My seven and a half year son, who has had diabetes since the age of two and is on NPH and Regular, lives with his mother in a small town in another state. His mother does not test his blood sugar before lunch at all when he is at school, and never throughout the night when he is sleeping. The school does not monitor his diabetes at all. His last A1c was 5.9% which I’m told means he has had several lows.

I live quite a distance away and visit once a month. I have spoken with my son’s doctor, who is not an endocrinologist and he will not respond to my requests to take better care of my son, but my wife refuses to take my son to an endocrinologist. How can I influence my son’s mother and doctor to take better care of my son?

A hemoglobin A1c of 5.9% reflects an average blood sugar of about 120 mg/dl [6.7 mmol/L] over the past three months and suggests that your son’s blood sugars have been well controlled. It would not be unusual to have an occasional low blood sugar when diabetes is managed this aggressively.

I obviously do not know the details of your son’s management, but on the surface it appears that it is being appropriately managed. Using NPH and R insulin may seem a little “behind the times” given the newer insulins that are available, but, if they continue to work well for your son and his A1c remains below 7.1%, I would not suggest changing. I would suggest, however, that he test at least four times per day including before every meal (even at school) and work diligently to avoid low blood sugars while maintaining desirable blood sugar control.

Children do not necessarily need to see endocrinologists for routine diabetes management. Indeed, there are many pediatricians and adult diabetologists who have a great deal of expertise in successfully treating diabetes in children and teens.

MSB

[Editor’s comment: I sense that you are in a rather nasty situation with your ex-wife and/or with your son’s physician. It’s not clear if you have spoken directly to the doctor, or only heard what your ex wants you to hear. Any physician who truly “refuses” to refer a child with diabetes to a specialist for a second opinion sounds like one that I’d want to avoid if possible, but again I’m not sure if the physician really said that or not!

It’s also not clear from your letter if you have offered to pay for a referral to a diabetes specialist or not. You could offer to pay for the endocrinologist’s visit, and the travel expenses if it’s a long trip to the nearest specialist, and even offer to come along and share your worries with the doctors.

Finally, it is important that kids with diabetes have access to diabetes specialists, even if only once or twice a year on a scheduled basis, or for emergencies in between. For example, your son’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. (See The Continuous Glucose Monitoring System.)

WWQ]