Funding for CGM, a game changer for young Bella

Ten-year-old Bella Hawkins was diagnosed with Type 1 diabetes at the tender age of two. Now, with medical scheme funding for a game-changing glucose sensor that attaches to Bella’s upper arm her diabetes management has gone to the next level.

Diagnosing Bella

“Bella Hawkins is one of the youngest patients I have diagnosed with Type 1 diabetes,” says Dr Neville Wellington, a Cape town-based GP with a diabetes speciality. “Bella’s parents had brought her in a few days before we diagnosed her. She had a nappy rash and was passing a lot of urine. At the time, I thought it was a case of thrush,” he explains.

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

Dr Wellington continues, “Two days later, on 30 April 2013, Bella was brought in again as she was really not herself. When I checked her blood glucose levels, they were very high. They should have been less than 7,8mmol/L, however, her blood glucose was at 53 mmol/L. Also, the goal in managing a patient with Type 1 diabetes is to get their HbA1c levels below 6%. When Bella was diagnosed, her HbA1c was at 12,5%.”

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

Bribery in the form of stick-on tattoos

“For the first few weeks after Bella’s diagnosis, Lance, my husband, and I were both completely numb. We had a little one who was sick and were trying to wrap our heads around this as a lifelong illness. We had to prick her finger every two hours, draw drops of blood onto a test strip, insert this into a blood glucose monitor, wait for the reading, then inject Bella with insulin according to the blood glucose reading.”

“The only way to know what her blood glucose levels were doing was to prick, draw blood and test. We were causing her constant pain that she initially did not understand. We were also trying to understand the impact of everything she ate and drank on her blood glucose and learn to balance her levels with the right amount of insulin throughout the day.”

The first two months, Lance and Kerry injected Bella with insulin every two hours. This meant finger pricks (to extract drops of blood for analysis in a blood glucose monitor) every 40 minutes, before and after injecting with insulin.

“We would have to bribe her with sticker type, press-on tattoos. Eventually Bella was covered in them and looked like a gangster,” Kerry recalls. “Fortunately, Bella soon began to feel better, and this helped to get her buy-in to the process.”

Finding a healthy rhythm as a family

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

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

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

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

High-tech glucose monitoring trial

In 2020, a manufacturer of a continuous glucose monitoring (CGM) sensor device contacted Dr Wellington. He offered him an opportunity to give some of his patients access to the sensors for a month on a trial basis.

This sensor is around the size of a R5 coin. It attaches painlessly to the upper arm with a small needle inserted into the skin which detects blood glucose levels. This device takes a blood glucose reading every five minutes.

To access the reading, you only need to swipe a smartphone with the linked app over the sensor. This process is a giant leap from traditional finger-pricking techniques used by millions of people with diabetes all over the world. The sensors cost around R1 000 each, and each last for two weeks (so two are needed each month).

Dr Wellington was keen for Bella to use the device. It would allow for 24/7 monitoring of her blood glucose levels in the least invasive way possible.

“Before Bella had access to this sensor, it was unclear whether she was experiencing hypoglycaemic lows (very low blood glucose) at night when asleep. It was also very challenging to wake her and do finger prick-based blood glucose testing. When they did occur, Bella found the symptoms very frightening, like feeling weak, a high heart rate, confusion and blurred vision,” explains Dr Wellington.

Life changing experience

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

Discovery Health Medical Scheme funds sensors

Unfortunately, both Kerry and Lance faced changes to their employment at the end of 2020, which meant they could not afford the R2 000 a month for Bella’s sensors. “However, we knew the value of the device for Bella,” says Kerry. “And she told us that, for the first time in eight years, she could feel her fingertips as she stopped pricking them for a month.”

“We were absolutely thrilled when Discovery Health Medical Scheme (DHMS) announced that in 2021, they would fund the bulk of the cost of CGM devices for people who have Type 1 diabetes. We only pay R3 90 a month for two sensors. So, we only pay R195 towards each sensor and Discovery pays the rest, making them really affordable for us.”

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

Dr Wellington adds, “It’s a huge shock to any parent to have their child diagnosed with a lifelong illness like Type 1 diabetes. I want to commend her parents, Lance and Kerry, for their dedication to optimising Bella’s condition through the years. Bella has also been incredible in the way she has adapted to coping with the condition and testing her blood glucose regularly, and now to the use of CGM devices.”

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

All medical information in this article including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to empower diabetes patients and their families by promoting a better understanding of a diabetes retinopathy.

Header caption: Bella Hawkins holding her sister Hayley.