Glucose monitoring device helps Bella manage Type 1 diabetes

Diagnosing Bella with type 1 diabetes

"Bella Hawkins is one of the youngest patients I have diagnosed with type 1 diabetes," says Dr Neville Wellington, a Cape town-based GP with a diabetes speciality.

• Read more about type 1 diabetes at the end of our article.

"Bella's parents had brought her in a few days before we diagnosed her. She had a nappy rash and was passing a lot of urine. At the time, I thought was a case of thrush," he explains.

Kerry, Bella's mom, was seven months pregnant with Bella's sister, Hayley, at the time. She adds: "We were also potty-training Bella at the time. We noticed that, not only was she going through a large number of nappies, she was also drinking over five litres of water a day from the dispenser attached to our fridge. We realised this as we kept having to refill it."

Dr Wellington continues: "Two days later, on 30 April 2013, Bella was brought in again as she was really not herself. When I checked her blood sugar levels, they were very high. Where they should have been less than 7.8mmol/L, Bella's blood glucose was at 53 mmol/l. Also, the goal in managing a patient with type 1 diabetes is to get their HbA1c levels below 6%. When Bella was diagnosed, her HbA1c was at 12.5%."

• What is "HbA1c"? HbA1c refers to glycated haemoglobin. It develops when haemoglobin (which carries oxygen in our blood and is found on red blood cells) binds naturally to glucose in the blood. The amount of glucose that attaches to haemoglobin is proportional to how much sugar is in your blood at the time. As red blood cells survive in the body for up to 12 weeks, a measure of HbA1c can show average glucose levels for this amount of time, giving doctors a good long-term measure of blood glucose control.

"Eventually Bella was covered in tattoos and looked like a gangster"

"Dr Wellington immediately diagnosed her with type 1 diabetes. He guided us as to what to do next, putting Bella onto insulin replacement medicine in the form of injectable insulin contained in an easy-to-use pen."

"For the first few weeks after Bella's diagnosis, Lance and I were both completely numb," says Kerry. "We had a little one who was sick. We were trying to wrap our heads around this as a lifelong illness. We had to prick her finger every two hours, draw drops of blood onto a test strip, insert this into a blood glucose monitor, wait for the reading, then inject Bella with insulin according to the blood sugar reading. The only way to know what her blood sugar levels were doing was to prick, draw blood and test. We were causing her constant pain that she initially did not understand. We were also trying to understand the impact of everything she ate and drank on her blood sugar, and learn to balance her levels with the right amount of insulin throughout the day."

For the first month or two, Lance and Kerry injected Bella with insulin every two hours. This meant finger pricks (to extract drops of blood for analysis in a blood glucose monitor) every 40 minutes, before and after injecting with insulin. "We would have to bribe her with sticker type, press-on tattoos. Eventually Bella was covered in them and looked like a gangster," recalls Kerry. "Fortunately, Bella soon began to feel better, and this helped to get her buy-in to the process."

Finding a healthy rhythm as a family

"Over time we were able to reduce the insulin we were giving Bella to five or so injections each day. This was due to lifestyle changes we made as a family - particularly towards healthier eating, with a focus on low-carbohydrate options, as we all followed the same plan. In fact, at seven months pregnant, I lost 7 kg of weight. This was weight I needed to lose which I had gained by eating a high sugar and junk food diet. So, we all got healthier."

Bella got through pre-school with her mom checking her insulin levels in the morning and at noon when she fetched her. By the time she went to primary school, Bella had learned to test her own blood sugar levels. She would send a WhatsApp message to her mom with the readings, and then inject the amount of insulin Kerry advised.

"Physical exercise really makes a difference to Bella's glucose control," adds Kerry. "On a Monday, she swims at school and its very clear that on Monday night her blood sugar levels are stable. This lasts through the night to the next morning when she wakes up fresh, energetic and hungry."

"From a parent's point of view, dealing with type 1 diabetes in a child takes complete commitment. Children's food preferences also change week-to-week at times, and we're always trying to get the healthy food in, in ways that Bella and Hayley will enjoy."

An amazing opportunity to use high-tech glucose monitoring technology

In 2020, a manufacturer of a Continuous Glucose Monitoring (CGM) sensor device contacted Dr Neville Wellington. He offered him an opportunity to give some of his patients access to the sensors for a month on a trial basis. This sensor is around the size of a R5 coin. It attaches painlessly to the upper arm with a small needle inserted into the skin which detects blood sugar levels. This device takes a blood glucose reading every five minutes. To access the reading, you only need to swipe a smartphone with the linked app over the sensor. This process is a giant leap from traditional finger-pricking techniques used by millions of people with diabetes all over the world. The sensors cost around R1000 each, and each last for two weeks (so two are needed each month).

Dr Wellington was keen for Bella to use the device. It would allow for 24/7 monitoring of her blood sugar levels in the least invasive way possible. "Before Bella had access to this sensor, it was unclear whether she was experiencing hypoglycaemic lows (very low blood sugar) at night when asleep. It was also very challenging to wake her and do finger prick-based blood sugar testing. When they did occur, Bella found the symptoms very frightening, like feeling weak, a high heart rate, confusion and blurred vision," explains Dr Wellington.

The chance to use a Continuous Glucose Monitoring (CGM) device to get proper insight into her blood sugar levels proved life-changing for Bella. "In children, these devices make a massive difference as they take away the need for finger pricks. They allow for an infinite number of readings at any time of day. They also allow older children to take their own readings in an instant while at school or elsewhere. The app gives others, like a treating doctor, access to the results. These devices offer an unprecedented opportunity to identify what is and isn't working in the management of a child's type 1 diabetes, with minimal impact on the child's life."

Discovery Health Medical Scheme announced they would fund the sensors

Unfortunately, both Kerry and Lance faced changes to their employment at the end of 2020, which meant they could not afford the R2000 a month for Bella's sensors. "However, we knew the value of the device for Bella," says Kerry. "And she told us that, for the first time in eight years, she could feel her fingertips as she stopped pricking them for a month."

"We were absolutely thrilled when Discovery Health Medical Scheme (DHMS) announced that in 2021, they would fund the bulk of the cost of Continuous Glucose Monitoring devices for people who have type 1 diabetes. We only pay R390 a month for two sensors. So we only pay R195 towards each sensor and Discovery pays the rest, making them really affordable for us."

"Now we can check Bella's blood sugar levels as often as we like, simply by hovering my smartphone (using the linked app) over the sensor. This sensor has enhanced Bella's understanding of her condition and its management, so much so that she has expressed an interest in studying medicine in future."

• Find out more about DHMS' new cover for continuous glucose monitoring for type 1 diabetes
• Find out more about continuous glucose monitoring.

Dr Wellington adds: "It's a huge shock to any parent to have their child diagnosed with a lifelong illness like type 1 diabetes. I want to commend her parents, Lance and Kerry, for their dedication to optimising Bella's condition through the years. Bella has also been incredible in the way she has adapted to coping with the condition and testing her blood sugar regularly, and now to the use of Continuous Glucose Monitoring devices."

Almost all of Dr Wellington's patients have either type 1 or type 2 diabetes. His practice focuses heavily on managing and correcting these (type 2 diabetes in particular) through a low carbohydrate nutrition approach.

Type 1 diabetes is an autoimmune disorder. This means that it occurs when the body's own immune system damages the pancreas - the organ that produces a hormone called insulin. It's often not clear why this happens or what triggers the damage.

Type 1 diabetes is more commonly diagnosed in children than in adults. Adults who are diagnosed with diabetes most often have type 2 diabetes, which can be prevented or delayed through healthy lifestyle habits.

Type 2 diabetes is a non-communicable disease that is linked to poor lifestyle habits such as unhealthy eating and a lack of exercise. It is reversible if caught early enough and well-managed. The disease's progress can be prevented through lifestyle changes and medicine as needed.

• Why do we need insulin? When we eat carbohydrates, our food is broken down in the digestive system into glucose (sugar molecules). The glucose goes into the blood stream so that it can move around the body to cells where it is stored or used as energy.
• However, when the pancreas can't produce enough insulin (as in type 1 diabetes), glucose can't enter the cells and it builds up in the blood. High blood sugar is very dangerous. It can cause problems with blood vessels, nerves, eyes, kidneys, the heart and other areas of the body.
• This means that people who have diabetes - whether type 1 or 2 - must regularly monitor and balance the amount of sugar in their blood. They can do this by pricking their fingers and putting blood drops onto a test strip which is inserted into a blood glucose monitor for a reading. They can also use Continuous Glucose Monitoring devices like Bella's.
• Type 2 diabetes is a non-communicable disease that is linked to poor lifestyle habits such as unhealthy eating and a lack of exercise. It is reversible if caught early enough and well-managed. The disease's progress can be prevented through lifestyle changes and medicine as needed.