TORONTO – A few months after the pandemic, doctors including Elizabeth Sellers noticed a worrying trend – more children were being hospitalized with a sudden and serious illness called diabetic ketoacidosis.
Also called DKA, it is a life-threatening emergency that occurs in people with undiagnosed type 1 diabetes.
“I have a very clear reminder that one of the long summer weekends was on call and there were four children with emerging diabetes, all with severe DKA,” Sellers told CTV News. “So it really brought me home that ‘Wow, I think we have a problem here’.”
Sellers is one of the researchers behind a new study that surveyed eight children’s hospitals across Canada and found a dramatic increase in DKA cases during the pandemic. The study results were published in the journal Paediatrics & Child Health in April.
“When we looked at the first four and a half months of the COVID era – from March to August last year – we found that 55 percent of children newly diagnosed with type 1 diabetes were presented [with] diabetic ketoacidosis, compared to 38 percent […] the year before, in the time before COVID, “said Sellers.
Not only were there more children presenting with DKA, the condition was worse, researchers found.
“If they had diabetic ketoacidosis, they had more severe acidosis,” Sellers said.
She stated that nearly half of the children who presented with DKA while studying had severe DKA.
In 2019, within a similar period of time, only 33 percent of the children presented themselves [with] DKA had severe DKA. “
What exactly is DKA? It’s when cells are unable to process glucose to be used as fuel. Instead, fat is quickly broken down into another type of fuel that can make the blood acidic as it builds up.
That happened to Ainsley MacPherson, now 10 months old, who lives with her family in British Columbia.
Her mother, Megan Black, told CTV News that they initially ditched what they now know as symptoms as part of their growing process.
“She peed through her cloth diapers night and day, which was new to her, and she drank more, too,” Black said. “I looked through 6-ounce bottles quite a lot throughout the day, which was new to her too.”
Then Ainsley woke up one morning with vomit – something that raised red flags for her parents.
“We found that things weren’t right,” said Black. “I took them out and put them in the bathtub, let them wash everything off. While she was in the tub, she started to turn a little blue. Her hands and feet started to turn purple and around her lips.
“It was scary for mom and dad.”
Ainsley was taken to the emergency room and then flown to the intensive care unit with her blood sugar levels many times higher than normal.
“Your sugar was very high,” said Black. “I think her starting sugar or blood sugar was 44 or 45, which is really high. They should be between six and eight for their age group. “
The family was blind.
“Nobody in our family has type 1 diabetes, I wasn’t expecting that,” said Black. “And so, to find out that my little baby, who I’m still on vacation with, has diabetes – it was a shock.”
Those who are quickly diagnosed, like Ainsley’s, are given insulin for their diabetes and the problem is resolved before the DKA can become severe. Your parents now regularly monitor their blood sugar levels like you would for anyone with type 1 diabetes.
If diabetes is not detected early enough in children and they have DKA, they may have cognitive problems due to brain swelling. In rare cases, DKA can be fatal.
“These children get very, very sick with severe dehydration and a buildup of acid in their blood,” said Dr. Shazhan Ahmed of BC Children’s Hospital told CTV News.
“And because of the severity of this disease, [they] present with decreased consciousness. Very, very dehydrated and almost always in need of an admission to the pediatric intensive care unit. “
Canada isn’t the only country where scientists have seen an increase in children with DKA. The same trend towards more serious DKA presentations in children has also been reported in Germany and Italy.
Doctors suggest the pandemic, isolation, and anxiety may have played a role in children who were not diagnosed with diabetes prior to the onset of DKA.
“You can imagine the fear families have of taking the child to hospital [during the pandemic]”Ahmed said.” And so the delay in getting your children to medical care has definitely impacted the rate of diabetic ketoacidosis. “
The researchers also suggest that virtual visits may not allow doctors to spot the more subtle signs of early diabetes, which, if left untreated, can lead to DKA.
In light of this new research, doctors in Canada urge parents not to ignore the early signs of type 1 diabetes:
I have to go to the bathroom more often
lose weight fast
“These are all signs of high blood sugar, and in a child, these are signs that they need to be seen urgently,” Sellers said.
Ahmed stated that although the majority of children recover from DKA, there is increasing research showing that DKA could have a lasting impact on children’s brain development.
“It is very important that we take steps to prevent diabetic ketoacidosis and to diagnose diabetes in children earlier before they get sick,” said Ahmed.
Ainsley’s type 1 diabetes is now under control and “thriving,” says her mother.
“The insulin pump does its job, it keeps your sugar regulated.”
Black hopes her daughter’s story can serve as a life-saving example for other families to take symptoms seriously and seek medical help quickly.
“I really think that it is important for families, parents of little ones, babies and toddlers, even young children, to know that it may not be that they are just a baby and just having a growth spurt that they’re ‘I drink more because they’re growing,’ she said.
“Sometimes it can be more serious […] what is up. “
She added that parents should consider any signs of illness that appear suddenly as big warning signs.
“To the [Ainsley]It was literally an overnight thing, ”said Black. “The night before she was healthy, she crawled around, she was happy, babbled and then, […] Twelve hours later she was sluggish, blue, and very, very sick. “
When she returned to work teaching third grade, she said she will now look out for these signs in her students just to make sure that if another child suffers, she can help catch them.
One thing that helped was the speed at which the family took Ainsley to the hospital when she got sick.
“Not once did it occur to me not to go to the hospital because of COVID and the pandemic,” said Black. “We knew immediately where to go to have it checked out, regardless of what it was. But I certainly think that this would be a good explanation for the increase in DKA cases, that people are suspicious of being in the hospital with the thought that they will get COVID. “
Doctors want patients and parents to know that finding medical care is important in times of crisis, especially if it is a disease that gets worse when ignored.
“The aim is to prevent DKA by diagnosing diabetes much earlier in the disease so that children are not treated with DKA, are not admitted to pediatric intensive care units and the trauma that a family experiences with such a critically ill child is prevented” said Ahmed.
“And based on research around the world, we are confident that we can do that in Canada.”