Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
October 17, 2001
Question from near Jefferson City, Missouri, USA:
Our eight year old son, diagnosed with type 1 diabetes almost a year ago, is currently under the care of a diabetes specialist out of the children's hospital at our state's medical school. Because of recent events, we have lost our faith in this doctor, who was once "god-like" to us in that we knew we could trust his opinion on anything but it has become obvious he is apparently very gullible and not able to see any possibilities other than his own opinions. We are searching for a good diabetes team since we are still new to this. We are told the clinics in two nearby big cities are good, but hard to deal with since they are so big. How do we find an endocrinologist who has a solid diabetes team (dietitian, nurse, educator, etc.)?
Talk to members of your local American Diabetes Association and Juvenile Diabetes Research Foundation. chapters. Set up an appointment, ask questions, and interview the team. Talk to your son’s doctor and parents of other kids with diabetes. Talk to the local ADA or JDF chapter/members.
Additional comments from Dr. Larry Deeb:
Seems reasonable to me to talk to your doctor. The worst you can do is make him mad and have him tell you to find another doctor. You might be surprised to find he is willing to listen and actually take your thoughts into account or even explain to your satisfaction his plans. Then you may need to go to the “big” clinics down the road. Eight year old children need a pediatric endocrinology team.
Additional comments from Dr. David Schwartz:
You can contact your local ADA to learn of the programs within your region that have been certified by them. I think you would preferentially want a program that has been certified as a pediatric education program. Once you learn the locations of the programs, then call them and ask to speak to their program coordinator (This may not always be a physician). Questions you might ask include number of pediatric patients with diabetes they care for, how often, generally, the children are seen by the various staff members (e.g., perhaps the dietitian only sees the child twice a year and the physician more often), ask if you will usually see the same staff physician or is it “first come, first served”, are there endocrine trainees (called Fellows), are there out-reach clinics that might be closer to your home?
Another approach is to ask your local parent/family support group of other places those folks have been and what there experiences were like. I would lean towards a dedicated pediatric faculty with board certified pediatric endocrinologists.
Additional comments from Dr. Matthew Brown:
I suppose I’ll be the only one to disagree with some of the answers given by my friends and colleagues on the Diabetes Team. Specifically, I respectfully disagree with Dr. Deeb’s comments that “Eight year old children need a pediatric endocrinology team”. Although I agree that seeking the care of a pediatric endocrinologist is appropriate for some, there are many areas in the United States that are not served by such a physician or team. Even in areas served by pediatric endocrinologists, there are many dedicated pediatricians who have sought additional training and experience taking excellent care of children and teens with diabetes. Many times these physicians are called pediatric diabetologists–and in most situations, these physicians have a diabetes educator and dietitian with whom they team to provide excellent care for kids and teens with diabetes. The expertise these physicians bring to taking care of children and teens with diabetes should not be ignored–indeed even in areas served by pediatric endocrinologists, many of these physicians are a great resource for providing excellent care of diabetes in addition to general pediatric issues.
[Editor’s comment: As Dr. Brown points out, there are areas of the world where it’s just not feasible to locate a pediatric diabetes team. In any case, Dr. Schwartz’s comments about asking questions (and getting answers!) will help parents decide if the proposed medical team seems appropriate for their child’s care.