Starting a conversation about adolescent health

Dr. Hatim Omar

Dr. Hatim Omar

Written by Dr. Hatim Omar, chief of the Division of Adolescent Medicine at UK HealthCare. This blog is the first in a series of posts by Dr. Omar and his team related to the unique health concerns faced by teens and young adults.

When I came to Lexington in 1998, I faced a tough assignment.

Tasked with starting UK HealthCare’s Adolescent Medicine program, I knew that teens in Kentucky were worse off than almost anywhere else in the country. High rates of obesity, suicide, pregnancy and drug use all plagued the Commonwealth’s adolescent population. Instead of seeing the statistics as an insurmountable challenge, I saw an opportunity.

My outlook from the start was that we could make a difference. I knew it wouldn’t take much to change Kentucky if we did things the right way.

That meant tackling adolescent health through three approaches – direct patient care, governmental advocacy and community outreach. I’m happy to say that we have been successful.

Our Adolescent Medicine Clinic now sees more than 10,000 patients each year, and in the nearly 17 years since the program started at UK HealthCare, adolescent health outcomes in Kentucky have improved across the board.

But as with most things, there’s always room for improvement. And that’s why I’m starting this blog about adolescent health and well-being.

One of the most important things we can do – as health care providers, parents, teachers, caregivers and peers – to successfully improve the health of teens and young adults is to facilitate honest and open conversations.

In the coming months, my team in Adolescent Medicine and I will author blog posts about the most pressing health concerns we see in our clinic every day. My hope is that this blog can enhance those conversations and bring the discussions about the unique health concerns faced by adolescents to a wider audience.

I encourage you to share this post with the young adults in your life as well as parents and caregivers who have teenagers.


Next steps:

Physical therapy

Physical therapy often better than opioids for long-term pain management

Written by Tony English, PT, PhD, director of the Division of Physical Therapy at the University of Kentucky‘s College of Health Sciences.  

Tony English

Tony English

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the U.S. since 1999, even though there has not been an overall change in the amount of pain reported.

People with chronic pain conditions unrelated to cancer often depend on prescription opioids to manage their pain. As opioid use has increased, so has the misuse, abuse and overdose of these drugs in Kentucky and across the country.

The statistics are sobering:

  • As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings suffer with addiction.
  • Heroin-related overdose deaths more than quadrupled between 2002 and 2014, and people addicted to prescription opioids are 40 times more likely to be addicted to heroin.
  • More than 165,000 people in the United States have died from opioid pain-medication-related overdoses since 1999.
  • Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

The CDC released guidelines in March urging prescribers to reduce the use of opioids in favor of safer alternatives in the treatment of chronic pain. Physical therapy is one of the recommended non-opioid alternatives.

If you or someone you know has pain not related to cancer, consider physical therapy as a safer alternative for managing your pain. Physical therapists diagnose and treat movement disorders that may be contributing to your pain and will develop an active treatment plan specific to your goals.

A 2008 study following 20,000 people over a period of 11 years found that people who exercised regularly reported less pain. Manual therapy can reduce pain and improve mobility so that people have more pain-free movement. That, in turn, promotes more activity, which reduces pain even further. Exercise and manual therapy are two components of an active treatment plan that may be used by a physical therapist to help manage pain.

The American Physical Therapy Association has launched a national campaign called #ChoosePT to raise awareness about the risks of opioids and the choice of physical therapy as a safe alternative for long-term pain management.


Next steps:

Philip A. Kern, MD, talks with Angelique Bell, who participated in a diabetes-related study he led.

Research participation leads to a life-saving personal discovery

On the first of May, 2015, Angelique Bell waited in a hair salon, reading the weekend section of the newspaper. She noticed an ad for a health research study that needed participants who had risk factors for diabetes. Since she met the criteria and had some time to pass, she decided to call about the study right then, from the salon chair. It was her 45th birthday.

“I don’t have diabetes, but I have a strong family history of diabetes and some of the risk factors, and I thought that the information from this study could be something that could benefit me in the future,” Bell said.

She didn’t expect, however, that her impromptu birthday decision to call about the study would potentially save her life.

An unexpected finding

As part of the screening for the study, Bell had to do blood work and an EKG — standard tests to get baseline health data. Her results, however, were anything but standard: they showed extremely low levels of potassium and an arrhythmia in her heart that could be fatal if not treated.

“When she came in, she was having a lot premature ventricular contractions, which is potentially dangerous because your heart could suddenly go into ventricular tachycardia or fibrillation, which can kill you,” said Dr. Philip A. Kern, director of the University of Kentucky Center for Clinical and Translational Science and principal investigator of the diabetes study in which Bell participated.

At the time Bell was taking two medications to help control her blood pressure. One medication was a diuretic, which, unknown to Bell, was causing her to lose too much potassium through her urine. The resulting potassium deficiency was causing the arrhythmia in her heart.

Kern and the research team sent Bell to the UK Gill Heart Institute for further evaluation and treatment. She was taken off the diuretic, had to wear a heart monitor for 48 hours, and received potassium supplements.

“I was 45 years old at the time and I had to wear this heart monitor. Three-fourths of my grandparents had heart attacks. My mother had congestive heart failure. So it was a scary,” Bell said. “I was relieved to find out that the condition had not gotten to a point of causing damage. A really serious problem was averted.”

The importance of participation

Once the arrhythmia was resolved, Bell, undeterred by her own health scare, went back to Kern and participated in the diabetes-related study that she had originally phoned about.

The study was not Bell’s first experience as a research participant, nor was it her last. She had previously participated in two asthma-related studies at other institutions, motivated by her own diagnosis as a child, and she subsequently volunteered again at UK as a healthy participant in a study examining how our bodies process fat intake. Through each experience she learned more about her own health.

“That is one of the good things about being in the study — a lot of times when people get in studies, they find out about other issues with their health,” she said. “There’s a pretty in-depth amount of testing done, and it could uncover something that wouldn’t be found in a routine exam.”

Bell was also familiar with health research through family members’ experiences. Her father participated in a longitudinal study on gout, and her uncle was a researcher with the Centers for Disease Control and Prevention (“he was very excited about science”). Exposure to both researcher and participant experiences has convinced Bell of the importance of empirical, evidence-based information, as well as the need for research participants.

“Having people around who do research, you see how important it is for them to get people in their studies so they have enough evidence,” she said.

She additionally emphasizes the importance of racial and gender diversity among research participants, in order to understand how health conditions and treatments affect people differently, but she simultaneously acknowledges the legacy of the infamous Tuskegee experiment conducted between 1932 and 1972. In the course of that study, hundreds of poor African-American men were knowingly left untreated for syphilis.

When the Tuskegee story was uncovered, it created an understandable distrust of health research, particularly among African-Americans. At the same time, however, the story initiated a host of stringent federal regulations enacted to protect research participants. In 1974, Congress passed the National Research Act and created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which developed guidelines for human subject protection, including the landmark Belmont Report.

Health research involving people is now “very highly regulated, with multiple layers of protection,” Kern said. Studies require a process of informed consent and communication of diagnosis, as well as reporting of the study results. Institutions like UK that conduct health research must have institutional review boards (which include community members) to review the plans for all studies. UK also has an Office of Research Integrity that can answer questions and support research participants.

“Because of Tuskegee I think a lot of African-Americans are leery of participating in research studies,” Bell said. “But if you don’t participate in the research then the data that relates to you is not there. Some things do have a genetic factor, and some things might affect people of African descent differently than people of European and Asian descent.”

Improving health for others

If there is residual distrust about health research, there is also a great deal altruism that motivates many people to participate. According to Roxane Poskin, participant recruitment manager at the UK CCTS, a large percentage of volunteers join studies as way to give back to society and contribute to discoveries that improve health for others and future generations.

This is particularly true for healthy participants, who don’t have a health condition they hope to address through a study but who are essential to research that broadens our understanding of what Kern calls “the basic mechanisms of disease and how the body works.” While participants receive information about their health and sometimes receive compensation for participating, they don’t always receive a direct health benefit for themselves.

“They want to be involved and help others even, if it doesn’t help them directly,” Poskin said. “If we didn’t have volunteers, we wouldn’t be able to accomplish research studies. Even the smallest things have been researched, like thermometers and crutches.”

Bell, who has spent her career in non-profit organizations (she currently works with Kentucky Refugee Ministries and ITNBluegrass), says she doesn’t personally know many people who participate in studies, but that she would encourage anyone to participate, either for their own benefit or to advance medical knowledge that could help others.

“We have to have evidence-based research,” she said. “And you get a lot more information about your health than you would in a normal physical.”


Next steps:

Better quality of sleep has obvious health benefits, like improved attention and memory. So how much sleep should your child be getting? It varies by age.

For children, how much sleep is enough?

Better quality of sleep has obvious health benefits, like improved attention and memory, but this is particularly important for children. So how much sleep should your child be getting? Doctors agree that the right amount of sleep for children varies by age:

  • Infants. Babies that are 4 to 12 months old should be sleeping for 12 to 16 hours a day, including naps.
  • Young children. If your child is around 1 to 2 years old, they need 11 to 14 hours of sleep each day, plus naps.
  • Toddlers. 3- to 5-year-olds require 10 to 13 hours of sleep each day including naps.
  • Older children. Children between 6 and 12 should aim to sleep between nine and 12 hours a day.
  • Teenagers. Teens – age 13 to 18 – should get eight to 10 hours of sleep per day.

Getting the right amount of sleep is as important for children as nutrition and exercise. Sufficient sleep not only improves mood, it can lower your child’s chances of becoming overweight, of developing diabetes and of having attention or learning problems.


Next Steps

Treatment options for patients with drug-resistant epilepsy

Treatments available for drug-resistant epilepsy

Written by Dr. Frank Gilliam, director of the Epilepsy Center at the Kentucky Neuroscience Institute at the University of Kentucky. 

Dr. Frank Gilliam

Dr. Frank Gilliam

One in 26 people will develop epilepsy – a chronic disease characterized by unpredictable seizures — in their lifetime.

A seizure is a sudden surge of electrical activity in the brain that can temporarily change how a person thinks or behaves. Seizures can be scary for both the patient and the people around them, since patients can lose awareness or even become unconscious, twitch or spasm, babble, have blurry or no vision, experience difficulty breathing, and/or a host of other symptoms.

Epilepsy has numerous physical and emotional costs. People with epilepsy have problems keeping up in school or at work, can be depressed and/or socially isolated, can suffer physical injury during a seizure, and can even die from a seizure. They may not be allowed to drive, play sports or have other restrictions that affect their professional or personal lives.

It’s important to remember that not all seizures are epilepsy. A person is diagnosed with epilepsy if they have one or more seizures that were not caused by some known and reversible medical condition such as diabetes. People can develop seizures after a brain injury (like a car accident or getting hit in the head with a baseball), a stroke, or because of an infection or a brain tumor. Sometimes there is a family history of seizures, but often the cause is unknown.

If you suspect you have had a seizure, you should see your family doctor or a neurologist for an evaluation. That is likely to include a detailed conversation about what happened during your seizure, medications you are taking, preexisting illnesses or injuries, family history and more. The doctor is also likely to order blood tests that might identify treatable medical disorders, an EEG, which measures brain waves and looks for abnormalities that point to epilepsy or other neurological disorders, and possibly also a CAT scan or MRI to look for abnormal areas of the brain.

There is no cure for epilepsy, but two-thirds of all people with epilepsy are able to control their seizures with medications. The remaining one-third have what’s called “drug-resistant” or “refractory” epilepsy. In those cases, patients may be able to find relief through surgery or through devices that can help override the abnormal electrical impulses in the brain.

In the U.S., there are more than 100,000 patients who are candidates for epilepsy surgery, and only about 2,000 people have the surgery every year. Patients don’t need to suffer from the physical and emotional effects of epilepsy for 10 or 20 years. If someone has uncontrolled epilepsy for more than a year, they should seek an opinion at an accredited epilepsy center.


Next steps:

Dr. Douglas Andres

UK lung cancer study picks up after 15 years

In the late 1990s, University of Kentucky Professor Douglas Andres found that mutations in a protein known as RIT1 could initiate cancer development in laboratory models.

RIT1 works as a molecular switch. In response to signals from outside the cell, it turns on fundamental cellular activities, and then turns them off again to ensure they don’t continue unchecked.

“Proteins like RIT1 control everything from how cells differentiate to how they grow,” Andres said. “In a disease like cancer, they often get broken in the ‘on’ position. The cells that have RIT1 mutations constantly grow, even though they don’t receive the necessary signals from the environment.”

When Andres applied for funding to follow up on his findings, his application was declined. The reviewers of his grant wanted evidence that RIT1 mutations might actually promote cancer development in people. Unfortunately, searching for RIT1 mutations in human tumors was, at that time, a difficult undertaking. The technological advances required to successfully complete this mission would not be made until several years later.

But Andres didn’t lose hope.

“I never really give up on anything,” he said.

Just over a year ago, his patience was rewarded – Alice Berger, a postdoctoral researcher in the laboratory of Professor Matthew Meyerson at the Broad Institute of MIT and Harvard, provided the evidence he needed. Working collaboratively, the research teams led by Andres and Meyerson showed what Andres had hypothesized all along: RIT1 mutations present in human lung cancers can transform non-cancerous cells into cancerous ones.

Now, after waiting more than 15 years, Andres has finally been awarded the funds to expand upon his initial discovery. Specifically, the breakthroughs gained from his collaboration with Meyerson helped him secure a two-year, $150,000 grant from the Kentucky Lung Cancer Research Program.

“With the grant we received, we will push the work forward,” Andres said. “We hope this will lead to greater understanding of RIT1 mutations and how tumors containing them may differ from other lung tumors.”

Ultimately, Andres hopes to use the insight obtained from these efforts to develop new tests that can diagnose RIT1-mutant lung cancers in patients. The awareness gained from such efforts could potentially lead to the development of therapies that specifically kill cancer cells containing RIT1 mutations.

“Each time that we gain fundamental insight into a problem – that is an exhilaration,” Andres said. “Sometimes it happens in six months of work, or, in this case, it’s taken 15 years between our initial discovery and our ideas actually coming to fruition.”


Next steps:

Make sure to dispose of expired medications

Written by Dr. Amy Meadows, assistant professor of pediatrics and psychiatry in UK’s College of Medicine.

Dr. Amy Meadows

Dr. Amy Meadows

When was the last time you cleaned out your medicine cabinet? Unlike a messy refrigerator, there’s nothing in your medicine cabinet to send a scented reminder that you need to throw out old bottles of ibuprofen and pain killers from your oral surgery two years ago.

Not only is this unsafe because medications should not be consumed past their expiration date, but they also have the potential for abuse. According to the 2014 National Survey on Drug Use and Health, the most commonly abused medications are opiates and other pain relievers, which is consistent with information from other sources.

Many medications have the potential to be misused, which includes both prescribed and over-the-counter medications. There are multiple ways drugs can be used incorrectly, or in some cases, illegally: they can be misused (used in ways other than recommended), abused (used for nonmedical reasons) or diverted (given/sold/bartered to people other than the intended patients).

When taken as directed and in the recommended amounts, over-the-counter medicines are generally very safe. However, those same medications can present a significant danger in overdose. Even over-the-counter analgesics like acetaminophen (Tylenol) or ibuprofen (Motrin) can cause organ damage or even death in some situations. It’s incredibly important that medications are taken as directed on labels or by a physician.

Children are especially at risk for abusing medications, either because they do not recognize medication as a danger or because of the impulsivity and risk-taking common in adolescents. It is recommended that medications be stored out of reach, such as in a medication lock box, to reduce to risk of misuse.

Medications should not, under any circumstance, be saved and used for future issues or ailments. This can be especially dangerous for antibiotics, which should be taken as directed until the full course of medication is completed. Other medications can become ineffective or potentially dangerous after their expiration. It is far safer to be evaluated by a medical professional to diagnose and treat a newly occurring issue rather than relying on old or expired medications.

Everyone can and should periodically dispose of old, unused and expired medications. In Lexington there are several options for safe disposal, including units at the Lexington Police Department and Fayette County Sheriff’s Office or on medication take-back days. Some pharmacies are also able to offer safe disposal of unused medication. Alternatively, if people are unable to access medication take-back programs, it is recommended that medications be placed in a sealable container or bag and mixed with kitty litter, dirt or coffee grounds before being thrown away.


Next steps:

Chandler Dining

Come enjoy the new Chandler Dining!

Chandler Dining, UK HealthCare’s new state-of-the-art dining experience, opened its doors to the public on Monday.

Our new dining space is unlike any hospital cafeteria you’ve seen before, and we want you to stop by to enjoy the tasty meal options our chefs are creating. Chandler Dining is open not only to patients, families and staff, but to the public as well. Stop by and enjoy a great meal!

Located on the first floor concourse of Chandler Hospital Pavilion A, Chandler Dining is open 22 hours a day, featuring nine food stations, eight checkout lines and several other unique features.

Stations:

  • Italian Tratttoria (pizza, pasta, flatbread)
  • Deli (freshly carved meats)
  • Chef Table (exhibition station)
  • Traditions (traditional home-cooked meals)
  • Chop Chop (made-to-order signature salads)
  • Salad/Soup Bar
  • Southwestern Grill (hamburgers, grilled cheese, French fries, chicken, fish)
  • Sushi
  • Starbucks Coffee

Features:

  • Stone hearth oven
  • Chef Table (featuring five interchangeable cooking display units)
  • Teaching kitchen
  • Global menu offerings
  • Healthy and sustainable initiatives
  • Specialty made-to-order coffee drinks and smoothies
  • Menus on digital screens
  • Fresh carved meats at deli
  • Local artwork in the dining area
  • Water container filling station in the dining area

Chandler Dining hours of operation:

  • Breakfast: 6-10 a.m.
  • Closed: 10-11 a.m.
  • Lunch: 11 a.m. to 2 p.m.
  • Light lunch: 2-4 p.m.
  • Dinner: 4-7 p.m.
  • Late night: 7 p.m. to 5 a.m.

Check out the video below to see our chefs in action and learn more about the Chandler Dining experience.

Colleen Swartz

Colleen Swartz, UK HealthCare chief nurse executive, named Leader to Watch

Congratulations to UK HealthCare’s chief nurse executive, Dr. Colleen Swartz, who is featured on the cover of this month’s Nurse Leader journal as a national nursing Leader to Watch.

Swartz sat down with Nurse Leader for an extensive interview about her career, the nursing profession and what it means to be a leader in health care.

She also offered advice for new nursing leaders, emphasizing the importance of ongoing self-improvement.

“Self-reflection and self-awareness must be an ongoing process for nurse leaders throughout their careers. An essential piece of the process is identifying the gaps in one’s repertoire of leadership skills, then developing a plan to address them,” Swartz said. “The strongest nurse leaders I know have honed this process and engage in it on a daily basis. It is truly an expression of humility that is foundational in leadership.”

Swartz also had a chance to reflect on the legacy of her career in nursing.

“Our nursing motto at UK, ‘Every patient, every time,’ is very personal to me, and I hope I have been able to impart that as a grounding principle for all of those whom I have had the privilege to lead,” she said. “Never losing sight of the reality that leading is both a privilege and a responsibility – one that can never be taken lightly or for granted.”


Next steps:

JC and Max Middleton.

Family confronts diabetes with help from UK

A natural instinct for a mother is to protect her children by keeping them healthy and safe. But what do you do when your spouse and not just one, but both of your children are diagnosed with a chronic illness like diabetes, all within a relatively short amount of time? That’s the challenge Lisa Middleton, her husband and two young children faced.

With the help of the University of Kentucky’s Barnstable Brown Diabetes and Obesity Center, the Middletons are confronting diabetes, ready to meet that challenge head-on, all day, every day.

The first diagnosis

James and Lisa Middleton look like the couple next door. Lisa, an energetic and personable young woman, received her doctorate degree in pharmaceutical sciences from the University of Kentucky College of Pharmacy and later was a research assistant professor in the College of Medicine. She is currently a lecturer at Eastern Kentucky University.

James “JC” Middleton is an avid long-distance cyclist and a software engineer at Valvoline. It was quite a shock when, 12 years ago at age 29, he was diagnosed with diabetes. JC suddenly dropped 20 pounds from his already slim physique. He was constantly tired, stayed thirsty and drank more than usual. That caused him to use the bathroom more frequently, even throughout the night. Weight loss, excessive thirst and frequent urination are common symptoms of diabetes.

Lisa was puzzled by her husband’s initial diagnosis of Type 2 diabetes sometimes referred to as adult-onset or non-insulin dependent diabetes because he didn’t completely fit the profile. Type 2 diabetes typically occurs in older adults and can be aggravated by unhealthy eating habits, inactivity and obesity. None of these traits describe JC. Following a visit to the endocrinologist, JC’s diagnosis was changed to Type 1, and that day he began insulin therapy.

Lisa describes her husband as “independent and incredibly smart.” He was immediately able to learn carbohydrate counting and quickly did the math to calculate his insulin doses. Although the diagnosis presented a huge change in JC’s life, she said “he just handled it.”

Barnstable Brown supports the family

The Middletons have two children, Kara, a lively and self-confident 7-year-old who loves horses and wants to be a famous singer, and Max, an active and strong-willed 2-year-old who likes to run, jump and climb.

About a year ago, the Middletons noticed something unusual about baby Max. He stopped gaining weight and produced a lot more wet diapers. Late one evening while JC was testing his blood glucose level, he decided to test Max’s glucose level on a whim. He couldn’t believe his eyes.

“It was off the charts; it simply registered high,” JC said.

The next day, Max’s pediatrician strongly suspected that at age 20 months, the Middletons’ youngest child had Type 1 diabetes, and their world seemingly turned upside down.

“It crushes you,” JC said. “We were all but on the floor crying.”

Their pediatrician immediately directed the Middletons to UK’s Kentucky Children’s Hospital where Max was hospitalized. The first night, as Max was sleeping, Lisa took out her smart phone and read everything she could on diabetes, including the latest on clinical trials and advances in research.

Today, Max wears an insulin pump connected to a strap around his waist that delivers constant short-acting insulin through a catheter placed under the skin. The pump offers freedom from multiple injections and can be programmed based on what Max eats throughout the day and his activity level. A continuous glucose monitor, called a Dexcom, is attached to Max’s upper arm. This allows JC and Lisa to continuously monitor his glucose levels every five minutes, 24 hours a day. If his glucose level reads too low or too high, the Dexcom will send an alarm to JC’s and Lisa’s smart phones to warn them, which is especially important throughout the night.

“He handles his diabetes like a rockstar,” Lisa said. “Once you see your 2-year-old handling their diabetes better than you are, you have to get over it and move forward.”

About six weeks ago, while on a family vacation in Lisa’s home state of Michigan, Lisa noticed Kara had wet the bed during the night and thought she had a possible urinary tract infection.

“I think it was always in the back of my mind that diabetes could also happen to Kara, but honestly, I thought we were in the clear with her. We had one child with diabetes, surely we wouldn’t have another,” Lisa said. “My mom had some urine test strips and I tested Kara. Her urine was full of sugar.”

Kara was taken to a hospital in Michigan and was diagnosed with Type 1 diabetes. She began treatment that day. The Middletons then contacted UK to consult with Max’s pediatric endocrinology team about Kara’s treatments. The team includes Dr. Alba Morales, associate professor of pediatric endocrinology and Barnstable Brown faculty member and diabetes educator Angela Hepner.

“They were incredibly helpful, supportive and confirmed treatments,” Lisa said. “As soon as we returned home to Kentucky, Kara was seen at Barnstable Brown immediately.”

Kara is currently taking four to six shots every day and checking her blood sugar by herself six to 10 times per day. She also will be starting on an insulin pump and Dexcom next week thanks to the quick work of the staff and doctors at Barnstable Brown.

Dealing with diabetes

According to the American Diabetes Association, there is a 3-5 percent chance siblings will develop diabetes. Hepner said UK is seeing more sibling sets with diabetes as well as several families where one parent has Type 1.

“Our team is committed to making families like the Middletons have as positive an experience with diabetes as possible,” Hepner said. “For our younger children, we focus our educational efforts toward the parents, and also emphasize to the kids that diabetes should never stop them from doing what they love.”

Morales says it is a huge challenge to manage children with diabetes because they are changing and growing on a daily basis and their management has to evolve with them.

“The mother has been wonderful in the way she manages her children’s diabetes on a daily basis. It is more difficult than anyone can imagine,” Morales said. “She is really good at keeping us informed here so that we can all work as a team.”

While the Middletons say they are fortunate because both their children were diagnosed early before they got extremely sick, their biggest challenge is managing their worry.

“Like all parents, we want the best for our children and want them to lead as normal a life as possible, and a diagnosis of diabetes is just a detour in the road,” JC said. “I try not to blame myself for my kids’ diabetes because in all likelihood, I passed it on to them. There are so many potential things that may cause diabetes, you can’t blame it all on genetics.”

Morales says that the reason there is no cure for diabetes yet is because the disease’s causes are still unknown.

“It’s a combination of factors and genetics is only one. We believe there are undiscovered environmental factors as well,” she said. “Diabetes is impossible to predict in children, even if both parents have diabetes.”

Lisa said JC knows the seriousness of the disease and is involved in every aspect of their children’s care, but as the mother and the only non-diabetic in the family, she worries about them all.

“I worry whose blood sugar is up and whose is down. I have to keep track of checking glucose levels and who ate what and when, and if they got their insulin. Now that Kara is in the mix, it’s even more worrisome. I have to work every day to keep my family alive,” she said. “Worrying can consume all of the energy I have that I could be putting somewhere else; so I have to push nervousness to the back of my mind and focus.

“Diabetes is an invisible disease. My kids are not obviously diabetic. They are normal and active. We can easily hide the monitors and pumps with clothes but the seriousness of the disease is always present.”

JC adds, “there is light at the end of the tunnel. You can live a normal healthy life with diabetes. Hopefully our children will see a cure for Type 1 diabetes in their lifetime.”

Dr. John Fowlkes, director of the Barnstable Brown Diabetes and Obesity Center, said the clinical team is about much more than just seeing patients and prescribing treatment.

“Diabetes doesn’t just impact the individual, it can potentially impact the entire family whether there is one diabetic or several,” he said. “We strive to educate our patients on how to live a full and healthy life with diabetes, and serve as a medical home that addresses all their needs.”