January 13, 2003
Question from Elkin, North Carolina, USA:
My seven month old niece was diagnosed with diabetes and was in critical condition for weeks at a reputable teaching hospital with blood sugar levels up to 800 mg/dl [44.4 mmol/L]. She is said to be the youngest baby they ever treated with this disease. Much difficulty is being encountered in regulating insulin and all that goes along with this disease. Is there a hospital/diabetes team in this country, or another country, for that matter, that specializes in this at the very youngest ages?
Treating the youngest children with diabetes is generally a challenge — You will want to find a medical center near you with pediatric endocrinologists/diabetologists and a team of nurses and dietitians who can teach your family how best to care for her and what insulin/diet regimens will be best suited to her eating/sleeping/play habits. Your local American Diabetes Association affiliate or Juvenile Diabetes Research Foundation may be able to help direct you.
It is important that her schedule and medications be tailored to age-appropriate blood sugar goals. In our youngest children we look for target range for blood sugars to be 150-250 with bedtimes over 180, in order to reduce the risk of severe hypoglycemia, while providing enough insulin for the child to develop and grow normally. Often this involves families learning carbohydrate-insulin ratios so they can tailor the insulin doses to what the child has eaten.
Additional comments from Craig Broadhurst:
If you have access to a diabetes team with full services, your child should stabilize and be followed by this team. An endocrinologist is paramount along with a dietitian, counselor, and pediatric diabetes consultant.
Additional comments from Dr. Stuart Brink:
There are hundreds of pediatric diabetes team in the USA who can provide excellent care for very young children with type 1 diabetes. You should discuss this with this child’s pediatrician and also make sure that a pediatric diabetes team is available for close consultation. Most of the large Children’s Hospitals will have such pediatric diabetology teams and many of the large clinics will also have pediatric diabetes teams as well.
Additional comments from Dr. Donough O’Brien:
It is perhaps inappropriate for us to suggest a referral when we have so little clinical information about your niece. In any case a decision on this issue is really a matter for the mother and father together with her present medical team.
The family might however like to read a recent report on the theme of diabetes in the first year of life. See D. Iafusc, et. al. in Permanent diabetes mellitus in the first year of life Diabetologia (2002) 45: 798-804,