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February 6, 2002

Daily Care

Question from Madison Heights, Michigan, USA:

My daughter was diagnosed with type 1 diabetes three days ago, and her doctor has referred her to a pediatric diabetes specialist. Can you please tell us what to expect as far as what kind of tests will they run?

Answer:

Pediatric endocrinologists may have their own nuances of testing (when, what, how often) that may also be influenced by the patient population, individual characteristics of the patient/family, travel to the clinic, etc. With those caveats in mind, you should expect many of the following:

A good history and physical exam
Further discussion about diabetes, ketone checking, meal planning, long-term issues, perhaps even the latest research.
You may be seen by other members of a “diabetes team” — which usually consists of physicians, diabetes dietitians, diabetes nurses, a psychologist, or even a social worker. Diabetes is not only a medical/metabolic condition — it affects the whole family life in terms of stresses, meal planning, activity planning, etc. A degree of “spontaneity” for activities and meal planning often is lost when a family member has diabetes.
Your daughter’s glucose meter may be reviewed and downloaded. Be certain to bring her glucometer and glucose log-book (glucose diary) with you to the specialist’s office.
They will probably draw blood for a test that measures overall glucose control. A common test is the hemoglobin A1c (also sometimes called glycosylated hemoglobin). In some offices, this test is run off a fingerstick amount of blood, while in other offices, a larger from-the-vein stick may be required.
Depending on what tests were already done at the time of the diagnosis, and the patient’s history and exam, the pediatric endocrinologist may also draw blood to look for co-existing thyroid problems. Approximately 20% of people with type�1 diabetes also have thyroid conditions), or other autoimmune diseases such as celiac disease (an intestinal disorder), adrenal gland problems, Vitamin B12 problems, or perhaps others. The office may also get a cholesterol profile or even a urine test to assess for protein in the urine (which can be an early sign of diabetes-related kidney problems.) However, kidney problems often will not occur unless someone has had poorly controlled diabetes for a number of years. That is not your child given the recent diagnosis. Depending on the age of the child, and the number of years since the diagnosis, many centers will screen for these related issues on an annual to every few years basis.

DS