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October 11, 2013

Diagnosis and Symptoms

Question from Souix City, Iowa, USA:

My 18-month-old child was diagnosed with type 1 diabetes on Monday. We've been at the hospital since then. We have not yet spoken with an endocrinologist or a pediatric endocrinologist, only the pediatrician doing rounds in the morning and the resident. The doctor told me today he doesn't know what else to do. We're at 1 to 25 insulin to carbohydrate ratio. Wer'e doing a sliding scale, correcting high blood sugars after meals with carbohydrate count corrections. We were at 341 mg/dl [18.9 mmol/L] at 2 a.m., again at 8 a.m. Then, he was 398 mg/dl [22 mmol/L] at 11. We'd done a correction and the long acting insulin at 9 a.m. At 2, he was at 75 mg/dl [4.2 mmol/L]. We had him drink juice and rechecked at 3; he was at 187 mg/dl [10.4 mmol/L]. At 5, he was at 440 mg/dl [24.4 mmol/L]; has had nothing to eat or drink since the juice. The doctors wanted to discharge us today. We weren't comfortable leaving. Now, I want to be transferred to children's hospital to see a pediatric endocrinologist. Do I just tell the doctors to make the referral? Do I call and tell them I'm coming? I need a second opinion.

Answer:

You are correct and you need to see an endocrinologist. You should have your pediatrician make an immediate referral to the nearest pediatric diabetes team. They will either transfer you and your child there for care or arrange for an emergency consultation to help with these decisions, set up follow-up. Many infants seem to thrive best with an insulin pump since very small doses of inuslin can be provided in the best possible way but this is a decision to be made with parents and pediatric diabetes teams working together.

SB