Jillian* was just 14 when she was diagnosed with type 2 diabetes in 2018. Dealing with diabetes at such a young age hasn’t been easy for this Singapore teenager.
Initially, she had to prick her finger several times a day in school to monitor glucose levels. Being naturally shy and reserved, Jillian was embarrassed about her condition, and tried to hide it from her classmates.
But today, thanks to technology, she is able to manage her condition more easily.
We ask Jillian’s mum, Jamie Ye*, about coping with the emotional and physical challenges of diabetes. Endocrinologist Dr Kevin Tan also gives us more information about the disease, including warning signs of diabetes in children.
Coping with Diabetes: A 14-year-old Singapore teen’s story
At what age was Jillian* diagnosed with diabetes? What were the symptoms?
“Jillian* was not feeling well and was initially diagnosed with appendicitis that required surgery. During the surgery, her heart was beating too rapidly. The doctor decided to test her glucose levels, and found that it was higher than normal,” says mummy Jamie*.
“After undergoing medical tests, she was diagnosed with diabetes. However, it wasn’t clear then if she had type 1 or type 2 diabetes. Even so, the doctor decided to give her insulin to control her glucose levels.
“It was only in Oct 2018 that the doctor suggested another round of tests, and she was officially diagnosed with type 2 diabetes.”
Is there a family history of diabetes? Were there any other risk factors?
“We have no family history of diabetes.
“In addition to Jillian* having a penchant for soft drinks and processed foods, she does not enjoy being outdoors. Her dietary choices and sedentary lifestyle may be a contributing factor for her diabetes.”
How did the family react to the news?
“We were shocked by the news. We had many questions – why and how did Jillian get it?” shares Jamie.
“Based on our understanding, diabetes is more prevalent in the elderly. We were surprised to learn that there’s such a thing as paediatric diabetes.
“Diabetes is known to be a gateway disease for many other conditions, such as heart disease. The fact that it is irreversible, also made us worried for Jillian’s* health and future.”
Do share about the medication Jillian* has to take. How often does she have to monitor her blood glucose levels?
“Jillian* has to take oral medicine once daily, and administer insulin three times a day over and above tracking her blood glucose levels 5- 7 times a day.
Has Jillian* been advised to take any special precautions when it comes to diet and physical activity?
“Jillian’s diet had a complete overhaul where she gave up processed foods as well as sugary drinks. She started eating more real foods.
“We started adopting a more active lifestyle. We now regularly go for walks in the park,”says Jamie.
How has the condition affected her life as a student, both physically and emotionally? Has it affected her studies and extracurricular activities?
“Jillian’s* teachers are aware of her condition, but she wanted to keep it hidden from her peers as she didn’t want to be treated differently.
“Jillian* is shy in nature and does not want her schoolmates to know of her condition. Without a doubt, having this condition and the process of monitoring glucose levels has affected her life.
“This often means stopping whatever she needs to do the necessary checks – no matter where she is – in class or when she is playing sport. She checks it 5-7 times a day, per doctor’s orders.
“Earlier, she had to check her glucose levels via the traditional finger prick method. When it was time to check her glucose levels, Jillian would hide in a corner, out of her classmates’ sight, to prick her fingers.
Traditional finger prick test (File photo)
“The traditional finger prick involves sterilising finger tips with an alcohol swab, after which the skin is pierced with a lancet. Blood will ooze out and it is collected via capillary action on a test strip. The strip will then be placed in a meter for analysis.
“The process can be cumbersome as it not only involves multiple steps, and can get messy. This, plus, the fact that it is quite painful does not make traditional finger prick tests ideal when one is on-the-go or in cases where children are involved.
“Sometimes, she may need to check her glucose levels in the middle of PE class, and in this respect, the traditional finger prick method is quite inconvenient.
“Ever since we started using the Abbott FreeStyle Libre system, Jillian* can check her glucose levels quickly and discreetly in class, providing her with greater convenience.
“I am also able to get real-time information whenever Jillian checks her glucose levels. If there are any anomalies, I am able to act on them immediately.”
Please tell us how technology has helped Joreen manage her condition better? How did you get to know of the FreeStyle Libre system, and how has it helped?
“When she was first diagnosed, Jillian was checking her glucose levels by means of the traditional finger prick test. It was hard for her, as this is often a painful process even for adults.
“Watching my daughter go through the pain of routine finger-pricks on a daily basis was hard. Apart from that, it can get frustrating for her at times, as more often than not, she has to check her glucose levels when she is in the middle of lessons. This is often disruptive, as she had to put her life on halt just to get a glucose reading.
“My heart ached whenever I looked at Jillian’s fingers – they had puncture wounds all over. I was determined to find a better way for Jillian to check her glucose levels.
I did some research and came across Abbott’s FreeStyle Libre system. What intrigued me most was that this system eliminates the need for routine finger pricking. I bought it for Jillian and we have not looked back.
“All she has to do is apply the sensor at the back of her arm and she can start checking her glucose levels at any time. This process is fast and convenient.
Abbott’s FreeStyle Libre system
“She doesn’t have to worry about changing sensors as it lasts for 2 weeks. She can go on with her life, without any disruptions. The sensor is small and sleek and doesn’t stick out – that’s a boon for teenagers with diabetes.
“The system also enables us to download Jillian’s glucose level readings and share with her doctors and nurses, providing greater insights to Jillian’s condition. With this, her condition is better managed and we can give her a better quality of life.
Abbott’s FreeStyle Libre system
“Glucose monitoring is now more convenient with Abbott’s FreeStyle Libre system and its accompanying apps. She is happy with the introduction of the FreeStyle LibreLink app, as this means she can check her glucose readings on-the-go by just scanning with her mobile phone, and do away with the traditional finger prick.
“The introduction of the app, brings me a greater peace of mind, as I know she is able to check her glucose levels anywhere, and anytime. After all, a teenager will forget many things, but will always remember her mobile phone!
“An accompanying caregiver app, LibreLinkUp, has given me a greater relief. Whenever Jillian checks her glucose levels, I am notified of her glucose levels real time.
“With the FreeStyle Libre system and its accompanying app FreeStyle LibreLink, we are able to help check Jillian’s glucose levels regularly, even when she’s asleep. This can help prevent a hypoglycemic episode.
“Prolonged periods of high glucose levels in system (hyperglycemic) can be detrimental to her overall health. This system has really helped us in monitoring and maintaining her glucose levels in the normal range,” says Jamie*.
What advice do you have for other parents, and for parents who have children with diabetes?
Jamie* has this to say, “Diabetes can affect anyone. As parents, we should always encourage our children to adopt a healthy lifestyle. This includes making wise food choices, getting enough rest, exercising, and maintaining a positive mindset.
“Diabetes is a lifelong condition that requires continuous management. This can get mentally exhausting for both parent and child. As parents, we are our children’s pillar of support. It is imperative that we remain strong, and encourage them every step of the way.
“When battling a condition like diabetes, there will always be ups and downs. We have to be patient and understanding, as our emotions may affect our kids.
“As a family, we have to show that we are supportive of Jillian’s battle with diabetes. This means adopting the same lifestyle changes as Jillian*, reminding her that she is not alone.
“This includes experimenting with the type of foods that Jillian* eats. In this way, we will be able to determine which kinds of food triggers hyperglycemia in her.
“We should also not be too quick the judge our children when their glucose readings are high. Dietary and lifestyle choices are not the only factors affecting glucose levels in the body. Hormones can influence glucose readings as well, thus it always important to check glucose levels regularly.”
Thank you, Jamie*, for sharing your experience and learnings with us.
In many ways, diabetes in children poses greater challenges than diabetes in adults. Do read on for more valuable information on the disease, and how it affects children’s health, from endocrinologist Dr Kevin Tan.
Warning signs of diabetes in children: Interview with endocrinologist Dr Kevin Tan
What is diabetes and what are the different types?
Diabetes is a condition that occurs when blood sugar levels are too high.Blood glucose is our main source of energy and it comes from the food we eat. Insulin, a hormone produced by our pancreas, helps regulate the glucose levels in the blood.
Sometimes the body doesn’t produce enough insulin, or doesn’t utilise it well. When this happens, blood glucose levels aren’t well-regulated. High blood glucose levels can have a negative consequence on the body. This includes damage to the blood vessels and nerves in the longer term.
There are a few types of diabetes, but the most common ones are type 1 diabetes, type 2 diabetes, and gestational diabetes.
95% of all diabetes cases are type 2 diabetes, making it is the most common form of diabetes globally.
An interplay of genetic factors, as seen in a family history of diabetes, and environmental factors, such as dietary habits, contribute to the development of type 2 diabetes. Out of which, obesity is the main driver of type 2 diabetes. This is often caused by bad dietary habits and a sedentary lifestyle.
Type 1 diabetes accounts for less than 5% of all diabetes. It can affect all ages, and in individuals with no family history of diabetes. It is due to the destruction of the insulin producing cells (islets) in the pancreas by the body’s own immune system.
Gestational diabetes or diabetes that is first discovered during pregnancy happens to 10 – 20% of pregnancies. It is brought about by several factors. These include hormones, maternal age, family history and being overweight. It usually disappears after delivery, but can occur in subsequent pregnancies and even later in life.
Is diabetes in children inherited, or due to lifestyle? Is it different from diabetes in adults, and how?
There was a clear distinction in the past where type 1 was specific to kids and type 2 was specific to adults. However, now the lines are blurred. Both children and adults can develop type 1 diabetes as well as type 2 diabetes. The reason why type 2 diabetes can occur in children is caused primarily by lifestyle habits and being overweight.
It would be unfair to say that there is no difference between diabetes in children or adults. Onset of diabetes in a younger person means more years are spent living with and managing the condition.
This exposes the individual to a greater risk of diabetes-related complications. Managing diabetes in young children and adolescence has its own share of challenges and difficulties, as the concept of morbidity and mortality are abstract at such young ages.
What are some warning signs of diabetes in children that parents should look out for?
In Type 2 diabetes, there may be no symptoms until the blood glucose builds up to a high level.
In Type 1 diabetes, however, symptoms of diabetes usually develop quickly. Some signs and symptoms that parents should look out for are:
- Extreme hunger
- Increased thirst and frequent urination
- Ants around the toilet bowl
- Weight loss
- Irritability or behaviour changes
- Fruity-smelling breath (this is often present when the disease has progressed further along; the person is usually in a semi-conscious state.)
Can diabetes in children be cured, or is it a lifelong condition?
Diabetes, once it develops, can’t be cured and is lifelong.
Type 2 diabetes is a lifelong condition. If it is developed due to obesity in the child, weight loss can lead to disease remission. The condition is preventable. This can be done by maintaining a healthy weight.
When there is a family history of diabetes, it is important to inculcate and cultivate the importance of healthy eating habits and an active lifestyle from young. This should be done as a family, as children learn by examples, especially from their parents.
Bad habits are hard to break. It is important to limit snacking and fast foods, and restrict idle television and computer time. We should encourage more outdoor activities, and eat more home-cooked meals as a family.
In the case of type 1 diabetes, it is not preventable. Thankfully, it is the less common form of diabetes.
What are the stats for diabetes in Singapore children? Has it been on the rise over the years?
There are no statistics available for children living with diabetes in Singapore.
It is estimated that the incidence of type 1 diabetes among children and adolescents, in particular those younger than 15 years, is increasing in many countries. The annual increase is estimated to be approximately 3%, with strong indications of geographic differences – usually in North American, European, and the Caribbean regions (Diabetes Atlas 2018)
Type 2 diabetes is a condition where probability increases with age:
- Aged 30 -39: 1 in 25 have diabetes
- Aged 65 and above: 1 in 3 have diabetes
In Singapore, results from two national health surveys done between 2004 and 2010, have shown that the number of type 2 diabetes cases in people (aged 30 -39) have doubled. Data has also shown that it is occurring at younger ages.
Why is it important to manage diabetes, especially in children? What are some diet and lifestyle changes needed to manage the disease?
Onset of diabetes in a child or younger person is a devastating blow, both to the person as well as the parents. If the condition is preventable, as in the case of type 2 diabetes, this has to be a priority.
A younger person diagnosed with diabetes means more years are spent living with and managing the condition. This exposes the individual to a greater risk of diabetes-related complications.
Managing diabetes in young children and adolescence has its own share of challenges and difficulties, as the concept of morbidity and mortality are abstract at such young ages. There are also other distractions and priorities at this stage in life.
If rules are enforced by parents without any explanation or discussion, children may rebel and resist. This can lead to years of poor diabetes control.
Long periods of poor diabetes control is linked to diabetes related complications. Poor diabetes management in youths can set the stage for complications later in life.
A dietitian’s role in diabetes management is very important. For an overweight child with type 2 diabetes, weight loss is required. Balanced caloric intake is important in ensuring that child achieves his/her ideal weight while coping with increasing energy demand of a growing child.
The child and family have to be educated on making the right food choices, even on special occasions, and the need to adopt an active lifestyle. This has to be done with caution, ensuring that the child does not feel restricted, and rebel against any rules imposed.
This needs to be further scrutinize for a child with type 1 diabetes. In order to manage the condition, insulin needs to be administered regularly by means of an injection or insulin pump. Proper lifestyle management is required to ensure that the child does not experience a hypoglycemic episode.
What is the role of technology, and some tools parents can use to manage their child’s diabetes? How often do parents have to measure the child’s glucose levels?
Technological systems that are easily integrated into people’s lifestyle can have a life-changing impact. Technological advances in diabetes management include:
- Insulin pump technology – for delivery of insulin to the body
- Continuous glucose monitoring systems – function on its own or with a pump device in a close-feedback loop-system
- Flash glucose monitoring – measures glucose levels in the body by means of a sensor
Flash glucose monitoring technology helps users understand the correlation between their lifestyle choices and their glucose levels.
Insight gained from the system informs and empower them to make healthier changes and choices, which can help prevent disease progression and the development of other associated risk factors (myocardial infarction, stroke, microvascular events, and mortality. This can potentially help reduce the burden of diabetes on Singapore’s health system.
As part of disease management, children with diabetes have to check their glucose levels regularly, between 4 – 10 times.
The finger prick test is the traditional way of testing for blood glucose levels. When the skin is pierced with a lancet, it can get quite painful. It can also get quite painful for adults, much less children.
For parents, it is heartbreaking to see the fear and pain in children’s eyes when they need to take their glucose levels.
Now, technological advances have enabled people with diabetes to move away from the traditional routine finger pricks to using flash glucose monitoring systems. Abbott FreeStyle Libre is one such system.
Studies have shown that patients are checking their glucose levels more regularly when they use the FreeStyle Libre system which results in a marked improvement in glucose level control.
It works by measuring glucose levels in the interstitial fluids by means of a wearable sensor. The sensor is attached to the back of a person’s arm, and the person can start reading their glucose levels with a reader.
The introduction of the FreeStyle LibreLink and LibreLinkUp mobile apps advances the functionality of this ecosystem.
People living with diabetes can easily scan using their mobile phones without having to carry another device, providing real-time data to users and their caregivers which ensures better control over their condition.
The biggest difference is that glucose level testing becomes very discreet, so there isn’t a stigma or social awkwardness that’s associated with the traditional finger pricking. For teenagers attending school, trying to make friends and ‘fitting in’, the social awkwardness of glucose testing is significant.
*Names have been changed on request