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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Comments
  1. It turns out the hospital made an error and caused this child’s death.

    Posted by Ellen |
  2. Hi Ellen. I’m wondering what your source is on that, because I didn’t read that conclusion in the follow-up article that can be found at http://tinyurl.com/57v24u

    Jan

    Posted by Jan Chait |
  3. OK, there are a lot of confusing facts coming out in this case. First, here is a link to today’s newspaper report: http://tinyurl.com/6b6urv
    I plan to do a little digging myself to see what I can find out. It could be that things need to shake up a little more, so, while I may not get back with you on this today, I will keep you posted on new developments.

    Jan

    Posted by Jan Chait |
  4. Hi Jan,

    As a reporter, were you able to get a hold of the newest charges filed against Amber? Or were you able to interview Linda Cook, who seems to make public allegations and charges on a whim without having all the facts?

    Respectfully,
    Ellen

    Posted by Ellen |
  5. Nope. None of my calls have been returned. In fact, none of my calls for anything, including an article I have due this week for the local newspaper. (Yes, it’s a bit stressful!) However, I would like to think that police generally base charges on information that is available at the time and, apparently, the second hospital was not initially forthcoming. Then that messed up the info in my blog, which annoys me. (That is, I’m kicking myself for not waiting until things shook out a bit more.)

    Jan

    Posted by Jan |
  6. that is SO sad! i have 3 children 1 boy 12, 1 boy 6 ,and 1 girl 5 months. my 6 year old boy has had type 1 since he was 18 months old. he had dka when he was diagnosed and one other time since then in Jan 2006. he spent 3 days in hospital on insulin drip and fluids it was very scary! he started out like the flu but got bad within 1 day . dka is very scary! mbarham

    Posted by marieb |
  7. I just got off the phone with Sgt. Linda Cook, who has been very busy investigating Kaitlyn’s death. They continue to wade through evidence and “boxes of records” and she said she just got some new medical records involving the child. The coroner still hasn’t released a cause of death, the situation between the hospitals hasn’t been resolved and law enforcement is checking into what happened while Kaitlyn was in the helicopter.

    One development I found particularly interesting is that a new deputy prosecutor assigned to the case has a child about the same age as Kaitlyn–who also has type 1 diabetes.

    I will continue to monitor the situation and let you know when something new comes along.

    Jan

    Posted by Jan Chait |
  8. Hi:

    I am new to this blog but have much in common with you all, I am a type one diabetic of sixty years and very healthy. I am finishing up my ebook about 10 principles that I have followed that have aided me in maintaing my health.

    I was the first one in my family diagnosed with this at the age of 3, but then my oldest sister (Ellen)became diabetic at the age of 16. My younger brother (Phil) was diagnosed at the age of 8, and sadly both siblings have had terrible side effects. Phil has been blind for about 25 years, and my sister died at the age of 34 from her second heart attack. So my family has paid the price for this devasting disease. Three other siblings have never become diabetic.

    I am struggling a little bit with the title of my ebook, here are two possible titles, let me know which one you think is better:

    (1) Controlling the challenges of diabetes!
    10 proven principles to a Healthier Lifestyle!

    (2) 10 secret principles to master type one diabetes.

    Let me know what you think!

    Thanks!

    Mary P. Nilssen
    Healthy Type one diabetic for over sixty years

    Posted by Mary |
  9. I am the mother of a teenage daughter who was sent to the hands of Children and Youth services for neglect. I was reported by the school nurse who had orders in front of her as to what to do for high blood sugars….apparently she could not handle the responsibility and not only called an ambulance several times but reported me. I have always taken my child to the doctor and abided by orders. However, a teenager especially a defiant one can very easily sneak all kinds of foods in the middle of the night or various other times of the day to bring on high blood sugars regardless of how well they are monitored by a parent also stress and other illness tend to cause a spike in blood sugars. I feel I was wrongly blamed and don’t know what to do about it. Teenagers want to do their own thing even if they don’t have diabetes so what is a parent to do?

    Posted by accused |
  10. i am a teenager wiht type 1 diabetes and i know how your daughter feels, it is awful seeing everyone around you eating what they want, and it doesnt help that i used to eat crap all the time but never got fat im actually quite skinny (otherwise i may have stopped) but now that i have diabetes i cant just eat what i want and protein bars are awful, chocolate is a low gi food so wont cause a massive fluctuation in the blood sugar so that could be an option, have you tried sugar free lollies ect?? some are alright and maybe try explaining the consequences of eating crap and the results of hyperglycemia (amputation of extremeties ect) that should put her off
    xx

    i hope you and your daughter sort this out

    xx

    Posted by bronte |
  11. Can someone please tell me what the outcome of the mother’s trial was and what her exact charges were? Also, who was the judge presiding over the case? I am having a hard time findind this info. Thanks

    Posted by Nicole Turner |

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