February 26, 2002
Question from Port Orchard, Washington, USA:
My 15 year old niece was just diagnosed with type 1 diabetes two days ago, and her doctor was going to discharge her today until we (the family) said we didn’t feel comfortable yet. At what point in a child’s care do you think it is appropriate to send them home after initial diagnosis?
I think that is very individualized. My general goals for discharge are:
There is no imminent health risk.
My diabetes education team “clears” the patient indicating the patient and family have “learned” the initial materials;
The family is comfortable to go things at home. (You have to leave the nest [hospital] sometime.) Remember, out of the hospital is not an abandonment by the diabetes team. Call them every few days for on-going insulin adjustments or reassurance.
The family knows “survival skills”:
how to check blood sugar
how to draw up, mix, and give insulin
how to recognize and treat hypoglycemia, including familiarity with the Glucagon Emergency Kit.
how and when to check urine for ketones.
[Editor’s comment: It is not always the physician’s decision as to when to send a child home as many insurance plans now have strict guidelines. In fact, many are nor requiring diabetes education to be done as on an outpatient basis, unless the newly diagnosed person was critically ill (as in your niece’s case).
It has always been my practice (and that of most of my colleagues) to have families call in blood sugar results on a daily basis for a while after discharge from the hospital. As Dr Schwartz has mentioned, at this juncture, frequent adjustments in insulin dose are need, and people in general need lots of reassurance. Monitoring blood sugar at least prior to meals and bedtime is extremely important, and it is helpful to ask check some two-hour after meal and middle of the night values for the first few days. Daily contact should continue until insulin does are stabilized and then, someone from the diabetes team should be available on a seven-day per week, 24-hour basis, as needed.
It might help you, your niece, and the rest of her family to visit some of our Chat Rooms. Many who visit have “been there” and can help you get through this difficult period. Also, be sure to at least glance through all of the educational material we have available, and don’t hesitate to ask further questions if/when they arise.