Both had diabetes. But one child followed directions, and the other didn't. Still, by using two very different treatments for two very different patients, Children's Hospital has reduced the danger and burden of their illnesses. My associate, Beth Schwinn, filed the following report:
Failure to follow treatment in juvenile diabetes is like failure to stop smoking -- the effects may not show up for years. Proper management of diabetes takes greater maturity than many adults possess -- and the disease can strike children at any age.
Eleven-year-old Jayne Draper of Sterling, Va., with a supportive family and a father who also has diabetes, adjusted very rapidly to the illness and now has an insulin pump, which uses a computer to feed insulin continuously into her blood.
Inga Lawrence, 15, of Southeast, whose family is unfamiliar with diabetes, required frequent hospitalization over a seven-year period because she did not keep up her regimen. Then, with the inception this year of a Children's Hospital home health care program for diabetics, Inga turned herself around.
Inga has known of her diabetes since she was 8. From the beginning, Inga's family didn't know how to react. "We treated Inga like she was made of glass," said her mother, Laverne Curry.
The family cannot always afford the foods Inga needs. Although her mother began by giving Inga her shots, "I always hurt her, and she did them herself. I used to shake for 10 minutes every time I had to give her a shot."
"The family has to change its schedule for the diabetic, too," noted Diane Rivkin, the nurse educator for diabetes at Children's Hospital. "Meals have to be at the same time each day. Discretion should be used in eating foods the diabetic can't have. You can't sleep in on weekends."
Last year, Inga stopped growing as a result of not maintaining her regimen. She weighed 85 pounds and was 5 feet tall. "I didn't know until Dr. Allen Glasgow brought it up that diabetes would have that much effect on growth," her mother said. "I had a negative approach. I didn't think Inga would be able to lead a normal, healthy life. It took a lot of visits to the hospital and talking to the other families to realize that."
Jayne Draper found out she had diabetes last year, two days before Halloween. Although she had not yet developed symptoms, her father, Daniel Draper, had tested her blood sugar level, as he does periodically for all five of his children, and had discovered it to be unusually high.
Jayne's father began trying to locate the best specialist. His choice narrowed to the Children's Childhood and Adolescent Diabetes Center and Glasgow, who directs it. He brought Jayne in immediately.
Daniel Draper was impressed by the program. "A lot of doctors set up very rigid schedules, and require patients to measure all their food. That's not realistic for a child. Dr. Glasgow lets her be a child. The nutritionist asked Jayne what her favorite foods were, and worked out with her which and how much of them she could eat."
For example, at a party where cake and ice cream are served, Jayne may eat cake without the icing, or ice cream, but not both. Daniel Draper also liked the team approach, which combines a doctor, a nutritionist, a nurse educator and a social worker, all oriented toward the diabetic child.
Inga and her family needed more help than the team approach provided, but Glasgow said this is not uncommon. "Diabetes is tough," he said. "It's a lot of responsibility for the child and the family. You don't go in for one operation. You don't say, 'Doctor, take care of this for me.' But we came close to doing that with the home health care team."
The team is a combination of nurses and social workers who work with patients in their homes. In Inga's case, they gave her shots and blood tests, and supervised her nutrition.
"The team was very nice," Inga said. Janice George, one of the social workers, took Inga out shopping, invited her to sleep over and asked Inga to help with Janice's Brownie troop on a visit to Kings Dominion.
"Janice would come in and sit and talk with us. Sometimes it was tough to get enough food together to make a balanced meal. She told us about where we could get food. Janice was just real easy to talk to," said Laverne Curry.
"I think this demonstrated to Inga how important it was," said Dr. Glasgow. "Here were people from the hospital going to her house, going to a great deal of trouble every day.
"We did this for about two months, until Inga said that she wanted to take over management of her diabetes again. The nurse continued to go every day to supervise her shots and nutrition. Gradually, our support was withdrawn. The family matured, too, had the right foods available, helped Inga stick to her schedule." Inga's recent check-ups show that she has kept her glucose level near normal.
Jayne has maintained an excellent record in managing her diabetes. In May, Dr. Glasgow agreed to let her have an insulin pump, which Jayne has wanted since her disease developed last year. Pumps are usually given only to adults, since the machines require more care than does one shot a day. Jayne is the first child to whom Dr. Glasgow has given a pump.
Jayne's insulin pump resembles a calculator. It fits into her hand, and a pack on the side of the pump holds her insulin. Forty-two inches of tubing lead to a needle taped to her abdomen, which feeds a low level of insulin continuously into her body. Because this simulates normal production of insulin, Jayne eats when she wants, increasing insulin before meals.
Her father, who also wears a pump, felt that the difference between a pump and shots was like the difference between contact lenses and glasses. Jayne cannot swim or shower with her pump on, but she can conceal the pump under loose-fitting clothes. To a passer-by, she appears normal.
Jayne's mother, Cynthia Draper, tries to have an equivalent for foods the family eats -- for example, sugar-free cocoa for Jayne when the family has cocoa. Since Jayne's father is also diabetic, there is little high-fat or sugared food in the house, anyway.
Jayne manages her own diabetes. From the beginning, Jayne handled her own shots and blood tests. Dr. Glasgow asked the family to call every day for the first two weeks, and Jayne took care of making those calls, too. "I know less about it than anybody," said her mother.
Both Jayne and Inga attended separate two-week sessions of a diabetes camp last summer with the Children's diabetes team, which sponsored the trip in conjunction with the Juvenile Diabetes Foundation. Jayne noticed the variety of equipment campers used for their diabetes, and took part in a number of volunteer research projects. She likes science.
For Inga, the camp represented her first time away from home as well as her first trip to the country. "I liked the horses," she said. "We could brush and feed them. I learned how to swim and got a beginner's certificate."
Jayne's parents are optimistic about the future. They think that medical advances will continue to make diabetes management easier. "Even though we knew some of our kids might have diabetes, it was hard for me when Jayne developed it," said her mother. "But you get used to it. There are a lot of people with worse diseases."
"That's funny," said her husband, who developed diabetes at 12. "That's exactly what my mother told me."
Inga still dislikes her diabetes. "Sometimes I say now I wish I never had it," she said. "If there's ever a cure, I'll be the first person in line." But "Inga accepts it now," said her mother. "It's easier for the whole family."
TO CONTRIBUTE TO THE CAMPAIGN:
Make a check or money order payable to Children's Hospital and mail it to Bob Levey, The Washington Post, Washington, D.C., 20071.