Living with Diabetes

Autumn Rivera diagnosed with Type 1 diabetes after life-threatening complication lands her in CHKD’s intensive care unit

The first sign of 4-year-old Autumn Rivera’s hidden illness was a sudden constant thirst. In September of 2020, Autumn’s mother, Taylor, became increasingly concerned when her young daughter lost five pounds and began to wet the bed nearly every night – something that hadn’t happened for years.

At a visit to her family doctor, a test revealed that Autumn’s blood sugar level hovered near 500, far above the normal range of 70 to 140. Taylor, a medical assistant, remembers the doctor telling her, “You need to take Autumn to CHKD right now. They’re going to have to admit her.”

By the time Taylor reached CHKD’s emergency department from their home in Newport News, Autumn’s blood sugar was over 600. Lab results confirmed what the doctors suspected: Autumn had Type 1 diabetes.

Type 1 diabetes is an autoimmune disease where the pancreas produces little or no insulin, a hormone essential for allowing glucose to enter the body’s cells to be used for energy. Left undetected, children who have Type 1 diabetes can

become dangerously ill and suffer brain damage. The complications can be fatal.

Like many children carrying this illness but who have yet to be diagnosed, Autumn had developed a life-threatening condition called diabetic ketoacidosis (DKA). More than a dozen children come to CHKD’s emergency department every month suffering from this condition, and for many parents, it’s the first indication their child has diabetes.

With DKA, Autumn’s body was breaking down fat for fuel, producing acids called ketones. When too many ketones are produced too quickly, they can build up to dangerous levels in the body. She would need to be treated in the pediatric intensive care unit at CHKD and placed on an intravenous insulin drip.

WRITTEN BY Alice Warchol • PHOTOGRAPHY BY Susan Lowe

When Autumn arrived at CHKD’s emergency department, her blood sugar level was nearly five times the normal range.

When Autumn arrived at CHKD’s emergency department, her blood sugar level was nearly five times the normal range.

Autumn, who wears a blood sugar monitor and insulin pump, doesn’t let diabetes slow her down.

“DKA can be very dangerous, even deadly,” says Dr. Melinda Penn, one of six pediatric endocrinologists at CHKD. “We want to make sure that we, as medical doctors and families, respect it and recognize it before it causes major issues.”

The signs and symptoms of Type 1 diabetes in children usually develop quickly and may include increased thirst, frequent urination, fatigue, excessive appetite, weight loss, irritability, and fruitysmelling breath – a warning sign of ketoacidosis.

The biggest concern in dealing with Autumn’s DKA was that she might slip into a coma. “It was very scary,” Taylor says. “Definitely the worst day of my life.”

Taylor was sitting in the ICU, in tears and feeling overwhelmed, when she first met Dr. Penn.

“She explained to me that although Type 1 diabetes is a serious condition, it doesn’t have to be scary,” says Taylor. “With proper care and diet, we can manage it.”

And then, Dr. Penn shared something personal: She also has Type 1 diabetes. Diagnosed as a teenager, her own medical journey steered her to study diabetes and endocrinology. “I share this with my patients because I’m also doing everything that I tell them they have to do to take care of themselves,” Dr. Penn says.

Taylor felt so reassured. “Dr. Penn has such a special place in my heart,” she says. “She was so patient and understanding.”

Over the next 48 hours, Autumn’s blood sugar level slowly came down. While her daughter’s condition improved, Taylor learned how to monitor everything Autumn ate and to give her insulin before every meal. Nurses from CHKD’s diabetes education center taught Taylor to calculate carbohydrates, measure Autumn’s blood sugar, and determine how much insulin her daughter would need and when.

After four days at CHKD, Autumn was well enough to return home, and Taylor was prepared to manage her daughter’s newly diagnosed illness. “CHKD is awesome,” Taylor says. “We appreciate everything everyone there has done for us.”

Today, Autumn is back to feeling like her old self. The 5-year-old, who is benefiting from technology advances in diabetes care, now loves to dance and play outside. To keep her blood sugar in check, she wears a monitoring device and a special pump, which delivers a constant flow of insulin throughout the day. The pump eliminates the need for multiple daily injections. Taylor monitors Autumn’s blood sugar readings through an app on her smartphone.

The entire family has made changes to their diet to support Autumn. Although she struggles at times to keep her blood sugar level within the proper range, she understands how important it is to limit how often she enjoys a sugary treat.

And, when Taylor has any concerns about her daughter, she knows that Dr. Penn will always return her call, even after hours.

“Dr. Penn always goes above and beyond,” Taylor says. “I love all of the staff at our endocrinology office at CHKD’s health center in Newport News.”