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From Maryland, USA:

Our daughter was diagnosed at 3 years old. She is now 7 years old. We belong to an HMO so she does not see the same doctor each time she goes for a minor problem. Each time the doctor finds her blood sugar to be high because of her illness. They panic and suggest treatment over and above the endocrinologist's suggestions for "Sick Day Treatment." It is difficult to make the pediatrician and advising nurses aware that we have been trained and are actively adjusting her dosage of insulin and intake to the prescribed regimen. Above all, we are now dealing with a new doctor and advising nurses. Any comments would be greatly appreciated.


This question was referred to several members of the Diabetes Team, who have each given an answer:

Answer from Dr. Lebinger:

I suggest when you see a pediatrician for a problem that also affects the diabetes, you ask that pediatrician to call the endocrinologist to coordinate treatment of both the non-diabetes related problem and the diabetes. It is important to have the pediatrician, endocrinologist, and patient all work together.


Answer from Dr. O'Brien:

It seems as though there is a communication problem between your daughter's pediatrician and her endocrinologist. I assume that you are pleased with her diabetic care generally and with her A1c levels and so perhaps the first step would be to ask your daughter's diabetes doctor to call the pediatrician-in-chief at the HMO and ask him/her to get the word around to individual pediatricians to get in touch if there seems to be a difference of opinion on managing sick days. Perhaps he could offer to give a talk on childhood diabetes at their next postgraduate session. All this needs to be arranged tactfully of course. An alternative approach is increasingly to deal with minor illnesses at home unless you think that specific treatment like antibiotics is needed, by now you should be pretty experienced in making appropriate small alterations in insulin dose. Your endocrinologist's office is presumably available on the phone if you need help.


[Editor's comment: As an adult-endocrinologist, I'd also plead with our adult readers with diabetes to do the same.

The problem is, what if the general doctor doesn't follow through and call the specialist? In an HMO, contact the Case Manager, or Consumer's Advocate, or Ombudsman, or if none of these, the Medical Director of the HMO. In any other setting, it's worth giving the doctor a second chance; if there's still no willingness to let you and your specialist participate in your diabetes care, it's probably time to consider switching doctors. WWQ]

Original posting 2 Feb 97


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