Cook Children’s Health Care System has successfully achieved six rankings in the U.S. News and World Report’s Best Children’s Hospital list for 2022-2023. This is an impressive and exciting jump from 2021 when Cook Children’s ranked nationally in two specialty categories.

The report, which was released today, uses clinical data to measure patient safety, infection prevention and adequacy of nurse staffing. Out of 284 children’s hospitals in the U.S., only 90 ranked in at least one of the 10 pediatric specialties evaluated. The following six Cook Children’s specialties were named among the top programs:

• Pediatric Neurology and Neurosurgery - #29 in the nation
• Pediatric Diabetes and Endocrinology - #38 in the nation
• Pediatric Orthopedics - #41 in the nation
• Pediatric Pulmonology and Lung Surgery - #43 in the nation
• Pediatric Cardiology and Heart Surgery - #48 in the nation
• Pediatric Cancer - #50 in the nation

“For more than 100 years, Cook Children’s has been committed to providing the best quality medical care for children. The U.S. News and World Report rankings further validate the tireless dedication of our staff to fulfill our Promise,” said Rick W. Merrill, President and CEO of Cook Children’s Health Care System. “As we look toward the future, with the opening of our new hospital in Prosper, Texas, later this year, we are excited to bring our world-class pediatric care to even more children and families.”

Out of the six specialties ranked on the Best Children’s Hospital list, all but one are currently operating at Cook Children’s Pediatric Specialties – Prosper. Neurology, endocrinology, pulmonology, cardiology and pediatric cancer services are all available for new patient appointments. 

What played a role? In some cases, junk food and lack of exercise as the COVID-19 pandemic wears on.

Childhood obesity was already a concern in the United States. In 2018, the Centers for Disease Control (CDC) reported that 19.3% of the 2-19 age group were considered obese. That’s about 14.4 million children and adolescents with excessive weight that could lead to other medical problems like diabetes, heart disease, high blood pressure, and joint pain.

But doctors and dietitians fear obesity has gotten worse due to habits that changed during the COVID-19 lockdown and afterward, continuing today. A study cited by the National Institutes of Health (NIH) even uses the term “covibesity” to describe the phenomenon of rapid weight gain that resulted when people changed their eating and exercise routines during the pandemic.

If the early months of the pandemic set the stage for higher obesity rates, the toll on health is current and ongoing. Consider diabetes, for instance: Cook Children’s has seen 91 new cases of Type 2 diabetes diagnosed already this year.

Escalation in childhood obesity becomes an even more relevant and urgent concern given reports of higher risk of severe COVID-19 symptoms for those with obesity. The CDC points out that excessive weight can cause impaired immune function and decreased lung capacity, which may worsen the illness. The CDC cites one study that linked obesity in pediatric patients to higher rates of hospitalization, admission to intensive care, invasive mechanical ventilation and death from COVID-19. At Cook Children’s Medical Center, this rings true. Many of the patients admitted to the COVID-19 ICU are obese are require life-saving measures.

Alice Phillips, M.D., a pediatrician at Cook Children’s, described the accelerated rise in childhood obesity as an outcome of the dramatic lifestyle changes brought on by the COVID-19 lockdown beginning in 2020. Multiple times a day, Dr. Phillips encounters and counsels patients whose body mass index (BMI) has surged since their last checkup.

When the schools were closed, lots of homebound kids began to snack out of boredom. They watched more TV and did online learning in front of a computer – no walking required. Recess, PE classes and team sports were canceled.

“Parents have been trying to nurture their children during a very difficult time. Food remains a cultural norm of nurture for families, and we are seeing the unexpected consequences,” she said.

Dr. Phillips emphasized it’s appropriate to expect a child to pick up some weight during a growth spurt. Pediatricians track the curve using the BMI calculations, which take a patient’s age, height and gender into consideration. Obesity by definition occurs when BMI reaches the 95^th percentile or higher.

Dr. Phillips and her colleagues at Cook Children’s point out two trends: an increase in patients whose recent weight gain put their BMIs in the 95^th percentile for the first time, and previously obese patients who became even heavier.

“When you see an acute change in the BMI from the 75^th percentile to the 99^th percentile, that’s when it catches your eye and you say, ‘What was different this year that caused that change?’” she said. “All too often during the pandemic the families will say, ‘We haven’t been getting any exercise, and our eating habits are maybe a little worse.’”

She worries about the long-term consequences on their health. When she raises the subject of obesity with her patients, she speaks with sensitivity and tries to help the families feel empowered to set goals they can achieve.

“You have to be very careful that you handle that conversation in an empathetic way,” Dr. Phillips said. “I don’t want how I handle it to be part of the problem for this child.”

Here’s what’s important to know:

• Obesity commonly begins between the ages of 5 and 6, or during adolescence. The causes include overeating, genetic predisposition, stressful life events (such as divorce or a move), depression and low self-esteem.
• Obesity is a chronic disease that adversely affects both physical and mental health. It’s easy to diagnose but hard to treat – potentially setting up a lifetime of complications.
• Studies referenced by the NIH show that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an adult with obesity.

Susan Hsieh, M.D., a pediatric endocrinologist at Cook Children’s, is seeing more patients diagnosed with obesity-related spinoffs that used to be considered adult diseases: hypertension, high cholesterol and Type 2 diabetes. She also points to the COVID-19 lockdown as a tipping point for kids who gained 30-40 pounds since last year. “The body isn’t designed to take on that much weight in such a short period of time,” Dr. Hsieh said.

She explained that obesity causes insulin resistance, impeding the body’s ability to control the blood sugar. It used to be rare, she said, to see an 8- or 9-year-old diagnosed with Type 2 diabetes. Not anymore.

Data at Cook Children’s show that Type 2 diabetes has been on the rise, with 55 new diagnosed cases in 2018, 107 new cases in 2019, and 126 new cases in 2020. The count so far for 2021 is 91 new cases through early September.

Early onset diabetes, if hyperglycemia is mild, can be treated with oral medications. For those patients who require insulin injections, Dr. Hsieh encourages weight loss as a motivation to wean themselves off the injections. She urges families to address their child’s escalating obesity sooner rather than later.

“In general, it’s easy to gain weight and very hard to lose weight,” Dr. Hsieh said. “The more we educate, the better, because prevention goes a long way.”

The Endocrine Clinic at Cook Children’s offers a program called Risk Evaluation to Achieve Cardiovascular Health (REACH), targeting kids affected by cardiovascular diseases caused by obesity or other factors.

Since the start of the pandemic, registered dietitian Lauren Williams found that her REACH patients and their parents often report more junk food consumption and less physical activity. She counsels them to treat food as a source of nourishment.

Williams’ main message? “We need a healthy relationship with food. We don’t snack throughout the day when we’re not hungry. We move our bodies because our bodies were made to move. Exercise helps our mind; it helps our sleep. Get out and run and play even if it’s just with your siblings in your backyard, having fun.”

Cook Children’s also offers a one-time, free-of-charge class called Healthy Weight Healthy You, which promotes the MyPlate nutrition guide and other tools to eat right. The class is offered in both English and Spanish for children ages 5-18 and their parents. A physician’s referral is needed.

Another resource to fight obesity is the Cook Children’s Outpatient Nutrition Services, available only through referral from physicians in the network. Jean Mankin, a registered dietitian in the outpatient clinic, said the incidence of childhood obesity “exploded” during the COVID-19 pandemic.

“Almost every patient that I’ve seen will admit to boredom eating. And the parents will agree,” Mankin said. “The parents will say ‘I was trying to work… I was there for emergencies but the kids were left to their own devices and they were grazing all day on chips and cookies and crackers.’”

Now she works with families to undo the damage. Bad habits – constant snacking, inactivity -- can be corrected. But it starts with recognizing the problem.

The patients Mankin meets with often arrive with complications tied to the excess weight on their bodies. She lists orthopedic problems, respiratory issues, elevated lipids, elevated liver enzymes and sleep apnea among the ailments.

A one-hour consultation with Mankin encompasses a review of the family’s journal of food intake over several days; guidance on problems she identifies; a packet of information to take home; and lots of encouragement. No one is forced to get on the scale. Mankin says she frames the conversation around the proper nutrition necessary for growth and development -- avoiding the word “obesity” out of sensitivity.

“Some of these little ones and adolescents can easily get their feelings hurt. And when that happens, they shut down. I also encourage parents to be mindful of the language used at home,” she said. “I work really hard to focus on overall health and to keep a positive vibe in my office. Initially, many kids that come to me are somewhat fearful or trepidatious, but most leave with a smile on their face.”

She emphasized that parents must be committed to making changes in the family’s approach to meals and exercise. Improvements don’t usually happen right away. A follow-up visit with the dietitian might be needed after the initial consultation.

If you have a concern about your child’s weight, contact your pediatrician.

Like a lot of boys growing up, Dr. Thornton’s interest centered on athletics. He calls himself a “sports fanatic,” playing rugby, cricket, tennis and swimming. As a kid, he played more than studied.

So when Dr. Thornton told his guidance counselor in high school that he wanted to become a doctor, the counselor told the man who would become a world expert in a rare disease that he needed a back-up plan.

What the guidance counselor didn’t understand just yet was that Dr. Thornton’s focus from an early age was on science and medicine. Dr. Thornton saw something in himself that nobody else saw.

“When I said I wanted to be a doctor they told me I should have a backup plan,” Dr. Thornton says now with a twinkle in his eye. “So that was always fascinating to me. I wasn’t the guy people thought was the most intelligent person in the class. Now I’m a world expert in a disease. Once I became a doctor, I realized where my true passion was and I followed it.”

Congenital Hyperinsulinism

Dr. Thornton resides at Cook Children’s as the medical director of the Endocrine and Diabetes Program and the Hyperinsulinism Center. He played a vital role in establishing the first two centers for congenital hyperinsulinism (CHI) in the nation.

His congenital hyperinsulinism program at Cook Children’s celebrates its tenth anniversary this year. The genetic forms of HI affect only between 80 and 120 babies each year. For those affected by the rare condition, it can be a life-changing event. Without an accurate diagnosis, children face living with seizures and permanent brain damage.

The program gives many patients an opportunity for a cure because of the expert staff and the use of an investigational new drug called 18F DOPA in combination with a PET-CT scan to more accurately diagnose and treat HI.

The 18F DOPA/PET-CT scan serves as a diagnostic test that has altered the treatment and even led to cures for children with certain forms of hyperinsulinism. Cook Children’s remains the only facility in the south and the second in the country to use 18F DOPA – an investigational drug – in combination with a PET-CT scan to diagnose focal lesions in children with congenital hyperinsulinism.

Dr. Thornton leads a team of physicians specialized in endocrinology, pediatric surgery, neonatology, neurology, gastroenterology, pathology and radiology. The team is supported by a dedicated HI nurse practitioner, social worker, clinical therapist, child life specialist, nutritionist and feeding and speech therapists.

At the heart of the program is Dr. Thornton, one of the most recognized and respected HI specialists here and around the world.

The Expert

To show what a leader he is in the field, Dr. Thornton’s served as lead author for an article titled “Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants and Children.” This article established the groundwork in creating new screening for physicians to recognize and manage neonates at increased risk for a persistent hypoglycemia disorder.

The guidelines help physicians recognize the symptoms of uncontrolled hypoglycemia caused by CHI who are at risk for seizures or permanent brain damage without early identification and screening.

Dr. Thornton’s recognition as a leader earned him one of the first two endowed chairs at Cook Children’s. He’s a recipient of the Rare Disease Hero award, which recognizes only five physicians each year for groundbreaking research and treatment in the rare disease community.

He’s come a long way from what Dr. Thornton calls his “quirky story.”

Growing Up

Dr. Thornton grew up in a middle-class family in Ireland. His grandfather ran the water department for the government, responsible for water purity for the country. His father did not go to college but rather became a businessman.

Little did Dr. Thornton know how hard his father worked to give his children an opportunity to continue their education.

“I went to a private Catholic school. This is going to sound really strange, but I did not know it was a private school,” Dr. Thornton says while laughing at the thought. “You know in Ireland, everyone wears a school uniform. It’s not like in the States where only private school kids wear one. And it’s not like here, where there’s a private school at every stone’s throw. It just never dawned on me. Later my father said, ‘Do you know how hard we had to work to pay for that school?’”

Maybe it’s that example of hard work that led to Dr. Thornton earning his medical degree by the age of 23, the culmination of a childhood dream.

“It’s funny because there was almost nothing else I ever wanted to be. I knew from the age of 12 that I wanted to be a doctor,” Dr. Thornton said. “I think it was probably because of our family practitioner (Dr. Brendon Deasy). Dr. Deasy was a really good friend of the family, so I got to know him very well. I went to see him professionally every year. I realized that the work of a doctor was a really nice career. You got to meet new people every day. You got to help people. He is probably responsible for showing me what a great job being a physician could be.”

Dr. Thornton went to college without a backup plan. He knew once he got into university and could focus on studying to be a doctor, he would excel.

A Pediatrician

Once his clinical rotations began, Dr. Thornton decided early on that pediatrics was for him.

“When you work with children, they are restorative. You can’t come in grumpy.. You end up having fun doing your day’s work,” Dr. Thornton said. “It never seemed like a lot of fun dealing with adults all the time.”

What did seem like fun was endocrinology. Although his focus came about through a bit of circumstance and travel.

In medical school, Dr. Thornton excelled and “fell in love with learning.” He begins to get noticed too and that eventually led him to Great Ormond Street Hospital (GOSH) for Children, the oldest and one of the most prestigious pediatric hospitals in the world. This job was part of a job exchange with residents from the Children’s Hospital of Philadelphia, so Dr. Thornton headed to the States for a year

Dr. Thornton pauses for a moment thinking about his arrival in the United States.

“I only spent 28 years of growing up in Ireland. I left for England at 28 and came to the U.S. at 29. So actually, I spent less than half my life in Ireland. Wow!”

At CHOP, Dr. Thornton met the mentors who changed his life. He learned about endocrinology and specifically, hypoglycemia. “It didn’t take me long to determine that’s what I want to do with the rest of my life,” he said.

“I was very lucky that I trained at the only place, at the time, that had that sort of hypoglycemia program,” Dr. Thornton added. “So two of the doctors (Lester Baker and Charles Stanley) out of my four attending physicians were the world experts in hypoglycemia. It was just fascinating. The patients we were seeing were very difficult kids to manage.”

At the end of his year commitment, Dr. Thornton planned on returning to England, but CHOP offered him a fellowship to stay. He wrote GOSH a letter that said he wasn’t going back to London.

Returning to Great Ormond Street meant Dr. Thornton couldn’t stay on his new chosen career path. He wanted to learn more about treating children with hypoglycemia. Dr. Thornton did return to Ireland from 1996-1999 but eventually went back to CHOP where he remained until 2002 when he got a call from a recruiter.

Welcome to Cook Children’s

Dr. Thornton admits now he’d never heard of Cook Children’s or even Fort Worth when approached about a new job. He turned the recruiter down. Then a few months later, Dr. Thornton presented a paper at a Pediatric Society meeting. The recruiter showed up to hear him speak and invited Dr. Thornton to breakfast for one final pitch.

The recruiter showed Dr. Thornton pictures of the medical center and information about the institution. They ended up talking for four hours.

Following a trip to Fort Worth and a visit to Cook Children’s, Dr. Thornton accepted the role of medical director of Endocrinology.

“Now I still had so much to do. When I got here there were only two doctors. The waiting time was something like nine months,” Dr. Thornton said. “We had to do a lot of work to get the place how I wanted it. Everyone was good people and everyone was working hard. They just needed new leadership and some organization. So the first two or three years was building the program, hiring nurse practitioners and doctors. I focused on the organizational things and developing protocols.”

Soon, the department blossomed and Dr. Thornton became very busy not only as an administrator but seeing patients. However, something remained that lurked in the back of his mind since his arrival at Cook Children’s.

“I reached a position where I had time to think about my future here in Cook Children’s, ‘I had a skillset and focus on hypoglycemia and congenital hyperinsulinism (CHI). I decided to approach the hospital and say, ‘I'd like to set up a new hyperinsulinism center and develop a surgical program for the babies with HI.’ We wrote a proposal and it was like ‘Boom!’ They said, ‘yes.’”

Building a Program

After helping to launch the first such program in the nation, Dr. Thornton knew what he wanted when he began the second one at Cook Children’s. He brought a nurse coordinator/ nurse practitioner, Lisa Truong, CPNP-AC, to help him with the day-to-day operations.

“When Dr. Thornton asked me to join, I was very excited. It was a challenge to build a program from scratch. Ten years later, it’s still a challenge but I love it. All the kids we see are completely different because it’s such a rare condition. No kids present the same, which I like because it keeps me on my toes. I have learned so much from Dr. Thornton throughout these 10 years. He is an awesome boss and a great mentor."

Over the next three to five years, the program continued to grow and build. Cook Children’s showed their support for the program by naming Dr. Thornton one of the first two endowed chairs in the history of the program. Everything clicked.

Even after all this time, nothing thrills Dr. Thornton more to give good news to the families he treats. He continues to carry on a tradition of taking pictures with his families and marvels at their excitement when things go well.

“They realize that ramifications of what life means for them now that their child’s cured,” Dr. Thornton said. “A lot of these families don’t understand what it will mean to their life until it happens. And then it’s a big shock when they get home and realize, ‘Oh my God, I don’t have to check on my baby’s blood sugar eight or 10 times a day. The difference is so huge. You can just see how very happy the family is when there’s a cure.”

If only that guidance counselor could see him now.

Brec was diagnosed with Type 1 diabetes at 8 years old. Shortly after her diagnosis, she spent a week at Cook Children’s Medical Center. Even with a busy career as an actress, Brec flies from her current California home back to Fort Worth every three months for a checkup.

“Of course an 8 year old doesn’t know what’s going on,” Brec said. “Doctors are talking to you and telling you that you are going to have take shots and do this and this and this. I didn’t know what was going to happen. But Nick Jonas had an article in People magazine in that same week I got diagnosed, and my mom brought it to me and said, “See if he can do it, you can do it.’ I remember feeling so inspired and so motivated. I’m like, “I want to be someone’s Nick Jonas.”

Brec, who is currently on Nickelodeon’s “School of Rock,” became well-known to kids as the star of “Bella and the Bulldogs.” She also has appeared in two episodes of ABC’s “The Goldbergs.” Brec grew up in Saginaw, Texas where she played volleyball, basketball and ran track. She also competed in beauty pageants and was an Our Little Miss World winner.

It was during an Our Little Miss World pageant in 2008 that Brec began to show symptoms of Type 1 diabetes. She was staying at a hotel in Alabama with her mother and grandmother.

“They noticed very easily there was something off with me,” Brec said. “I was wetting the bed. I didn’t do that normally. I had lost a lot of weight. I was very thirsty. My mom planned on taking me to the doctor when we got back. But when she typed in what was going on, before we even went to the doctor, she knew what the diagnosis was going to be.”

Shelley, Brec’s mom, said she couldn’t believe it at first. The family has no history of diabetes. But she couldn’t ignore the facts. In one week she spent at the pageant in Alabama, Brec needed her fitted clothes taken up numerous times because she had lost so much weight.

They flew home and as soon as the tests returned and Brec was sent to Cook Children’s.

During the week that she spent at the medical center, Brec learned to take care of her “life-changing disease.” She learned to count her carbs and by the second day, she was learning to give herself injections of insulin.

“For me that was very emotional because you never want to see your child have to do that. I remember that was a very emotional time for me as a parent,” Shelley said.

Brec, laughing interrupts. “How about when you had to learn to give me a shot!”

Shelley recalls, “Oh, I struggled probably just as much as you did the first time the nurse had me give you a shot. I remember saying, 'I don’t want to poke her.'”

Brec recalls the teddy bear she received from Cook Children’s staff to help her practice giving shots and how that began a relationship with Cook Children’s that lasts to this day. While she was at Cook Children’s today for her checkup, she took time out to visit the Child Life Zone and talk to other patients.

You know, basically being their Nick Jonas.

“I just turned 18 and so I’m probably going to transition to a doctor out in California,” Brec said. “That’s unfortunate because Cook Children’s just seems so safe for me and change is always weird. I’m nervous. This place, they are so nice here and so welcoming. It is a little scary and this place just makes me feel like a kid, which I love. I want to always feel like a kid. I cried when I had to leave Cook Children’s after that first week I came here because I had such a good time.”

While Brec looks back on that first week fondly, she remembers other kids who took the news of their diagnosis hard. She said she remembers one little girl vividly. She “just seemed so sad.” Brec wonders now if that child didn’t have the supportive family that she had as a child.

Brec’s dad, Raymond, wouldn’t allow sadness into his daughter’s room. Everyone had to remain upbeat during a visit.

“When Brec was first diagnosed, her dad told her, and I don’t know if she knew how literal this was, but he said, “(Type 1 diabetes) is going to be a pain in the butt the rest of your life,” Shelley said. “But it changes nothing. His whole mindset was even though this is a big deal, it never should be treated like a big deal. She was still Brec. The only difference was she had to count her carbs and take a shot every time she ate. But I think that set the tone for her and for all of us. She never felt different. She never felt like it was that big of a deal in her life, even though it is.”

Brec has taken that positive attitude from her dad and carried it into her own life. She wants to serve as a positive example for other kids living with Type 1 diabetes. She is an ambassador for the Juvenile Diabetes Research Foundation (JDRF) and never shies away from talking about her condition.

“For newly diagnosed kids, specifically, I just want you to know that it’s going to be a daily struggle, but it’s just something you are going to have to deal with and you will be able to deal with it,” Brec said. “It doesn’t change who you are. Yes, you now have diabetes, but you are not diabetes. And in the long run, it will just make you a stronger person.”

Who knows? Maybe there’s a child reading this right now thinking, “I want to be someone’s Brec Bassinger.”

Resources:

• Cook Children's Endocrinology Program
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• Appointments and Referrals
• Specialty Programs 
• Diabetes Program

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I’m a teenage girl with a lot of hopes and dreams, but with a lot of desires comes big responsibilities. One responsibility that I did not get to “choose” is being a Type 1 diabetic. I’ve been a Type 1 diabetic and a patient of Dr. Paul Thornton at Cook Children's for over eight years now.

My day-to-day life is different than the lives of many others, but I’ve chosen to embrace my differences. Type 1 diabetes is NOT a setback. Dealing with my illness has made me realize that everyone is dealing with a battle we all know nothing about.

Type 1 has helped me be more aware of others and just to be kind when kindness might not be the first resort.

I still am very active in sports, hanging out with my friends, studying at school, and spending time with my amazing family.

My day-to-day life includes many finger pricks, insulin shots, and carb counting. I’m constantly looking at food as just a number. There are often many ups and downs in a single day including being frustrated or irritated due to a high blood sugar or even dazed and confused from a low.

These emotional swings can take a toll, especially at school. Luckily, I have a fantastic team of nurses who help me combat these issues while I am at school. It was more difficult when I was younger because I wasn’t as self- sufficient and needed to rely on one of my parents or a nurse 24/7.

My parents didn’t hold me back from going to birthday parties or even sleepovers, but it was tougher on all of us because nighttime is extremely dangerous. Therefore, my mom and I would have to devise plans to keep my life somewhat regular as a child but still be cautious of my situation.

This often called for some midnight or even 1 a.m. pickups by my parents from sleepovers. Through the years, I have generated an amazing group of friends who are always there to support me. Most recently, I have established some great friendships with some other “Type Ones” … Some people who finally understand what day-to-day life is like for me (and them too).

I don’t look at my disease as a burden but I will say that having someone with whom I relate was and still is a key factor in coping with my case scenario. When I was diagnosed, my world stopped and I did not think that was possible at such a young age.

At the time I was diagnosed, I was really into the Jonas Brothers, and it just so happened that Nick Jonas has Type 1 as well. Knowing this about Nick brought me a lot of comfort because he did not let diabetes stop him.

His ability to still perform and live a normal life while working with his condition in the background is still so inspiring to me.

If you only take one thing from this, I want you to know that you are not alone. With each passing day, it will become easier as you learn more and more about yourself. I have chosen to speak out because this disease does NOT define us.

Diabetic alert dogs like Journey are specially trained to detect high or low levels of blood sugar for kids like Hannah. Journey was Hannah's constant companion for the past three years and news reports say they went "everywhere" together: school church and camp.

"(Hannah) is struggling, but hanging in there," Hannah's mom told ABC news. "She has an amazing support system."

As one of Cook Children's endocrinologists, this story hit me especially hard. I see some amazing kids every day who are coping bravely with diabetes.

The story also reminded me of time I met Kyle Cochran (@KyleCochranANW) who was kind enough to volunteer at Camp Aurora one summer. Cook Children’s diabetes staff strongly support this camp, and many of the children attending are patients at Cook Children’s.

Kyle has lived with diabetes for most of his life and has competed at a very elite level in American Ninja Warrior. He uses both his diabetes service dog, Leeloo, as well as Continuous Glucose Monitoring (CGM) technology to closely track his blood sugars during high intensity training and competitions.

I asked Kyle to share unique perspective.

Why did you decide to get a diabetes alert dog?

Kyle: I decided to get a service dog because during my training I tend to drop really rapidly. I needed to be warned of the drop much sooner to avoid missing training time to treat a low. Leeloo alerts me before I even get low so I can treat the low and never have to pause the workout.

How do you use both Leeloo and CGM together?

Kyle: I love using Leeloo alongside my CGM. She is great at catching highs and lows before they even happen and the CGM is great for letting me see the exact number I’m at.

What advice do you have for a person or family considering a diabetes alert dog?

KyleThe advice I would give to people is to realize the HUGE responsibility it is to have a service dog. It’s kind of like having a child since you bring him/her with you everywhere. You must remember basic things such as ensuring enough food and water, avoiding over-heating, and dog bathroom breaks.

You will be asked questions about them EVERYWHERE you go. Training never ends, You must have more patience than you’ve ever had. I suggest buying the book, "Training Your Diabetic Alert Dog” and read the whole thing before getting a dog.

How do diabetes dogs help?

The high blood sugars and especially low blood sugars are a major concern for people with diabetes and their family. Low blood sugars in particular can lead to loss of consciousness and seizures. Any assistance in avoiding extremes in blood sugar is important and helpful in improving quality of life and keeping blood sugars in target range.

It's believed that the keen sense of smell is the key in blood sugar detection. A research study showed s dogs could sense blood sugar levels in sweat samples.It's possible that diabetes alert dogs (DADs) sense changes in the appearance, heart rate, or breathing associated with changes in a person’s blood sugar.

Technology vs Dog

Continuous glucose monitoring (CGM) technology continues to improve and has the ability to identify low blood sugars correctly in 90 percent or more cases. Given the cost and commitment of a diabetes alert dog, a prime question to be answered is how diabetes alert dogs compare to CGM reliability.

There is surprisingly not much information regarding alert dog reliability. Most of the information is comes from small sample size research surveys or reports. There are wildly differing reports on dog sensitivity to detect hypoglycemia ranging between 22-100 percent in a compilation of reserch studies.

Final Thoughts

It will be interesting to see if a research study is done to compare head to head dog vs CGM. One of the prime concerns regarding diabetes alert dogs is the quality/consistency of training. In the meantime, I agree with Kyle’s viewpoint. I believe the decision to choose a diabetes alert dog is very personal and needs to be researched before making a huge, expensive commitment. 

Finally, I want to dedicate this post to the memory of Sam. My mountain dog buddy.

Get To Know Joel Steelman, M.D.

Dr. Joel Steelman is an endocrinologist at Cook Children's. He grew up a military brat, on the move every three to four years, to a new home, in a different state. Nevertheless, his family roots remained in Texas, where he finished high school and developed a love for writing, working on the school newspaper and yearbook. He attended Texas A&M University both for his undergraduate and medical degrees.

Almost half of the people who participated lost an average of 30 pounds, went into remission and were no longer diagnosed with diabetes. They did not take any medications during this time and relied solely on weight loss. “Remission of type 2 diabetes is a practical target for primary care,” the authors of the paper wrote.

The participants in the study were on a liquid diet of 825 to 853 calories daily for three to five months and then were reintroduced to solid food, while maintaining a structured diet over the course of a year.

All the individuals who participated in the study were adults (20-65 years of age).

Joel Steelman, M.D., an endocrinologist at Cook Children’s, said that weight loss has been especially effective in treating adults, whether through diet or after weight loss surgery, and can lead to de-escalation of treatment or stopping therapy. This has been especially true in adults, whether through diet or after weight loss surgery.

Dr. Steelman said children with type 2 diabetes will also benefit greatly from weight loss, but an extreme low calorie diet, like the one the participants in the adult study were on, is a bit more of a concern in a still growing, developing child. Dr. Steelman said pediatric endocrinologists focus on eating a healthier, lower calorie, lower carbohydrate diet, while also stressing the child becomes active.

“Weight loss and improved diet often leads to de-escalation of treatment for children – stopping insulin often and sometimes stopping oral medication,” Dr. Steelman said.

But a child can’t make extreme lifestyle changes without the entire family buying in and everyone in the household living healthier. A child needs the full support and active involvement from all family members. Therapeutic lifestyle changes need to last a lifetime.

“It’s essential for the parents to be extremely involved. You to have buy-in and support from the family,” Dr. Steelman said. “There’s often type 2 diabetes in one of both parents. It’s a no-brainer that the whole family will experience some benefit, whether immediate or future, from improving food choices and increasing activity. It’s critical to understand that type 2 diabetes is a deadly disease, and is associated with earlier and more frequent cardiovascular disease and premature mortality than type 1 diabetes mellitus.”

Both girls and boys can be develop Type 1 and Type 2 diabetes, but only females have to be concerned with a type of diabetes that begins during pregnancy. Gestational diabetes, which can cause high blood sugar, is not only a concern for mom, but her baby as well.

Here are four other unique ways that diabetes of all types affects females:

1. Compared with men with T1D, women with T1D are more likely to have a fatal heart attack. In a study of 23,000 men and women, women were 4 times more likely to die from a heart attack. The increased risk for cardiovascular disease that leads to this often starts in the teenage years where teenagers are already starting to show risk factors.
2. Girls are more likely to develop T2D than boys, occurring in both usually after 10 years of age. Along with other important factors we can’t control, such as family history and certain ethnicities, just being a woman increases your risk for Type 2 diabetes. Girls with T2D have a unique risk for polycystic ovary syndrome which can lead to irregular periods, excessive hair growth and acne.
3. Pregnant moms with T1D and T2D must be aware of the effect of pregnancy on their diabetes control and that they are at increased risk for complication because of their diabetes, including death.
4. Pregnant moms with all forms of diabetes must also worry about their baby’s health as diabetes during pregnancy, particularly when poorly controlled, can have a significant impact on the developing fetus.

As you can see, the risk of diabetes and pregnancy is a big part of the unique challenges that women with diabetes face. Diabetes occurs in approximately 5-10 percent of U.S. pregnancies (2 percent have Type 1; 8 percent T2D and 90 percent have gestational diabetes).

Along with the risk of cardiovascular disease, women with diabetes have to contend with the fact that babies born to moms with poor diabetes control have an increased risk of birth defects, such as spina bifida or microcolon. The babies can also have complications at delivery such as low blood sugar, low calcium and increased risk for certain breathing problems.

“I know that all moms would like to be at their ideal health prior to conception, it’s especially important for women with diabetes. However, 50 percent of all pregnancies are unplanned and the majority of those with diabetes have gestational diabetes; therefore, the mother’s glycemic control may be inadequate at time of conception and during the early part of her pregnancy,” said Don Wilson, M.D. an endocrinologist at Cook Children’s.

The report published in The Lancet states the amount of children and adolescents rose to 124 million in 2016, compared to 11 million in 1975.

More than 20 percent of children in the United States were found to be obese in the age groups of ages 5 to 19 years of age.

While the study focuses on children, experts at Cook Children’s say the parents have to take accountability in keeping their children healthy.

Joel Steelman, M.D., an endocrinologist at Cook Children’s, said unhealthy food choices are more accessible with the increase of fast food choices across the world. These foods are usually higher in sugar and lower in not only nutrition, but cost of the food.

The other factor in the increase in obesity is sedentary behavior. But Dr. Steelman said increasing activity is easier said than done for many families, who are faced with children relying more on electronic media for entertainment and parents facing unsafe environments to let their kids go outside and play. Still, he said changes begin with the entire family making as many health changes as possible.

“Families have to be involved in helping a child with weight management,” Dr. Steelman said. “Often times this is not just a child issue, but a family-wide issue that needs to be addressed. I think that the biggest issue for families though is not to become militant and overly rigid in trying to help a child with weight management. Definitely, no shaming. The things you can do right now are pretty basic. That is changing your diet and encouraging more physical activity. I know it sounds simple, but this seems to be the best solution.”

Don Wilson, M.D., an endocrinologist at Cook Children’s, is the medical director of the Risk Evaluation to Achieve Cardiovascular Health (REACH) Clinic. The clinic is committed to improving the lives and well-being of children who are at risk or affected by obesity.

“The only way to be successful in the struggle with obesity is for all adults and children (with the assistance and encouragement of their parent/caregiver) is to embrace therapeutic lifestyle changes,” Dr. Wilson said. “Success starts with a positive self-image and a ‘can do’ attitude. We in the medical profession can help educate and encourage, but need to avoid blame and comments that demean the victim. Obesity is, and always has been, a disease. It should be treated as such. In general the public needs to understand the short-term and long-term consequences of obesity, including diabetes, premature heart disease, and several forms of obesity-related cancer. Only then will successful management/prevention be achievable.”

Virginia Landrum, a dietitian in clinical nutrition in Gastroenterology at Cook Children’s, said she stresses to parents and children that the entire family must be involved in making changes.

She lets her patients who are working to lose weight not to look at their changes as diet, but as a lifestyle change.

Landrum advises parents to help their kids get healthier by taking these steps:

1. Help your children be involved in the meal. Let them pick out some healthier food options that they may want to try.
2. If they are old enough, let them be involved in food prep.
3. Offer new foods. Studies show it can take as much as 20 times for some children to accept new food options. Landrum said parents may have to start by simply placing the new food item on the plate.
4. Parents have to set the example. Eat the healthy foods with your child. Let your child watch you eat vegetable. Go outside and walk with your child, play a sport or ride a bike.
5. Turn off the TV, video games and eat together as a family.

The daily routine for most kids with type 1 diabetes includes multiple insulin shots, numerous blood sugar checks and analyzing the carbohydrates in every food eaten. Mental focus and motivation are essential and it’s a challenge to maintain the constant effort.

But new technology has the potential to make life easier for these children. The U.S. Food and Drug Administration has approved the first automated insulin delivery device for type 1 diabetes. The device is intended to automatically monitor glucose (sugar) and provide appropriate basal insulin doses in people 14 years of age and older with type 1 diabetes.

The human pancreas naturally supplies a low, continuous rate of insulin, known as basal or background insulin with spurts of insulin released when food is eaten. In patients with type 1 diabetes, the body’s ability to produce insulin is destroyed or severely impaired.

Joel Steelman, M.D., an endocrinologist at Cook Children’s, says this technology is the latest in insulin pump treatment that began to emerge in the 1980s with the promise of more precise insulin dosing and eliminating daily shots.

The old, basic insulin pump has steadily evolved into a smaller, smarter insulin pump. Current progress has allowed the joining of the relative diabetes technology newcomer, the continuous glucose monitor, with an insulin pump – displaying CGM readings on the insulin pump.”

In spite of all these advances in diabetes care technology, there remain two major challenges facing those affected by type 1 diabetes:

1. Daily mental work of diabetes care is not much different in pumping vs. injections.
2. Variability in blood sugars remains even when using a pump and keeping up consistent efforts.

The new diabetes technology holds the promise to shrink these two challenges and help children have more stable blood sugars. The device called a hybrid closed loop system pairs an insulin pump with a continuous glucose monitor (CGM) which has already been done, but contained within the software program of the insulin pump is an “AI co-pilot” that adjusts basal insulin delivery from the pump based on blood sugars detected by CGM.

“We’re getting there,” Dr. Steelman said. “It will only be a matter of time, people are testing devices now, before we achieve an insulin pump device where kids can ‘set and forget it.’”

Dr. Steelman believes the current technology to be a major step in the right direction, but he does see some concerns:

1. More diabetes technology makes a child more visible and obvious to the general population that could result in bullying or discomfort in sharing his or her condition. He said that will be a topic that the pediatrician and the parents will have to address with the patient.
2. It is technology. Computers, smartphones, etc. do break. “We do get lazy and rely on them more than we should sometimes,” Dr. Steelman said. “Kids using the device will need to stay engaged and responsible for their own health. They can’t just rely on the technology.”
3. While a step forward, the hybrid closed loop system still requires counting carbs in food and activating the pump to give boluses of insulin. Also, blood sugar finger prick tests must still be done.
4. According to Dr. Steelman, the equipment is expensive and physicians will have to work closely with insurance companies to find out what is covered for children and be aware of age restrictions.

Once he addresses these issues with the patient family, Dr. Steelman anticipates the Cook Children’s diabetes team will discuss the new technology with interested teens who have demonstrated good basic understanding and practice in their diabetes self-care. He said the staff and patients will need some additional training on the specifics of the technology, but looks forward to the possibilities.

“We already speak with parents about insulin pumps and technology in diabetes care. We have a formal process that we follow on insulin pumps,” Dr. Steelman said. “This technology has the capacity to further improve diabetes control and chip away at the pesky unpredictability in care. I’m especially excited about the positive impact of reducing nighttime low blood sugars.”

About the source

Dr. Joel Steelman grew up a military brat, on the move every three to four years, to a new home, in a different state. Nevertheless, his family roots remained in Texas, where he finished high school and developed a love for writing, working on the school newspaper and yearbook. He attended Texas A&M University both for his undergraduate and medical degrees.

He trained in endocrinology at the University of Colorado Children’s Hospital in Denver. During his tenure in Colorado, where he met his future wife, Dr. Steelman trained at the internationally renowned Barbara Davis Diabetes Center, one of the world’s largest and most esteemed diabetes medical facilities for adults and children, specializing in type 1 diabetes research. Along the way, he discovered another strong research interest in the area of bone disorders, and Dr. Steelman began to treat children with osteogenesis imperfecta, or brittle bone disease-- a rare, crippling malady. After completing his training, Dr. Steelman left the West to enter academic medicine at Vanderbilt Children’s hospital in Nashville, Tennessee. Over the next seven years he focused on research projects and medical education.

The birth of his daughter, in 2005, and the desire to be closer to family, brought Dr. Steelman back home to Texas, and to Cook Children's. Today, he provides endocrine care for children living in the Dallas/Fort Worth metro area, as well as Denton and West Texas. He expanded his practice, after arriving atCook Children's, to include the care of childhood cancer survivors, collaborating with the neuro-oncology program and Life After Cancer programs.

Planning and gear is necessary when setting off for a day of water fun, but for kids with diabetes it can sometimes feel like an Everest expedition. Their checklist can include any or all of the items below:

●Blood glucose meter

●Supplies to check blood sugar

●A cooler or ice packs to keep insulin cool

●Insulin

●Insulin injection supplies

●Insulin pump supplies

●Snacks for low blood sugars

Children and their families with Type 1 diabetes deal with additional risks on top of the typical worries that all families deal with. Some diabetes specific risks include:

●Low blood sugar

●Dehydration

●High blood sugars

●Ketones

The wisdom and experience of a parent of a child with Type 1 diabetes adds more practical value. I discovered this article on swimming with Type 1 diabetes.

I reached out via Twitter to the mom and author of the article. As the mother of two girls with Type 1 diabetes, she had a lot of good, practical advice, which I endorse and would give to my own patients.

I know it helps to here from other moms. Here are some of the thoughts and tips that she shared about her now older girls.

Importance of swim lessons

My girls passed all of their swim lessons and have reached the level that will safely take them into adulthood ... I still tend to hold the book and scan the water until both are safely drying off on my blanket. Once a mom, well, always a mom.

“Managing” blood sugars

Despite this natural maturity and necessary growth, our family is still cautious with Type 1 diabetes and swimming. We know that blood sugar management during exercise can be tricky on a good day, let alone, on a day of intense swimming, where every single muscle is engaged and active.

Here is a list of strategies that we use to help keep teenager independence while staying healthy with Type 1 diabetes.

1.Check blood sugar before you go into the water.

2.Blood sugar MUST be above 100 mg/dl.

3.If not, BEFORE swimming, eat a small protein and carb snack and do not bolus. Our girls like re-sealable chocolate milk jugs, cheese and crackers or small peanut butter and jelly sandwiches.

4.Swim with a buddy and never alone.

5.Every hour, get out of the water and check blood glucose.

6.If blood sugar is rising, which often happens due to adrenaline during exercise, reconnect the pump and take ½ of the recommended bolus amount. This also helps to avoid ketones from lack of insulin.

7.Stay hydrated. Even if you feel like you are not thirsty, drink 8 ounces of water each time you are checking your blood sugar.

8.Always bring money. If you find yourself eating through snacks, be prepared to purchase carb-laden food from the snack machine or beach shack. This happens more often than not, so I stress this often!

9.Be prepared for lows that might happen an hour or two after leaving the water. With T1d, it’s not just the first event (swimming), but the second, third and fourth events that need proper planning. For that reason, always tuck in more glucose, more meter strips and extra supplies than you think you might need. Chances are, you will need it!

I hope this article was helpful and makes for a better water safety experience.

My gratitude to naturallysweetsisters.com for sharing.

There’s been a lot of progress in type 1 diabetes care in the last five years, and I can only expect more in 2016 and upcoming years. I offer my thoughts on three areas for anticipated progress in type 1 diabetes care.

DRUGS

Insulin has been the mainstay in type 1 diabetes care since its purification and use in 1929. We’ve come a long way from purified animal insulin. We’ve had synthetically produced human insulin now for about 20 years.

Further modifications were made to human insulin creating long and short acting insulin analogs which are used today in basal/bolus insulin plans - considered standard of care in those with type 1 diabetes.

Several new analog insulin, either released or awaiting FDA approval, could be game changers for 2016.

Long-acting insulin activity is currently around 24 hours, but having a longer range of activity may benefit some patients with diabetes. Two new long-acting insulins, Tuojeo and Tresiba, continue working beyond 24 hours and have been approved for use only in adults with type 1 diabetes.

Fast acting insulin is essential at meals to control the rise in blood sugar from carbohydrates eaten. An “ultra-fast” acting insulin faster than the current batch of rapid-acting insulins recently started the review process for approval.

None of the current long or short acting analog insulins are generic. The cost of insulin and other diabetes supplies is a significant ongoing expense. A new “semi-generic” form of the long-acting insulin analog, Lantus, received recent approval.

The release of new analog insulin offers more choices, and research will be essential to see how these insulin can be used in children. Also, the number of insulin and increased choices will hopefully mean lower prices for vital medicine in the future.

DEVICES

Technology continues to move forward in its role helping children and families co-pilot type 1 diabetes.

Continuous glucose monitoring (GGM) continues to move into mainstream as a vital tool giving children and families real-time blood sugar information and better managing the highs and lows in blood sugar.

CGM in the clouds refers to the technology allowing remote monitoring of blood sugars. CGM sensor information is broadcasted via a smart phone to a server where it can be retrieved by using another smart phone or internet connected device. Parents can be hundreds of miles away and still have the comfort of monitoring their child’s blood sugar.

All the major insulin pumps have or will shortly have CGM integration allowing the most efficient use in these two tools together. The ultimate pairing of these tools, the artificial pancreas, continues in development.

The artificial pancreas holds the promise to lessen the work in diabetes care and help children have more stable blood sugars by allowing the insulin pump to use CGM information to make adjustments in insulin delivery.

Recent major funding received from the National Institute of Health and other sources will help fuel continued development and improvement.

Ditching the needles

Needles and sharp things are tough reality in diabetes care. Shots and finger pokes are a daily necessity in diabetes care. There’s been talk about non-invasive, needle-free monitoring in diabetes care for decades, but little progress has been made. Although CGM represents major progress, a needle is still needed to insert the device.

Wouldn’t it be great if monitoring of blood sugars or insulin treatment could be done without needles?

2016 has the potential to move forward in this area.

Inhaled insulin was recently approved for use only in adults with type 1 and type 2 diabetes. Further study is needed to see if inhaled insulin has a safe, effective place in treating children with type 1 diabetes.

Google’s glucose-sensing contact lens is probably the most recognized in the effort of various companies developing blood glucose checking without the stick. An ear sensor is being tested by two different companies.

The hormone glucagon is essential in the body to work against insulin and keep blood sugars up. Glucagon treatment, given as an injection, is an emergency measure used in type 1 diabetes when severe low blood sugars happen.

Nasal glucagon development is progressing and will probably reach the market soon with the promise of one less shot needed in an emergency situation of low blood sugar.

Defeat Diabetes

Removed first part For all of us in the field of endocrinology, defeating diabetes is the ultimate goal. For now though, I think 2016 offers the promise of new technology making those the life of someone with type 1 diabetes easier.

Research is also ongoing in re-creating insulin producing cells for re-implantation in the body which is the ultimate in defeating diabetes for good and what a great story that would be as we look ahead to 2017.

Halloween can be a particularly challenging time of year for families and children dealing with diabetes. Whether a family is dealing with type 1 or type 2 diabetes, there are important health decisions to be made about handling the seasonal free flow of candy.

Type 2 Diabetes

Recent stats report 23 million people in the U.S. have type 2 diabetes. While most of those people are older adults, there are still many children who are at high risk for developing type 2 diabetes.

Obesity is a central problem in type 2 diabetes. With all the tempting treats, it’s no wonder that the average adult weight gain from Halloween until New Years is estimated at 5-7 pounds.

Therefore, it is essential to have a healthy game plan in preparation for Halloween and the other end of the year holiday.

Type 1 Diabetes

Obesity is not as often a central problem in children with type 1 diabetes; however, healthy snack/candy choices are still of prime importance. There’s a common misconception that people with type 1 diabetes can’t eat candy or other sweets. Those with type 1 diabetes can eat candy, but they must take insulin for the carbohydrates in the candy. Finding the right balance between healthy snacking and insulin dosing for candy is a real challenge for children and families dealing with type 1 diabetes.

Asking a veteran type 1 diabetes parents about their approach to Halloween is always a good idea. Amy Ohmer (@NatSweetSisters), a mother of two children with type 1 diabetes was kind enough to share some advice.

There are several wonderful ways in which families can handle Halloween. I prefer to tell parents to continue previous traditions, post diagnosis, expecially with older children or children with older siblings. First, this sends a message that type 1 diabetes will not change anything and secondly, there is no better time than the present to practice some real life carb counting/dosing skills.

If the plan is to go trick-or-treating, remember that the goal is to amass as much candy as possible, not necessarily to eat all of it. After bringing home the candy, counting the amount, and choosing their favorites, our kids are ready to part with much of it. There are several organizations that accept leftovers from food banks to senior centers.

Another great reminder is that Halloween candy is the perfect carb snack for low blood sugar treatment. A running joke amongst our parenting group is that this is the time where we can stock up on free carb snacks!!!

One year, our children sold candy back to us in exchange for "Halloween bucks" to buy things at a silly store that we set up in our living room. Every ten pieces of candy, provided a Halloween buck. At the end, they received a book, some dollar store items and a new Barbie doll. They loved that even more than the candy.

Finding the Balance

Not all candy is created equal. A quick check of nutrition breakdown on different Halloween candies helps children and adults pick “healthier” candy.

A recent research study gives some needed perspective for parents on children’s eating habits. The research examines different strategies to help children manage their food choices. Eating strategies that included structure, consistency, and clear communication between parent and child created the best success in helping children make better food choices long-term.

The lifelong goal for children and families is making consistent healthier choices in both the kinds and amounts of food eaten.

Halloween should be a fun time for all children, including kids with diabetes. Once again I’ll go back to Amy for good advice for us all:

No matter what parents choose to do with their children, they should take a deep breathe, relax and enjoy the event, whether it is trick-or-treating, bobbing for apples or enjoying donuts and cider. Halloween is truly a fun family event.

They could all learn a lesson from a young woman named Marissa Heintschel.

I learned about Marissa during one of my recent searches for news about my field, pediatric endocrine. The news story featured students in the Frisco high school independent study and mentorship program.

One of the students in this program was Marissa, who had chosen pediatric endocrinology as her focus of study. I reached out to her via Twitter to learn more about her experience in the program and was very impressed by her story.

Like many in my field, she had a personal connection to pediatric endocrinology, having been diagnosed with Type 1 diabetes at 7 years old. She shared with me her passion for medicine and her experience she’s gained and the research that she did during her year in the program.

I asked how her experience had changed her view of children living with a chronic condition such as Type 1 diabetes. Her answer gave me a fresh, personal perspective on challenges of life with this chronic condition:

“I have always made it very public that I had Type 1 diabetes,” she said. “I went through the whole phase of trying to hide it away from people. I wish I would’ve realized sooner the importance of taking care of myself because when I was 14 or so I was stupid and thought that if I ignored my diabetes it will go away and that I could run away from my problems.

I wear an insulin pump. I’ve been called things like a robot and people in random places will just stare at me.

There was once this kid in my class sophomore year that I started to become really good friends with. One day I asked where he went and someone said that he went to go take his shot because he was diabetic. It was so surprising to me because no one really knew he was diabetic.

So then I started talking to the kid more and more about his diabetes and he just opened up to me and was able to talk about his problems that only people like us could understand. After he opened up to me, he told me how thankful he was that we had grown closer because he now felt he had the confidence to tell people about his diabetes.”

Marissa’s story got me to thinking about the importance of sharing about having Type 1 diabetes and how difficult it can be. I, and others on the Cook Children’s diabetes team, speak to children and their families about sharing about their diabetes when we meet with them at Cook Children’s during the difficult period of initial diagnosis.

• Support
• Safety

These are the two important reasons for S haring with others about having diabetes.

Sharing opens the opportunity to understand better the routine (checking blood sugars, taking shots, meal planning, etc.) that someone with Type 1 diabetes must do daily. Sharing opens up opportunity for support and encouragement. In Marissa’s case, it may be the opportunity to encourage and support someone else with Type 1 diabetes.

Marissa’s story also shows that sharing does open up vulnerability and risk. I asked Cook Children’s endocrine clinical therapist, Kim Cox, how she talks to children and families about sharing about diabetes.

“I usually talk to them about how ‘secrets’ tend to make other kids think it’s a bigger deal.

Why don’t they want others knowing? Are they

…. embarrassed?

... afraid of bullying?

... etc.

Being honest (but brief) about answering peers questions seems to work best. For example, I have diabetes, I have to take medicine when I eat now. We then discuss those issues.”

I use the example of a kid who gets glasses in school. In the beginning, you notice every time you see them, peers will comment and possibly even say mean things, but as time goes on, their glasses just become part of them and you only notice if they don’t have them on. Other kids move on to something else.

Safety is important because even in the best of cases diabetes care is unpredictable. High or low blood sugars affect mood and behavior. In particular, a low blood sugar can cause erratic behavior and eventually unconsciousness. Knowing about the diabetes allows others to have the advantage of understanding and help someone with Type 1 diabetes.

Marissa has a future of opportunity ahead of her and will be starting college at my alma mater, Texas A&M, where she will major in biomedical engineering and pre-med. She told me that she chose biomedical engineering because the potential that technologies such as stem cell research and tissue engineering for a cure for diseases such as diabetes. Being a doctor is her dream, and I think that she has learned a lot from her experience that will help her in the long journey to a field in medicine.

And now the next time you see a mom looking at her smartwatch, she may be monitoring her child’s blood sugar levels.

Progress in diabetes care has mostly come from the medical community and medical industry. However, this changed recently when a new innovation came from a people on the very front line of diabetes care – parents.

Who better to understand the pitfalls in diabetes care and be the best advocates for kids with type 1 diabetes?

I think that most people not affected directly by type 1 diabetes would probably guess that the multiple daily insulin shots is the hardest part in diabetes care.

But, I think (and perhaps many others touched by type 1 diabetes would agree) that the complete uncertainty about blood sugars is the true hard part of diabetes.

There are an infinite number of questions or worries surrounding the blood sugar:

• How does my child feel when his or her blood sugar is high or low?
• How will illness affect my child’s blood sugar?
• How will activity impact my child’s blood sugars?

Right now, most parents and children are flying blind in between blood sugar checks, not knowing for certain which way blood sugars are heading – up or down.

But they don’t have to any longer because glucose monitoring now lives in the cloud.

Continuous glucose monitoring

Anyone can see that the daily constant attention and mental energy needed for good diabetes care is immense. Any progress in diabetes care that reduces this strain right now is worth it.

Continuous glucose monitoring (CGM) is a technology useful in diabetes care. I wrote about the technology several years ago. The technology uses an IV-like catheter placed under the skin which constantly samples the blood sugar (glucose) level in minute amounts of body tissue fluid in the area between skin and muscle. A larger sensor attached to the catheter sits on the skin and beams the blood sugar reading to a receiver device. It allows families and children to see blood sugar trends in between finger pokes. Below is an illustration of the technology:

A number of barriers in the past such as size of the unit, wear comfort, sensor/receiver communication problems, and insurance coverage made wider use of this promising technology in children with type 1 diabetes a challenge. Fortunately, there has been progress and today there is wider use of the CGM use in children.

The proximity problem…..

Previously, a child wearing a CGM must be in receiver range (a max of 20 feet) to see blood sugar readings, and factors such as walls may further affect the ability of the receiver to detect the blood sugar readings.

Why can’t there be remote diabetes monitoring?

Today’s mobile technology makes it possible to shop or surf the web virtually anywhere in the world.So the thought process was, “Why couldn’t this same technology be used to make remote diabetes monitoring possible?”

Starting roughly 18 months ago, that’s exactly the problem that parents of children with type 1 diabetes solved.

Two tech-savvy dads who had children with type 1 diabetes pieced together a CGM receiver with a cell phone and they were able to transmit the CGM data into a cloud-based database. A basic set-up is shown below:

.#wearenotwaiting

The twitter hashtag speaks to the commitment of the group and other advocates for improvement in type 1 diabetes care to strive for innovation and progress right now in type 1 diabetes care.

The movement has evolved from a core of interested parents sharing with other parents to a Facebook group to now a nonprofit called the Nightscout Project.

The group continues to look at ways to move diabetes care forward with support of innovation, FDA device discussions and collaboration with other non-profits.

“People focus on the cure, but we want to focus on tomorrow. The cure is the future.”said James Wedding, Nightscout Project.

CGM in the cloud.

Once in the cloud, the blood sugar information could be accessed by any Internet enabled device (smartphone, tablet, smartwatch, etc.).

Families and children now have access to real-time blood sugar info whether their child is right beside them or half a world away.

The help and peace of mind has probably been immense as parents have access to blood sugar at field trips and sleepovers.

Parents can have date nights again and not worry about their babysitter monitoring their child’s blood sugar. They can now do it at the dinner table.

Quick blood sugar info is available with a glance at the smartwatch, and children never miss a bit of fun at the beach.

* Photo from beach, courtesy of Jasmine Cruz-Bohren.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.

Now she prays for Tre’s caregivers to make her son all better.

Tre, who is 9 years old, has been seen by the Rehabilitation Services team at Cook Children’s since his parents adopted him as an infant. Most of those issues centered on his articulation skills. Tre’s history with Rehabilitation Services started with audiology and other physician specialists; speech therapy services began at 7 years old working on articulation skills. 

Then about 15 months ago, Sara Adams, Tre’s speech pathologist, received a call from Jennifer to say her work with him would have to go on hold indefinitely.

Tre was involved in a horrible boating accident. He sustained a head injury and was in a coma at another hospital. But the miracle for the Faulkner family occurred and within two weeks, Tre was up and walking.

After his accident, Tre returned to therapy at Cook Children's Urgent Care and Pediatric Specialties – Mansfield and worked with Occupational Therapy, Physical Therapy and Speech Therapy to regain skills that were lost after his brain injury.

A year later, much of Tre’s care takes place at the Cook Children’s Rehabilitation Services at Mansfield. The focus is on Tre’s short-term memory loss and his severe ADHD, as a result of the injury.

“God has blessed us so much,” Jennifer said. “The Mansfield community has been with us since the beginning, I’m so thankful. I’m also thankful for the amazing care Tre has received since his injury. At Mansfield, Tre has really been helped in many ways, through his physical, occupational and speech therapy. They have helped him so much with his memory and his balance. It’s truly been miraculous.”

The rehab at Mansfield is working for Tre. Academically, Tre’s test scores are in the average range for a child his age. His mom says he’s learning and making strides every day.

And Tre’s doing very well physically. He recently received his gold belt in karate. Makes sense for a kid who has proven time and time again how tough he is.

“The progress Tre has made since his accident is truly remarkable,” Adams said. “Tre still has some struggles with his attention and memory that impact him every day. However, he continues to improve and learn how to work through these struggles. Tre’s sense of humor, determination, and supportive family are his greatest strengths. Tre is such a funny kid! He loves to tell jokes and riddles. One of his favorite jokes is: ‘Why don’t ducks tell jokes when they are flying? … They might quack up!’”

To see how far Tre’s come since his injury it’s hard not to smile at the miracle that’s occurred and the occasional duck joke.

For more information

At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices throughout Texas. Thanks to our skilled group of clinicians who support the leading-edge technology found among our specialty services, Cook Children's is the destination when it comes to taking care of your children.

Cook Children's Urgent Care and Pediatric Specialties - Mansfield is located at:

801 Matlock Road

Mansfield, TX - 76063

To make an appointment, call 817-347-8400.

Specialty services at Mansfield inlcude:

• Endocrinology and diabetes
• Gastroenterology and nutrition
• Nephrology and dialysis
• Neurosciences
• Orthopedics
• Pediatric surgery (inpatient/outpatient)
• Psychiatry and psychology
• Rehabilitation
• Urgent care

TECHNOLOGY ... 

Wanting to learn more, I contacted the lead researcher, Shelagh Mulvaney to ask her about her results. Shelagh is no stranger to diabetes care. Her career as a research psychologist has been spent studying behavior change in chronic condition management including Type 1 diabetes. She is interested to learn how technology use can make these types of changes.

You would think it’s the wave of the future, right? This is the technological age and most 6 year olds know how to work a smart phone better than most adults. You would think the teens who participated in this survey would jump at the chance to use technology to help them with their diabetes care.

At least that’s what I would have thought before Shelaugh’s survey. The participants used the technology as you would expect based on how digitally plugged in most teens are. But a barrier occurred when it came to the teens wanting to share their life challenges and sharing on social media.

Why is that the case? I wanted to know more so I contacted Shelagh, who was kind of enough to speak with speak me about her work and its significance.

Me: Tell me about your survey.

Mulvaney: Our goal was to enhance website and mobile programs to support self-care in teens with Type 1 diabetes. To accomplish the aim, we did an initial survey. The survey was a challenge because we had to create a questionnaire and scales from scratch to learn how teens use a variety of technology, including social media to support themselves in daily diabetes care.

Me: How did the survey work?

Mulvaney: We surveyed 174 teens from the Vanderbilt diabetes clinic, as well others from the children’s diabetes website (CWD) group, asking them a variety of questions on how they used technology in care of their diabetes. We also did additional face-to-face interviews of 26 teens who had been classified by the online survey as low, medium and high users of technology.

Me: What did you find?

Mulvaney: Teens will find technology to address a pressing need. In this case, the survey did show that most of the teens surveyed use common technology tools to simplify the often complicated task of calculating insulin doses or looking up carbohydrate amounts in food.

Me: The social media use part of the survey gained the most attention in the news. With a recent report that 9 out of 10 teens use social media, I’m interested to hear how teens with Type 1 diabetes used social media.

Mulvaney: Surprisingly, social media use to aid in diabetes care was seldom used. Only about 70 percent of the participants said that they used social media, but use of social media for specific diabetes issues was very rare.

Some of the reasons given for not using social media included”

• Lack of time
• Boring
• Never thought about it
• Don’t know what websites
• Don’t like to talk or think about having a chronic condition
• Or mom takes care of it

Teens said that they didn’t know anyone else with diabetes or felt that someone without Type 1 diabetes just couldn’t relate to their life when asked why they didn’t use social media specifically to help in their diabetes care.

Me: So, it sounds like use of social media to improve diabetes care is not going anywhere fast?

Mulvaney: Teens with type 1 aren’t completely closed to social media as an aid in diabetes care. We did find a sizeable number of teens who were willing to share with others on social media, even details about how they care for themselves, if it would help other children or teens with Type 1.

Me: How would you sum this up?

Mulvaney: It’s hard to make diabetes exciting. Technology has to make something easier, less cumbersome, less complex …THAT will motivate teens.

I continue to believe in the opportunities that technology creates to improve diabetes care. I’m an optimist. I hope that maybe with time and education by medical professionals, young people will take advantage of tools available to them as they expand at an amazing speed. Yet, the human factor – family, friends, others with type 1 diabetes – remains an important part in maintaining consistency and motivation in teens with Type 1 striving for the highest level of health. It’s hard to compete with good, old fashioned peer pressure. Social media is unlikely to fully replace the personal touch. We have to remove the stigma that these kids have about their disease. But continued research like Dr. Mulvaney’s will help all of us maximize technology use in the care of Type 1 diabetes.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices.

Cutting back on the candy 

Trick or Treat alternatives at Halloween have become more popular over the years. Fun games and other events replace some of the candy focus. Head off to the nearest Fall Festival or other child-friendly Halloween party instead of the usual neighborhood Trick or Treat candy run. Children with diabetes may need to substitute the candy they receive for a healthier snack or a lower carb snack, depending on their exchange value. 

Better choices with the candy. 

Not all candy is created equal. Some candies pack much higher sugar and calories per fun size serving than others. A quick Internet search has a number of articles and references on nutrition breakdown on different Halloween candies. Strategies such as choosing the “healthier” candy and limiting the amount of candy collected make progress towards a healthier Halloween. Also, stretching out the eating of Halloween candy over a week or more may help with candy becoming an after meal dessert or even being forgotten. Kids with diabetes may want to save their treats for meal time when they would normally get a dose of insulin. This prevents the need for adding extra insulin doses or shots. 

Hit the road 

Walking door to door in the neighborhood is not always possible, but when possible, it offers some calorie burn to soften the sugar rush of the Halloween haul. Practically, walking means fewer doorbells will be rung and probably less candy collected. It’s important to not have too much candy during this time of year, but enjoy Halloween. And of course, feel free to share any extra Kit-Kat bars with your favorite pediatrician, especially if he’s an endocrinologist who happens to be writing this particular blog. 

Enjoy the treats.  

Joel

In the field of endocrinology, however, there has been ongoing serious scientific study regarding risk of diabetes and metabolic syndrome linked to artificial sweetener use. Unfortunately, a definite answer hasn’t been reached to this question. One of the primary barriers making scientific investigations difficult is the fact that many of those using AS are already obese and at high risk for diabetes and metabolic syndrome.

A number of theories have been offered by those who believe the link between AS and diabetes/metabolic syndrome is real. Perhaps, those using AS over-estimate the calorie savings from AS and over-eat. Perhaps, the craving for sweetness is increased with AS use leading again to extra sugar-rich calories in the diet. Perhaps, there is premature loss of satiety (that sense of fullness with a meal) when AS is used leading to earlier return of hunger. There are many other theories as well with individuals lining up in support or against the theories.

A newly published article from last month adds more information on the possible link of AS to diabetes/metabolic syndrome. The scientific study investigates the effects of AS in both mice and humans from a unique perspective and made national headlines.

The most provocative part of the article deals with an 11 week investigation in mice. The mice were given artificial sweeteners (saccharin, aspartame, sucralose) along with a regular diet. They were tested at the start and at the end of the experiment. The mice given AS had an abnormal, pre-diabetic response to a large meal of glucose (sugar) compared to mice given water or sugar-water. A smaller number of mice in the study were tested with a combination of saccharin and a high fat diet and showed a pattern of pre-diabetes in blood testing within 5 weeks. The research reported in humans in this study was less compelling and showed pre-diabetes changes in some but not all of the human research participants.  

What was the reason offered by the researchers explaining pre-diabetes changes seen in AS use in their research? Gut microflora and the changes they believe occur in the digestive system from absorbing artificial sweeteners. I know you want to know more about gut microflora, right?

Gut microflora refers to the many kinds of bacteria living the digestive system. Our knowledge about the kinds and roles of these helpful bacteria continues to increase. Scientists have known for a while that these bacteria help make some essential vitamins such as vitamin K and help keep bad bacteria from multiplying too fast.

The research reported drastic changes in the types of gut microflora in all the mice fed artificial sweeteners and in some of the human subjects. The unique theory offered by their research is that changes in the gut microflora caused by AS exposure were responsible for the pre-diabetes seen in the research. In other words, the artificial sweeteners changed the numbers (increasing some and decreasing others) of the many different microflora in the bodies of the mice.

As a pediatric endocrinologist, I welcome the ongoing investigation of the safety of AS use. For many of the children and their parents whom I care for there is a problem. Excess dietary sugar represents a significant fuel to the obesity epidemic and must be managed. Dietary use of AS is almost essential in those with type 1 diabetes to help in maintaining stable blood sugars. For those with type 2 diabetes, AS may help in managing daily calorie intake and reversing obesity.

It is probably overly optimistic to believe that AS are completely without impact on the body. The real ongoing scientific challenge is gaining the proper perspective on their health impact. Proper perspective is very important. For instance, the AS exposure in the mice studied was maximal, which would be comparable to drinking 19 diet drinks per day which is very unnatural.

The big, unanswered question brought up by this research is what could be the long-term effects in those who eat or drink much lower levels of AS. I personally decided within the past year to reduce my AS intake as part of an overall decision to eat healthier. This study doesn’t persuade me yet to eliminate AS completely (I love Diet Coke^® too much). My best advice after reading this article is moderation and continued focus on a healthy diet.

I’ve written in the past about my love of peaches. A hot August in Texas is the perfect time to enjoy this delicious fruit. Although most peaches start coming into season in July, it is August when they can be enjoyed in abundance. In fact, August is National Peach Month.

I’ve sampled peaches grown in a number of different states. I had the chance to enjoy an old favorite, the Palisade peach, during a recent Colorado vacation. Tasting an old favorite from years ago inspired me to search for a few fun facts about peaches to share.

Peaches were one of the earliest cultivated fruits with their origin in China. The fruit is thought to bring good luck and longevity in China. Even though Georgia has the nickname of the peach state, most U.S. peaches are grown in California. There is a lot of state pride regarding peaches. Colorado held a vote recently to make their state’s peach the official state fruit.    

Besides being tasty, peaches may have some important health benefits. They contain natural chemicals that may help fight against obesity and heart disease. Peaches are also rich in vitamin C, as well as high in fiber.

Right now, I’m enjoying a box of East Texas, Sunprince, peaches and hoping to get one more box or bag before the season ends. I’ve decided to combine two traditions – my love of peaches and the Hatch Chile festival – at the end of this month for a delicious treat. I plan to make Hatch Chile Peach Salsa. Here’s the recipe I will use. I hope you enjoy it with me. Please share with us your favorite peach stories or memories.

• 1 large finely chopped red onion
• 1-2 roasted hatch chiles finely diced (I plan to use 2)
• 1 tablespoon of olive oil
• 6 peeled and chopped peaches
• ¼ cup of apple cider vinegar
• ¼ teaspoon salt
• 2 tablespoons of chopped fresh cilantro
• May add 1 tablespoon of sugar if needed for more sweetness 

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices.

A recent announcement of a new smartphone app by Eli Lilly for glucagon use instructions reminded me specifically of the growing number of smartphone apps in diabetes care. A recent survey showed that the average smartphone user has 41 apps loaded on his or her smartphone. Apps powered by Internet connectivity affords users many options ranging from productivity to entertainment. I use my smartphone multiple times per day for various tasks ranging from checking email, reading medical news briefs, or entertaining my daughter with Angry Birds.

Health related applications loaded on smartphones along with other devices such as tablet computers represent a growing new trend of mobile health (Mhealth). Mhealth is a term used for the practice of medicine and public health supported by mobile devices. Mhealth currently provides a number of useful services including access to health information, real-time patient monitoring, and communication with the health care team. Many health care organizations, now have apps providing families with useful health information. A growing number of diabetes care apps are appearing to meet the needs of children and families dealing with this chronic condition.

Caring for type 1 diabetes involves a great deal of daily work: recording essential information such as blood sugars, insulin doses, carbohydrates eaten at meals, exercise, and illness. The diabetes education received by children and their families in the Cook Children’s pediatric diabetes program stresses two key skills of organization and interpretation of the daily flood of information. An organized system for capture of information is vitally important to give children and families maximal control over type 1 diabetes. The “old school method” for organization is a paper logbook carried everywhere with all information recorded. This system remains the best overall method helping both families and the pediatric diabetes care team to make important medical treatment decisions.

I know that many children and families struggle with maintaining a high level of organization. Diabetes smartphone applications present the potential to meet the needs of a mobile, tech-savvy population seeking a step beyond paper logbooks. I think this population is already comfortable with downloading and using apps from either iTunes or Android Market (Google play) and is willing to experiment with new methods of managing diabetes information.

Diabetes apps lend themselves to the necessary skills of management which include:

· Recording blood sugar readings

· Recording carbohydrates eaten at meals and snacks

· Looking up food carbohydrate content

· Calculating insulin doses

· Recording other information such as exercise or illness

· Communication with the diabetes care team

The growing number of diabetes apps (free and pay) makes it hard at times to determine which app is best for diabetes care. There is technology, such as IBGstar, that was designed to specifically integrate with Apple devices such as the iPhone or iPad. Other applications, such as Wavesense and Glucose Buddy, work with both Apple and Android devices. Newer apps also include allowing the user to link his or her social media accounts such as Facebook or Twitter with the app. A recent entry into diabetes apps designed by a pediatric endocrinologist, Endogoddess, offers another twist by rewarding care efforts with points.

I believe that technology advances such as diabetes apps and glucose sensors are part of the continuing forward progress in diabetes care. As with all new technology, I strive with families to make the best use of the tools available to improve diabetes care.

By now you’ve heard about trans fats so much, you may start to tune out how dangerous they can be for your child. We hear these buzz words all the time and it’s hard to tell any more what is and isn’t a serious threat.

How bad are trans fats for you? Toward the end of last year, the U.S. Food and Drug Administration (FDA) made the decision that hydrogenated oils may no longer be generally recognized as safe. That means if a final determination is made (which should be any time now), food manufacturers could no longer sell food products with trans fats or use them as an ingredient without prior FDA approval.

Here are four things you should know about trans fats to help you the next time you’re out shopping or ordering at a restaurant:

1. What are trans fats?

Trans fats are one of the “bad fats.” Some do occur naturally in foods, but most are created by adding hydrogen molecules to liquid vegetable oils. You’ll see them on food labels as “partially hydrogenated oils” or “hydrogenated oils.”

2. Where are they found?

Companies use trans fats because they’re inexpensive, last longer than other fats (increased shelf life), and give foods a good taste and texture. Trans fats are most often found in processed foods or fast foods.  Examples of trans fats are fried foods, baked goods, shortening and margarines, canned frosting and baking mixes. 

3. Why are they so bad?

Trans fats increase your LDL (“bad”) cholesterol and decrease your HDL (“good”) cholesterol.  They can increase your risk for heart disease and stroke, and there’s an association between trans fat consumption and higher risk for Type 2 diabetes mellitus.

4. What should we do?

• Look for trans fats on nutrition facts labels and look for partially hydrogenated oils in the ingredients list. Try to avoid trans fat (0g and no partially hydrogenated oils).
• Cook and eat at home as much as possible.
• Limit processed foods, especially at snack time. Reach for fruit, almonds or a light string cheese instead of chips or processed snacks.
• If eating out, choose baked or grilled proteins and watch “extras” like breads and sauces that may contain trans fat.

Trans fats are dangerous, but the good news is you can protect your kids from them. Start today by reading nutrition facts labels, ingredient lists, and eating at home as often as possible.

We know that children who are overweight or obese often continue their unhealthy habits into adulthood which may predispose them to heart disease, diabetes, and many other health problems. The HCCPC adopted “5-2-1-0 Let’s Go!” as their program to address this problem in Parker County. The evidence-based program encourages healthy nutrition and fitness in schools, after-school settings, and at home. Emphasis is placed on regular exercise and incorporating healthy foods into everyday life. HCCPC has been working with community and educational leaders to step foot into elementary schools to implement the program.  Here is how it works:

5-2-1-0 Every Day! 

5 or more fruits and vegetables 

2 hours or less recreational screen time    

1 hour or more of physical activity                     

 sugary drinks, more water and low-fat milk

I, and I’m sure many others who care for children, were excited by the news. It was with great interest that I read the news article and began to examine the story more closely. The news while exciting deals with a relatively small number and specific population of children.

The study examined obesity rates in pre-school children, age 2-4 years old whose families received WIC assistance (The Special Supplemental Nutrition Program for Women, Infants, and Children). Not all of the states submitted information. Of the 41 participating states, 18 states showed modest declines in the number of obese preschoolers from information collected from 2008-2011. The remainder of the 41 states showed no change or even increases in obesity rates.

The challenge is understanding what this information means and placing it in the proper perspective. Experts in the field of childhood obesity believe the positive numbers reflect changes in the WIC program beginning in 2008. The program was changed in an effort to increase fresh fruits and vegetable purchases as well as other health options such as whole grains and low fat foods. Additionally, encouragement of breastfeeding is thought to help contribute the improvements.

The news validates the central importance of healthy eating in weight management. I believe that fresh ingredients and home preparation of meals is a major key in overall health and weight management. I have slowly continued reading the book, Salt, Sugar, and Fat, and am increasingly convinced of this belief.

As discussed in the article, challenges remain. One in eight pre-schoolers remain obese. And unfortunately, the likelihood is high for these children that obesity will persist into adulthood.

For more information:

• Cook Children’s Endocrinology and Diabetes Program
• Obesity where we live
• The Center For Children’s Health
• Checkup Kitchen
• Overweight and Obesity
• Keeping Portions Under Control
• How Can Families Be Healthier?

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to the Physician Perspective page on the Cook Children’s Web site.

Occasionally, I’ve been lucky to know someone personally whose life has benefitted from such progress which was the case this past month. Multiple news outlets reported dramatic results of a new therapy for infantile hypophosphatasia. Hypophosphatasia is an extremely rare genetic condition affecting less than 20,000 people in the U.S. The condition is due to defective action on a vital bone enzyme known as alkaline phosphatase which is necessary in the formation of bone. There is a spectrum of severity tied to how active the enzyme is. Those with some to modest enzyme activity have symptoms appearing in childhood or adulthood, including weakness in bones that causes them to break more easily and premature loss of teeth.

Babies with the severe infantile form of hypophosphatasia progressively weaken as bones dissolve away. Movement and eventually the vital function of breathing become progressively more difficult. Toll of the disease is terrible with half of babies with infantile hypophosphatasia dying of respiratory failure in the first year of life. Progressively fewer live to see subsequent birthdays.

The news stories reported specifically about one patient, Janelly Martinez. Janelly’s parents watched helplessly as their daughter followed the typical grim course of infantile hypophosphatasia, requiring escalating levels of medical care to survive. For a time, I shared in the family’s struggles as a member of the endocrine team at Vanderbilt University that diagnosed and cared for Janelly.

Janelly’s parents faced the prospect that she would not survive the scarce few months until her third birthday. Her parents needed a medical miracle. For Janelly and her family, the miracle came. A new experimental therapy with the drug Asfotase alfa, a synthetic form of alkaline phosphatase became available in 2008. The results were dramatic for Janelly and other babies receiving the drug. New bone began to grow. Treatment results were dramatic, appearing within six month. Some older toddlers were able to stand for the first time.

I am deeply touched by the new life Janelly has received from this treatment. From struggling to breathe with mechanical assistance to now bearing some weight, Janelly has made remarkable progress. The prospects for an average childhood for Janelly even with treatment remain unknown. She is nearing 7 years old but remains the size of a toddler. Her contribution and her family’s contribution to medical discovery will endure.

It doesn’t matter how many years I’ve been in medicine, I continue to be impressed with advancements in modern medicine. I’m amazed at the science of it all and so thankful that it can helps special little children like Janelly.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to the Physician Perspective page on the Cook Children’s Web site.

Detractors point out that a large portion of Armstrong’s impressive athletic career was aided by illegal performance enhancing drugs. Furthermore, Armstrong strongly denied use of performance enhancers and aggressively countered accusers – calling them liars or suing them.

Things turned decidedly negative for Armstrong this past year when the U.S. Anti-Doping Agency (USADA) released a report documenting evidence of illegal performance-enhancing drug use extending back sixteen years. Armstrong chose not to dispute USADA and was stripped of his Tour de France titles and banned for life from cycling. International organizations followed suit, and the end of 2012 saw Armstrong disgraced, bereft of corporate sponsors, and facing possible legal action.

2013 now turns the page for Armstrong with his interview with Oprah Winfrey this past week. Armstrong was mostly candid and contrite with Oprah in admitting his wrong-doing. A few of his own words below convey the essence of the interview.

“I know the truth. The truth isn’t what was out there. The truth isn’t what I said, and now it’s gone—this story was so perfect for so long.”

“And then the ultimate crime is the betrayal of these people who supported me and believed in me, and they got lied to.”

All of the reasons for his decision to admit his use of performance enhancers and acknowledge the wrong done to those who accused him of performance enhancer use will probably never be known.

Moving forward, I think that there are three things that we as adults and parents should take away from Armstrong’s story and share with our children. Again, I think Armstrong’s own words help.

Tolerance of cheating

Speaking of use of performance enhancers…….“That was like saying we have to have air in our tires or we have to have water in our bottles. “That was, in my view, part of the job.”

Lack of Humility

“Yes, I was a bully. I was a bully in the sense that I tried to control the narrative and if I didn’t like what someone said I turned on them.”

Loss of Perspective

“My ruthless desire to win at all costs served me well on the bike, but the level it went to, for whatever reason, is a flaw. That desire, that attitude, that arrogance.”

A recent study reported that 3.3% of high school students admitted to anabolic steroid use. Those using performance enhancers such as anabolic steroids risk damage to vital organs such as the heart, liver, and reproductive organs. I believe the health risk is even higher in teens and young adults. It is up to us to counter the attraction to performance enhancers.

Fostering a culture of sport fairplay where cheating is not acceptable and competition is rewarded, whether or not a win is achieved, is a first step. Lastly, remembering that, unlike Armstrong, most of a person’s life is not spent in pursuit of athletic excellence. The single-minded pursuit of a “win at all costs” goal may compromise more important lifelong things such as family, friends, or a career.