The day in February started normally enough for the Snyder family of Midwest City with a father-son after-school outing to some nearby batting cages. After only a short time at practice, however, Bob Snyder knew something was wrong. His 10-year-old son, Jacob, complained of being tired and not feeling well, and he was thirsty, downing 64 ounces of liquids--a couple of bottles of a popular sports drink and a bottle each of a soda and water--in less than half an hour.

Jacob had not been feeling at the top of his game for several days. He had dark circles under his eyes and had been slacking off a bit on his studies. To this point, his parents had not been overly concerned, attributing his tiredness and lack of interest in his homework to staying up too late and the normal vagaries of childhood. Ginger, his mother, recalls with some guilt that she had reprimanded him. Still, as a precaution, they had scheduled an appointment with his pediatrician for that Friday, still two days away.

That day at the batting cages, Bob put all of these signs together for the first time, and his alarm grew. Bob had a sister with diabetes, and he knew these symptoms were classic for type 1, or “juvenile,” diabetes.

They called the boy’s pediatrician, who advised them to go immediately to OU Children’s Hospital, where, they found his blood sugar was alarmingly high. The couple was told that had they waited the two days to see the pediatrician, their son might have gone into a diabetes-induced coma. Jacob was admitted to the hospital overnight, where the doctors and staff worked to stabilize his condition.

Now an active 17-year-old, Jacob deals with his diabetes on a day-by-day basis. He still plays football, runs track and hangs out with his friends. “My friends push me to work out and treat me like I don’t have diabetes,” he says.

Jacob has graduated from taking insulin shots to using a pump that delivers his medications throughout the day, but he still has to “count carbs” and closely monitor his blood sugars. He also pays a visit every three months to HHODC children’s center for check-ups.

“You just have to make sure your blood is right, which is sometimes difficult, especially during sports. You learn to handle it, through experience. At first, I had a hard time controlling it, especially in sports. I realize now what my blood sugar has to be at the start, during the game, and to test whenever I’m off the field,” he says.

Still this disease can never really be taken for granted. “Just when you think you’re in the groove, it throws you a curve ball and shows you how unpredictable it is,” Ginger says.

In January, Jacob and his family had a bad scare when he suddenly fell ill. The first day he could not keep his food down and was so tired he barely managed to pull himself out of bed and go to school. The next day, the symptoms worsened, and he missed school. Frightened, his parents again rushed him to the hospital, where they determined that, for the first time, he was undergoing diabetic ketoacidosis.

A serious condition that can lead to coma or death without prompt medical treatment, diabetic ketoacidosis, or DKA, can occur in both type 1 and type 2 diabetes. Without insulin, the body begins burning fatty acids and produces acidic ketone bodies that cause most of the symptoms and complications.

At the hospital, Jacob was given intravenous fluids to correct his dehydration, insulin to suppress the production of ketone bodies, treatment for underlying causes such as infections, and close observation to prevent and identify complications.

“It was really scary,” Jacob recalls. “We didn’t know what was going on.”

He was lucky. One night’s stay in the hospital, and he was well enough to be released.

Ginger Snyder says that, despite the latest scare, they are determined to continue to treat their son no differently than they would if he did not have diabetes.

“Diagnosis was very, very upsetting,” she admits, but from the start, Jacob was never ashamed of his diagnosis and was determined to continue to be active in the sports he loved and to live a normal life.

There was a sharp learning curve, both in and outside sports, both for son and parents. For example, she says, they discovered that playing football increased his production of adrenaline, which made his blood sugar spike. On the other hand, both swimming and wrestling would “drop him like a rock.”

Then there are the mood swings. While it is normal for teenagers to have mild to severe mood swings in response to hormone changes in their bodies, these swings can be greatly exaggerated in teens with diabetes – “by up to 100 percent,” Ginger claims. “They say it’s like the flu; when they get sick, they can’t help it. . . . But he can get really crabby when he has high blood sugar.”

Both Jacob and Ginger offered some advice for newly diagnosed patients with diabetes and their families: “Try not to get overwhelmed with all the information coming at you in the beginning about the disease and its management.”

Early in his diagnosis, the entire family attended classes and panels at HHODC children’s center, where they learned about dietary changes that would have to be made, some of them obvious, like avoiding sugary sodas, but others than were less intuitive, like managing his cholesterol and blood pressure levels. Ginger said that, surprisingly to her at least, the most challenging part of the dietary changes regarded the cholesterol management.

Jacob says children and teens who receive the diabetes diagnosis need to realize that, with time, “you will be able to do all the things your friends do. It’s going to be hard at times, but you gotta stick in there. After a while, you learn to check your blood sugar and go on. You don’t keep thinking about it.”

Both had high praise for the doctors and other caregivers at HHODC children’s center, and Ginger called the entire diabetes and endocrinology section, including Drs. Kenneth Copeland, section chief and director of HHODC-Childrens, and Piers Blackett, a pediatric diabetes physician, and the physician assistants, “just phenomenal.”

“They quickly taught us what we needed to know,” she says. “We couldn’t have done it without them.”

“The people at HHODC Children’s are very helpful,” Jacob agrees. “They help you get a good grasp on it – how to take your shots, check your blood. They’ve got people available to help you 24 hours a day.

“My parents also have been really helpful, understanding. They’ve been there through it all with me, and take off work if I’m sick. They are there at every sporting event, and my father is especially helpful on the sidelines.”

Ginger admits that the diagnosis in their son at age 10 was “devastating.”

“It affects your whole family. For us, it’s been one day at a time. You try to be as positive as you can. There are things that are a lot worse in life. Try not to get overwhelmed.”

She sometimes worries, too, that her son will tire of her nagging, noting that she is constantly asking him if he has checked his blood. Laughing, she says her mother gave her a T-shirt that reads, “I’m not a nag, I’m a motivational speaker.”

“We’re both just in awe of our son--great grades, in sports – he makes the best of it,” she says.

“(Nagging is) just part of our job as parents.”

Diabetes Fact Check

• Diabetes – often called the silent killer because it has no outright symptoms – is epidemic in the United States and around the world. Oklahoma is disproportionately affected, with direct and indirect costs attributable to the disease exceeding $3 billion annually ($174 billion nationally).

• More than 65 percent of Oklahomans are either overweight or obese, and these rates, along with a physically inactive lifestyle, are expected to continue to rise, leading to an even greater increase in the prevalence of diabetes.

• Almost 278,000 adult Oklahomans have diabetes, and another 113,400 are estimated to have undiagnosed diabetes. Approximately 678,300 have some form of impaired glucose intolerance, or pre-diabetes. In total this represents 39 percent of Oklahoma’s population, according to the Oklahoma State Department of Health.

• Just over twice as many Oklahomans age 18 to 24 have diabetes as do Americans nationally.

• Uncontrolled or poorly managed diabetes can lead to reduced years (up to 15) and quality of life; premature death; and immense (and avoidable) economic impact upon both those coping with disease and their families, and upon society at large.

• Diabetes or its complications is the fourth-leading cause of death in Oklahoma.

• The principal cause of early death in people with diabetes is cardiovascular disease, which is five times more likely in the presence of diabetes, and twice as likely in the presence of pre-diabetes.

• Diabetes also is the leading cause of end-stage kidney disease, non-traumatic lower extremity amputations, and blindness among adults ages 20 to 74.

• The costs of diabetes are staggering -- nearly $12,000 a year to treat a patient for diabetes and its complications. Currently, more than one of every four health care dollars and about one of every four Medicare dollars are spent on this disease and its consequences.

• The estimated costs of the disease to the state, including both direct medical costs and lost productivity, is in excess of $3.3 billion annually; this is expected to double in the next five years unless effective action is taken.

Education and Outreach at HHODC

The HHODC offers an array of programs as part of its education and outreach efforts. Two of them are briefly described below.

Know Your Numbers

Know Your Numbers is a project funded through a seed grant from Blue Cross/Blue Shield.
Through the program, which is aimed at individuals ages 18 to 40, the HHODC partners with health care providers in communities throughout the state, especially in rural areas and those with high percentages of minority populations, to offer free blood glucose, blood pressure and cholesterol screenings, then help ensure the attendees receive the required treatment locally.

Martha Ogilvie, administrative director of the center, says so far they have conducted about 10 of these screenings, with plans to do 10 more during the current fiscal year. What they have discovered is alarming. Of the people tested so far, about half showed some sort of chronic health issue, such as high blood pressure or unhealthy cholesterol numbers, while others showed indicators for diabetes or pre-diabetes, and one of three was found to be at risk of one of these or another serious medical condition.

“This underscores the necessity of getting to these people early,” Ogilvie says.

“Thirty-nine percent of the population is walking around with a time bomb in their pockets,” HHODC director Dr. Timothy J.Lyons says. “That’s a heavy price to pay” when the solution is as simple as being tested and, if found to have a problem in these areas, receiving simple, effective treatment.
 
Native Youth Preventing Diabetes (NYPD)

Since its formation, the HHODC has worked to develop formal agreements with the 39 federally recognized tribes in the state, beginning with the Choctaw and Chickasaw Nations, to provide onsite clinical services for children with diabetes and to partner in research and patient care.
Heading outreach efforts to the various tribal governments is Lancer Stephens, special populations outreach core director for the OU College of Medicine’s Clinical Research Center. Stephens, who is of Wichita and (Muscogee) Creek heritage, has experienced a great deal of success in establishing trust within American Indian communities.

One program of which he is especially proud is Native Youth Preventing Diabetes, or NYPD. Founded in 2001, it began as a two-day camp for children sponsored by the Absentee Shawnee Tribe, Citizen Potawatomi Nation, Kickapoo Tribe of Oklahoma, Sac and Fox Nation and Iowa Nation. Today, this nationally recognized camp attracts children ages 8 to 12 from 13 tribes (with five added this August). Attendance at the camp is underwritten by 11 participating tribes, and the camp is supported by grants from a pharmaceutical firm and through the National Institutes of Health-funded Oklahoma Center for American Indian Diabetes Health Disparities, housed in the OU College of Public Health.

During the camp, the children have opportunities to go horseback riding and participate in such activities as arts and crafts, archery, canoeing, caving, fishing, hiking, several sports, zip line, and a variety of Native American cultural activities. While at camp, they also receive classes in diabetes prevention, nutrition and self-esteem, among others, and are tested for a variety of health-risk factors, such as high cholesterol and blood pressure, obesity and diabetes.

Through health assessments conducted at the start of each camp, some shocking findings have emerged: children as young as age 8 with metabolic syndrome, as well as high cholesterol, high blood sugar and other serious health conditions.

Michelle Dennison, a diabetes clinician and dietitian at the HHODC who has coordinated the camps since their start, and Stephens say that because of the prevalence of diabetes in Native American populations, all of these children are familiar with the disease and, in fact, many assume that they, too, one day will get it.

Their goal is to show these children, through participation in these camps, that they do not have to develop type 2 diabetes. By making some lifestyle changes – like turning off their televisions and computers and running and playing outside and replacing fast food with a more balanced diet – they do not have to be diabetic just because they are Indian.

For more information about the Harold Hamm Oklahoma Diabetes Center and a listing of other links to sites where you can find out more about diabetes, please visit www.oklahomadiabetescenter.com.