My six year old little girl, who has had type 1 diabetes since age one, is followed by an adult endocrinologist who seems to be against the pump but will not tell us why. Should we change doctors if he is not up to speed with pumping? Should she be seeing a pediatric doctor?

Pump knowledge and preferences apart, my honest opinion is that adult physicians should not be looking after six year old children. If you live somewhere remote, then a compromise may be to have shared care between a general paediatrician and the adult endocrinologist, but this is a poor second best.

KJR

[Editor’s comment: It’s unclear from your letter if the endocrinologist is against pump use in general, or against its use in children (in which case it may simply be that he has no experience with using pumps in children). In either case, ask for a referral to a pediatric diabetes program that uses pumps. If he uses pumps with adult patients, but has no experience with pumps in kids, encourage both the pump program and your daughter’s present endocrinologist to coordinate your daughter’s care. If he’s opposed to pumps in any age group, perhaps you should change doctors completely.

P.S. — Frequently the doctor’s nurse, or the hospital’s diabetes nurse educator, can help clarify what the doctor’s situation is if the doctor can’t or won’t explain things clearly.

WWQ]