Melissa Mucha’s son hadn’t been feeling right.
The symptoms would ebb and flow — one day 11-year-old Connor would feel fine, and the next he’d be sick. But with cold and flu season, she figured it was just a bug. His COVID-19 test came back negative, so Mucha and her husband, Matt, “didn’t really think too much of it.”
Soon after, Connor had gotten progressively worse. He couldn’t keep anything down and was rapidly losing weight.
“He looked like a skeleton,” said Mucha, of Keene. “He’s a small kid to begin with, so when you lose 12 pounds that rapidly, it’s a marked difference in appearance. ... It was like he was dying.”
He was rushed to the emergency room, where it was quickly determined that — based on his blood sugar levels — he was in diabetic shock. Within minutes, Connor was diagnosed with Type 1 diabetes.
“There’s nothing you can do to prevent it or cure it, so it is a lifelong, manageable condition,” Mucha said. “And when you’re 11, it’s hard.”
Dartmouth-Hitchcock’s children hospital is reporting that it’s seeing more serious cases of pediatric Type 1 diabetes coming in amid the COVID-19 pandemic.
And while the viral disease itself isn’t causing this uptick, some of the pandemic’s effects — like increased use of telehealth services — can lead to physicians missing early warning signs, according to Ann Christiano, a pediatric nurse practitioner and coordinator of the pediatric diabetes program at the Children’s Hospital at Dartmouth-Hitchcock in Lebanon.
“What we’ve been seeing since COVID is that kids are presenting sicker than they used to,” she said.
‘A concerning trend’
There are two types of diabetes, which occurs when one’s blood glucose, also called blood sugar, is too high.
Type 2 is the most common in the United States, making up about 90 to 95 percent of cases, according to data from Johns Hopkins University.
It is usually diagnosed in adults who are overweight or inactive, Christiano said. These individuals can still produce insulin initially. However, the body becomes resistant to its effects, and over time, the pancreas stops producing insulin.
Insulin allows cells in the muscles, fat and liver to absorb glucose that is in the blood. The glucose serves as energy for these cells, or it can be converted into fat when needed. Insulin also affects other metabolic processes, like the breakdown of fat or protein.
With Type 1, which is usually diagnosed in those under 20 years old with no family history of diabetes, it’s a different process. Christiano said it’s an autoimmune disease in which the body fights against itself, ultimately destroying the cells that make insulin.
“When you can’t use your glucose for energy, your body actually turns to fat burning for energy, and the byproduct of that is acid can rapidly build up in the system when you don’t have insulin, and you can get very sick from that,” she said.
Because it’s an autoimmune disease, it takes about nine months to a year for Type 1 to develop in children, so they won’t show symptoms until they have lost about 85 percent of their function, according to Christiano.
And while people with Type 2 diabetes can try to control their blood glucose by losing weight or changing their diet, Type 1 is a lifelong disease, and those diagnosed need to take insulin.
Every fall, Christiano said, there is usually an increase in pediatric Type 1 cases at the same time that more people are getting the common cold or flu.
“The process isn’t directly caused by a virus ... but what ends up happening is hormones go up, and it causes our sugar to go up because our body needs more energy to fight this illness,” she said. “And if you are in the process of developing type 1 diabetes, now you are producing more sugar to help fight this illness, and that’s why kids are more likely to present when they have some kind of other illness going on.”
That has continued during the COVID-19 pandemic, but Christiano said more children have needed to be hospitalized for their diabetes.
At Dartmouth-Hitchcock children’s hospital, about 50 percent of new diagnoses usually require hospitalization, and the remainder are able to start outpatient care. Now, she said, “it’s a much higher percentage” who are hospitalized.
“It’s been a concerning trend,” she said.
There are several reasons for this, according to Christiano. This includes pediatricians assessing some patients over the phone to limit the number of in-person visits and kids not being in school, so school nurses aren’t catching it early.
Early signs of Type 1 diabetes include excessive thirst and urination, Christiano said. More serious symptoms are unusual-smelling breath or urine, nausea, vomiting and fatigue.
Keene resident Tanner Thompson, 13, was diagnosed with Type 1 on Jan. 30, according to his mom, Briana.
Like Connor, Tanner was very dehydrated and said he wasn’t feeling right.
“I’m a nurse, and I saw some of the signs like peeing a lot, and I made him go to the walk-in clinic,” she said. “He didn’t want to go. He was kicking and screaming, saying he was fine ... then they sent us to the ER where they did some more tests on Tanner, and said that he was in DKA.”
Diabetic ketoacidosis, or DKA, is a serious condition that can lead to a diabetic coma or even death. It happens when the body begins burning fat cells for energy.
Tanner is still new to his diagnosis, and his mother said he’s working to adjust.
“I think he’s [reacting] like a typical 13-year-old ... a ‘why me?’ kind of thing,” Thompson said. “He’s coming to terms with the whole grieving process.”
For 10-year-old Henry Germana, symptoms began in early December.
His mom, Leslie, said he was extremely tired for about three weeks, despite sleeping more than 12 hours a night. Like the others, he also was urinating excessively and was always either nauseous or starving.
“The day before his diagnosis, he was even more nauseous and tired and had started getting winded just walking from one room to another,” Germana, of Keene, said in an email. “He then woke up vomiting at midnight and was unable to really tell us what was bothering him.”
She took him to the emergency room after Googling his symptoms and seeing it could be diabetes. He was also taken to Dartmouth-Hitchcock and stayed there for four days to get his insulin levels back up.
“We were all very scared and apprehensive about what Type 1 Diabetes meant for his future,” Germana said, “but we have all settled in to this new normal and feel confident.”
Like the other parents, Mucha, Connor’s mom, said she hopes that telling his story will make more people aware of the disease’s early signs.
“It was extremely traumatizing to see him have the stomach bug and watch it go downhill that fast, and realize it’s not the stomach bug,” Mucha said. “And the responsibility that it requires to manage this successfully, it’s hard. It’s hard to realize your kid needs to have that kind of awareness.”