Diabetes Self-Management Blog

It’s happened again. Another child with Type 1 diabetes has died because the adults in her life failed to protect her.

You may recall the case last March of 11-year-old Madeline “Kara” Neumann, who died of untreated diabetes after her parents prayed for her healing instead of seeking medical care. (I wrote about it in the blog entry “There’s More Than One Way to Answer a Prayer.”) Her parents have been charged with second-degree reckless homicide. You can read about the latest decision on that case, released last week, here.

“The free exercise clause of the First Amendment protects religious belief, but not necessarily conduct,” the judge wrote in a 20-page decision that cited two state laws saying:

  • Treating illness through prayer alone is not child abuse; and
  • The state’s homicide law makes no exception for prayer.

Now in Muncie, Indiana, we have the case of eight-year-old Kaitlyn Mae Borson, whose mother, Amber Sky Bertram, 29, is in jail, charged with neglect of a dependent causing death, a class A felony, for failing to manage her child’s Type 1 diabetes. A class A felony carries a prison sentence of 25 to 50 years plus a fine of up to $10,000.

According to an article in Sunday’s Muncie Star Press, Kaitlyn died the day after Thanksgiving, two days after being taken to a hospital — and one month after Child Protective Services had closed an eight-month-long case involving the family.

The death was “very much preventable,” a Muncie police sergeant was quoted as saying. “It boils down to her mom not managing her Type 1 diabetes. Her death was related to her blood sugar being out of (range). The mother had been ordered to test her blood sugar four to six times a day and to give the proper slow- or fast-acting insulin. The daughter was not correctly monitored, and when she became ill, the mother waited too long to seek medical help.”

It’s also interesting to read the comments section. The girl ate a funnel cake for breakfast one morning: Is that a good breakfast for somebody with diabetes? She was in school, too, and ate breakfast and lunch there: Why isn’t the school culpable?

Now, I’m not a doctor (or any other type of medical professional) and all I know is what I read in the paper. But does it maybe sound like diabetic ketoacidosis (DKA) to you? For DKA to occur, three things have to be present: high blood glucose, ketones, and dehydration.

You know if blood glucose is high if you check it. You know you have ketones if you check for it, either in the urine or in the blood. Dehydration generally can be taken care of by drinking, or at least sipping, fluids. If you can’t keep fluids down, protocol is to go to the hospital, and particularly so if hyperglycemia and ketones also are present.

Ketones are formed when the body has insufficient glucose in the cells to use for energy and turns to fat to use as fuel. Too many ketones in the bloodstream causes it to become acidic. Your body’s chemistry begins to change which, in turn, changes the mechanisms that regulate your body. Those changes can affect your heart and, perhaps, your brain, according to Dr. Richard Hellman, immediate past president of the American Association of Clinical Endocrinologists.

There are, to be sure, differences in the two cases. Kara had not yet been diagnosed with diabetes. Her parents may have believed she had the flu and would get well (although they were being told by family members that they should take the child to a doctor).

Kaitlyn’s family knew she had Type 1 diabetes and, presumably, had been instructed on what to do if she were sick (check blood glucose more often, check for ketones, keep her hydrated), especially if Child Protective Services was involved. Plus, Muncie isn’t exactly in the boonies: It’s closer to Indianapolis and a plethora of doctors, hospitals, and diabetes educators compared to where I am.

In my opinion, the adults were stupid in both cases. When I was a teenager, I babysat for a family whose faith relied on prayer for healing. I was given the names and phone numbers of healers if one of the children became ill and the parents were unavailable. I was also instructed to get a doctor — fast — if I deemed it to be an emergency. You do whatever you need to do to sustain life.

When diabetes is present, illness can never be thought of as being benign. The stress of the illness itself can raise blood glucose levels. High blood glucose can result in the formation of ketones. Both ketones and high blood glucose result in increased urination. Increased urination contributes to dehydration.

Check, check, check. Give more insulin. Sip fluids, suck on ice ships or a frozen pop. If things aren’t getting any better, get to an emergency room. Now!

Death is such a waste. Especially if, with education and today’s tools, it can be prevented.

DKA can be deadly. It’s the biggest medical emergency you can have if you have diabetes. “It’s also the most likely time for a child with diabetes to die,” Dr. Hellman has said.

For more information on avoiding and treating DKA, read the article “Hyperglycemic Crises: What They Are and How to Avoid Them.”

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