June 8, 2009
Other
Question from New York, USA:
Yesterday, on her 23rd birthday, my daughter was diagnosed with diabetes. She is presently living in Japan. The two doctors she has seen aren’t sure if it is type 1 or type 2. Given her age and body type, it is a safe bet to say it is type 1.
My daughter is teaching English in Tokyo and had planned on returning home in January 2010. I suspect that she will not want to return home. As a type 1 diabetic myself, I’m inclined to get her home and on an insulin pump as soon as possible. She was just admitted to a clinic and has been put on an insulin I.V. Her blood sugar was just under 500 mg/dl [27.8 mmol/L]. Her A1c was 9.9, but I’m not sure whether the Japanese use the same scale as we do in the U.S.
Should she return to New York City or can she get good care in Tokyo? Her doctor said that he would not put her on pump therapy.
Secondly, do you know of an endocrinologist in Manhattan? My wonderful endocrinologist is quitting her practice as of today. Does any one know an excellent endocrinologist who accepts Aetna HMO?
Answer:
Diabetes is a universal disease. Patients with type 1 and type 2 diabetes are managed by physicians in Japan all the time. The HbA1c is universalized so that it should compare favorably with what we do here in the U.S.
The answer to your first question is very subjective. I think that really depends on how your daughter responds to treatment. Remember that during the first six months of treatment, she can go into a honeymoon period where she doesn’t need any insulin therapy at all. To put her on insulin pump therapy now would be premature, especially if she goes into a honeymoon phase. If, on the other hand, she has poor control, feels bad, and wants another opinion, she can return to New York where they have many excellent endocrinologists who can see her.
As far as question 2, I would recommend getting out the book or appealing to your endocrinologist for a referral. Many times the insurance company themselves will have a list of endocrinologists who are part of their program and you can select from those already listed.
JTL
