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February 16, 2002

Community Resources

Question from Columbus, Georgia, USA:

My 20 month son was 16 months old when diagnosed, and he receives six shots a day (Humalog, NPH, and Ultralente). He goes to an endocrinologist, and I want to know what the difference in treatment is compared to a pediatric endocrinologist.


I don’t know if a pediatric endocrinologist would do anything different, but, my bias, as a pediatric endocrinologist, is that children should be seen by pediatricians. A 16 month old is not the same as a six year old, a 16 year old, or a 60 year old. I might go so far as to say that an adult endocrinologist has little business in treating a 16 month old child with diabetes especially if you have a pediatric endocrinologist available. This may be a very important argument to make with a third party payor, such as an insurance company.

I think a pediatric diabetes team can try to balance out the realities and practicalities of your child’s diabetes management, meal planning (for a toddler), insulin dosing and timing, activities, and the social issues of parental work schedules, Family Medical Leave Act, and others. Six insulin shots a day seems a bit excessive to me, but if it works for you and your child is well controlled, and not having hypoglycemia, then perhaps nothing need change. The insulin “cocktail” that he receives is an interesting one, although it sounds as if things may be more complex than they really need to be. At this age, “tight” control is not the primary goal.