CALGARY — A doctor has testified that the parents of a teen who died of starvation and complications from untreated diabetes were providing fake blood-sugar readings while caring for him after his initial diagnosis.
Dr. Daniel Metzker from the B.C. Children's Hospital told the couple's trial on Tuesday that they refused to believe their son had diabetes and had to be pressured by child and family services to treat him before he could be released from hospital in 2000.
"The major thing that I remember is the initial resistance: that I was wrong about the diagnosis of diabetes, that we hadn't done the right tests, that we still were not correct with the diagnosis,'' Metzker testified.
Not guilty plea
Emil and Rodica Radita have pleaded not guilty to first-degree murder in the death of 15-year-old Alexandru, who weighed less than 37 pounds when he died in Calgary in 2013.
A judge, who is hearing the case without a jury, has yet to decide if evidence dealing with the family's time in B.C. will be admitted in the trial.
Metzker, a pediatric endocrinologist, was one of the first physicians to deal with Alexandru and his parents when the boy was diagnosed at about age two.
The doctor said training the couple on the basics of diabetes was difficult and, after Alexandru's release, a community health nurse had to visit the family's home twice a day to make sure he was getting insulin.
Fake blood-sugar readings
It was discovered in March 2001 that the parents appeared to be taking their own blood-sugar readings and calling them in to the hospital, Metzker said. A check of the blood-sugar meter confirmed that something wasn't right.
"At one point, the blood sugars were very consistently the same. I've been doing this for 23 years. We have a lot of teenagers who fabricate blood sugars. You start to recognize patterns,'' he said.
"I concluded that somebody was probably falsifying the blood sugars — perhaps doing their own finger pokes, because you have to put a sample on the meter to get a reading.''
"I concluded that somebody was probably falsifying the blood sugars."
The results from a non-diabetic person were being recorded, Metzker concluded.
The doctor documented his concerns to the government ministry that was looking out for Alexandru. A short time later, the B.C. Children's Hospital was told the boy was going to be treated at a hospital in Surrey.
"Our social worker had contact with the social worker in Surrey, and that social worker had been persuaded by the parents that we were persecuting the family, that we had taught them about diabetes and that they no longer wanted to be followed up at Children's (Hospital),'' said Metzker.
He said the ministry needed to remain involved.
"It was our very strong recommendation and medical opinion that the ministry had to remain involved in this case because we were, if you will, losing control of the situation.''
After another admission to hospital for malnutrition in 2003, Alexandru was placed in foster care for one year. At that point, the boy gained weight, his condition was being managed and he appeared to be thriving, Metzker said.
In 2005, a judge returned Alexandru to his family. They moved to Alberta three years later.
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Commonly referred to as Juvenile Diabetes, because it’s often diagnosed in childhood. However, it can also be diagnosed in adults. Type 1 diabetics have a pancreas that produces little or no insulin, which requires insulin management through medication that is usually injected.
Type 2 diabetes is a chronic condition that almost always develops in adulthood — which is why it’s sometimes referred to as adult-onset diabetes. "About 90 per cent of diabetics are Type 2, meaning that their ability to produce adequate levels of insulin is highly compromised and they have significant levels of insulin resistance,” says Dr. Barry Sears, president of the Inflammation Research Foundation. "The combination leads to significant increases in a variety of additional disorders — in particular heart disease and Alzheimer’s — in addition to the standard problems of loss of vision, increased amputation, and kidney failure."
Insulin is a hormone. It’s produced by the islet cells of the pancreas, and its role is to regulate glucose levels in the blood. The pancreas secretes insulin into the bloodstream, where it works to allow sugar to enter the cells and lowers the level of sugar in your bloodstream. As blood sugar drops, the secretion of insulin from the pancreas does too. While both types of diabetes involve insulin and the functioning of the pancreas, there are key differences in their causes and treatments.
Symptoms of type 1 diabetes include the emergence of bedwetting in children, frequent thirst, frequent urination, unintended weight loss, extreme hunger, blurred vision, and fatigue.
With type 2 diabetes, the condition can exist for years before diagnosis. But many of the symptoms are the same as with type 1: blurred vision, unexplained weight loss, excess thirst and urination, fatigue. Also watch for sores or infections that are slow to heal, as type 2 diabetes can affect your ability to heal and fight infection. As well, areas of darkened skin (acanthosis nigrican) in creased areas like the armpits and neck are a sign of insulin resistance.
A variety of factors may contribute to the development of type 1 diabetes, according to the Mayo Clinic, including possible genetics and exposure to certain viruses. Risk factors for the disease include family history and young age, with peaks in outset occurring between ages 4 and 7 and ages 10 and 14.
With type 2 diabetes, the risk factors include having excess fatty tissue, carrying fat around the abdomen, having a family history of diabetes, being inactive, having polycystic ovary syndrome, and getting older. As well, people of black, Asian, Hispanic, and Aboriginal backgrounds are at higher risk of developing type 2 diabetes, though it’s not known why.
Interestingly, the incidence of type 1 diabetes increases as you travel away from the equator, according to the Mayo Clinic, leading some researchers to think it could develop more readily in winter than summer. The highest incidences of type 1 diabetes are found in Finland and Sardinia, for example, where rates are about double or triple those in the U.S. and 400 times those in Venezuela.
It’s unknown exactly what causes type 1 diabetes, but in those with the condition, the immune system attacks the insulin-producing cells of the pancreas. In type 2 diabetes, the islet cells are still functioning as they should, to release insulin — the problem instead is that the pancreas doesn’t produce enough insulin, the body becomes resistant to the insulin, or both. But while we know about some contributing factors, it’s also not known exactly what causes type 2 diabetes.
Type 1 and type 2 diabetes can both have serious effects on your health if not managed. Diabetes can affect your eyes, heart, blood vessels, nerves, and kidneys, though keeping your blood sugar levels well managed does a lot to mitigate these effects. Nerve damage can manifest in loss of feeling or pain, usually beginning in the feet or hands. It could cause gastrointestinal problems or erectile dysfunction. Damage to the blood vessels in the kidneys can lead to kidney failure or kidney disease. Eye problems are also seen in some diabetics, and problems in pregnancy are also a risk.
Prevention of type 2 diabetes can be done in part through dietary choices, and making sure you get enough magnesium may be one of them. "Magnesium plays a pivotal role in the secretion and function of insulin,” Dean says. “Without it, Type 2 diabetes is inevitable.” Measurable magnesium deficiencies is common with the condition, she says, and related to many of the related complications.
Managing stress and anxiety can also help to keep your overall health steady, including possibly staving off type 2 diabetes. "The connection between stress, obesity and diabetes cannot be overlooked,” Dean says. "The stress chemical cortisol signals a metabolic shutdown that makes losing weight almost impossible. Magnesium can neutralize the effects of stress and is known as the anti-stress mineral.” And of course, if you do have diabetes, it’s easier to manage your condition if you aren’t overwhelmed.
There is no cure for type 1 diabetes, though the disease is manageable and treatment has advanced considerably in recent decades. Those with type 1 diabetes must take insulin for the duration of their lives; the physician works with the patient to find the best insulin and dose for blood sugar maintenance. Other medications may be required for related conditions. Not all type 2 diabetics require insulin therapy, but some do. For both types, regular exercise and a healthy diet, along with weight control, can also help keep glucose levels consistent.
For some type 2 diabetics, bariatric surgery may be an option to lose weight and control the disease. However, the surgery does involve serious risks that should be discussed with your physician.
If you suspect you or a family member has type 1 or type 2 diabetes, it’s important to seek medical help as soon as possible. It may be helpful to keep track of your symptoms leading up to the appointment, and go in with a list of your medications and general information about your diet and exercise routines.