation and I keep thinking how it happened so suddenly for such a little girl? How is it that we knew nothing when I was expecting her? There are many difficult questions and images from the hospital. This is something that will continue to stay with us.”
The prevalence of type 1 diabetes has increased dramatically in the last two decades, especially in young children under five years of age, according to Dr. Moshe Philip, director of the Institute of Diabetes and Endocrinology at Schneider's.
“The disease has no cure and its patients are treated with insulin all their lives,” he said.
Juvenile diabetes is an autoimmune disease in which the body's immune system attacks the cells that produce insulin in the pancreas. Due to the lack of insulin the sugar values rise, which causes the disease.
About 30% to 40% of new cases are diagnosed with diabetic metabolic acidosis, a life-threatening condition that sometimes also has long-term effects. In recent years, doctors and researchers have begun to understand that diagnosing juvenile-type diabetes at an early stage will allow for the prevention of diabetic metabolic acidosis events, in addition to opening up possibilities for understanding the disease and possibly even for early treatment that will prevent its onset.
According to Philip, early diagnosis of the disease is possible by early detection of antibodies against the pancreas. Eighty percent of children diagnosed with diabetes at some point have two or more antibodies against the pancreas and have a high (85%) chance of developing the disease. The antibodies that cause diabetes usually develop at one to two years of age, so it’s crucial to get tested at this age."
He added that a serological test for antibodies against the pancreas would identify children at risk for developing diabetes, prevent life-threatening diabetic metabolic acid events, provide guidance for families of children at risk of developing the disease, and help understand the disease and develop treatments that would prevent and cure it.
"In these children, the percentage of diabetic metabolic failure in the diagnosis of the disease is expected to drop to below 5%. In the not-too-distant future, we hope, we’ll be able to delay or prevent the onset of diabetes in this group of children," Philip concluded.