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February 9, 2001

Behavior, Hyperglycemia and DKA

Question from Ontario, Canada:

My 14 year old nephew has had type�1 diabetes for three years, and most of his readings are so high they don't register on the monitors. He only levels out when on insulin by IV in hospital. His needles do not seem to be effective. His doctor does not seem to be too worried. They are saying it is five years before they test other organs for damage, but riding high like this, I think he should be tested now. How can we contact someone to suggest a plan of action? Who can we talk to?


It certainly sounds as though your nephew needs help, but without knowing a lot more it would be unwise to make suggestions here. I would suggest starting by getting in touch with the nearest office of the Canadian Diabetes Association. You should ask them to help this child’s parents find a diabetes team that includes not only a doctor, but a nurse educator, a dietitian, and a medical social worker.


[Editor’s comment: Several thoughts:

There is little you can do without the consent of this child’s parents. Make sure you have their permission before doing anything.
As Dr. O’Brien has suggested, this young man is in great need of assistance from a diabetes team specializing in the care of adolescents. There a many possibilities as to why your nephew is having these problems which can only be sorted out by an experienced team. I suggest you encourage his parents to seek such consultation.
It is inappropriate not to screen for complications in teenager.
The International Society For Pediatric And Adolescent Diabetes has published the 2000 Consensus Guidelines for the Management of Insulin-dependent Diabetes in Childhood and Adolescence. You (and this young man’s parents) may want to look at them to assess his current level of care.