From Virginia, USA:
My 10 year old son has been diabetic since he was 5 and has been seeing a pediatrician. He seems to have fairly good control and can give his own injections. Should we be taking him to a specialist? We are in a small town and the closest one would be 45 miles away. We want to keep up with the latest in research and we are not sure if the doctor we are using now is doing that. Should we change and if so to what kind of specialist?
It seems as though your family has made a good start in adapting to diabetes, so the question of changing doctors is not an urgent one, especially if your son's pediatrician has been a partner in the diabetes care for some years, your son likes him/her, and the practise is accessible if you need help and has a real interest in diabetes.
At the same time current practice increasingly aims for meticulous control; i.e., an A1c that is not greater than the 15% above the upper limit of normal for the method used or as near to that as is reasonably possible. Not at the moment then: but in the years to come your son may need help with the control problems of the teen growth spurt and with the emotional turbulence of those years. After the age of 15 he should be routinely screened for small blood vessel changes in the eyes and the earliest signs of kidney involvement because early intervention can be important. He is also going to need some preparation for moving away from home to college living. Meals are going to be much less structured and he will have to be responsible for their content this may involve changing to one of the intensive insulin regimens, to perhaps using Lispro instead of Regular insulin and even to trying an insulin pump.
It is unlikely that any pediatrician, unless he is in a big group practice, will be able to cover all these needs up to the point that your son enters the work force independently, so that I think that you should begin to look at alternatives. Ideally this should be a specialised team where a pediatrician or pediatric endocrinologist is working with one or more nurse educators as well as a nutritionist and a social worker and if at all possible able to provide continuity with internal medicine and ophthalmology. You may have to go more than 45 miles to find such a group and if so you may only wish to once a year initially, so that it is important to make plans jointly with your pediatrician.
You might like to look at the standards of care for Type 1 Diabetes as established by the American Diabetes Association; this will give you some idea what to look for. As to keeping up to date, you would, I am sure, be helped by looking over the pages right here at children with DIABETES.
Original posting 27 Apr 97
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