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October 24, 1999

Daily Care

Question from Scranton, Pennsylvania, USA:

My 17 year old niece has type 1 diabetes. She was diagnosed when she was 10. I don't think she has ever gone any length of time when she was completely under control. My sister has switched doctors twice and is still not pleased. I don't think they are taking her seriously. I believe they are only interested on blaming my niece for doing something wrong. Yesterday morning she woke up and was 597 and had ketones is her urine. This morning she was 26 when she got up. She called the doctor's office and spoke to the Physician's Assistant who told her to drink some juice and rest. She has already had to quit one job and may lose the summer job, and she has flunked 11th grade from missing so much time. Can you give me any suggestions on how to help? I think she sounds like she should be on the pump, but I don't know to much about it. Are some people this hard to control? I feel she should have been put in the hospital and monitored for a few days and taught how to cope with this. Any advice? [email protected]

Answer:

Such wide swings in blood sugars do not bode well for this young woman! I’m sure that you are very worried about her.

My first question is whether or not she is seeing an Endocrinologist. That is a physician who specializes in diseases like diabetes. If not, she certainly should be in the care of this type of doctor.

Second, I have concerns about the effects of losing jobs and failing grades on this individual’s self esteem — is she depressed? A therapist could be helpful on this matter.

Third, the insulin pump might be an option: but only under the supervision of an endocrinologist and with his/her recommendation. It takes a very dedicated patient to be considered for pump therapy.

Last, the very best approach for diabetes care is one involving a multidisciplinary team (M.D., Dietitian, Psychologist, Exercise Specialist, and RN) and this young lady needs all of these professionals to help her. That is why we are all represented on the Diabetes Team at Children with Diabetes! See if there is a multidisciplinary team in your area.

CMB