Everything the General Pediatrician Wants to Know About Diabetes

October 28, 2007

The families of pediatric patients who receive a diabetes diagnosis often have a million questions for their physician about the disease. Pediatricians, in turn, have a million questions for the journals, studies, and experts in the field.

The families of pediatric patients who receive a diabetes diagnosis often have a millionquestions for their physician about the disease. Pediatricians, in turn, have a million questions forthe journals, studies, and experts in the field.

Two of those experts, Stephen E. Gitelman, MD of UCSF's Diabetes Center, and Nicole Glaser,MD, of UC Davis' Children's Hospital, tried to address as many topics in the world as diabetes as twohours would allow. Speaking to a relatively young audience of pediatricians, Dr. Gitelman and Dr.Glaser hit on topics as diverse as post-traumatic stress disorder after a diabetic hospitalization,who the candidates for an insulin pump are, when to screen for type 2 diabetes, and duplicitous soysauce.

"We don't want a child managing their diabetes independently," Dr. Gitelman said,emphasizing the role of the parents or guardians. "Ultimately it's the parents' responsibility toadminister insulin, until the child is 18." It may be necessary to contact a state's child servicesbureau to step in if the child goes without proper care, and look for medical care via schoolprograms.

Dr. Glaser found that up to one third of women with diabetes had withheld insulin to help controltheir weight. "I was surprised by the fact that they weren't surprised when I asked them about it,"Dr. Glaser said. Often it was as simple as not taking an extra boost of insulin after eating adessert, she explained.

Five-minute test results from an A1c test have prompted a new issue: what to do when theglucose record and the A1c are in disagreement. Occasionally, the A1c will be unnaturally low,instead of unnaturally high, putting it in line with the glucose record. Other times, a child willtest anyone - or anything - but himself. "It turns out soy sauce reads a pretty goodglucose level," Dr. Gitelman quipped.

This can be a child acting alone, or in collusion with parents. The parents need tounderstand there is no value judgment to high numbers. "Fixing" the numbers doesn't "fix" the child,but denies him or her medical care.

Who to screen for type 2 diabetes? It's more likely found in adults than adolescents, and inadolescents than children. Dr. Gitelman expressed doubts of the "tidal wave" of childhood type 2cases reported in the media. Children who are overweight, with a family history of diabetes, asedentary lifestyle, and indicative in utero experience should be screened. Check every two yearsstarting at puberty or age 10, or when your gut tells you to.