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Beyond blood sugar: MUSC offers comprehensive pediatric endocrine care by Ron Menchaca Marketing Services The proper treatment and management of Type 1 diabetes in pediatrics requires comprehensive care that extends beyond insulin injections. Because the blood sugar disease impacts virtually every aspect of a diabetic child’s life—and the lives of their family members—patients need lifelong clinical care that takes into account their physical and mental health.   “Diabetes is very stressful on families because everything in that child’s life depends on blood sugar,” said MUSC pediatric endocrinologist Deborah Bowlby, M.D.   That’s why MUSC offers pediatric patients specialized diabetes care, from initial referral through early adulthood. “Many of the pages I get are from pediatricians who have just detected a high blood sugar level in a child,” said Bowlby. “A child with diabetes should be referred to a pediatric endocrinologist because diabetes is very different in a 60-year-old man than in a 3-year-old little girl.”   MUSC immediately admits suspected Type 1 diabetes cases to the ED. From the moment a child hits the emergency room, MUSC’s clinical teams know exactly what to do. They will assess the severity of the presentation and initiate treatment. Initial assessments are done in close cooperation with the hospital’s endocrinology service, which includes physicians, fellows, case managers, floor nurses, intuitionalists and certified diabetes educators.   In cases of ketoacidosis, children are sent straight to the ICU, where attending physicians follow standardized protocols.   Once a child is established with a treatment program, the comprehensive care continues with expert guidance and education from nutritionists, practitioners, social workers and mental health workers. Patients return to MUSC for follow-up appointments about every three months. These visits include an A1C test, which measures how well a patient’s diabetes is being controlled by insulin.   Diabetes education for the patient’s family, caregivers and teachers is crucial, Bowlby said. In addition to the diabetic child’s immediate family, the endocrinology service also communicates with school officials and school nurses to make sure a child’s blood sugar is monitored and that their insulin is properly administered.   As diabetic children age, they often require higher insulin doses. “Initially, they need a lot of insulin, but then they go through a partial remission stage because their own pancreas starts to produce more insulin again,” Bowlby said. “Eventually, though, the beta cells that produce insulin will fail and they become totally insulin-dependent.”   Adolescence typically brings about a desire for more independence and many children will want to assume more responsibility for their disease. But Bowlby says that this handoff of responsibility is an important step and the appropriate timing will vary from child to child depending on their maturity.   South Carolina has among the highest rates of diabetes in the nation with an estimated 270,000 people living with the disease. MUSC has been at the forefront of efforts to educate people about their risks for the disease and how to properly manage it. MUSC spearheads a diabetes education program that recently won national recognition for its efforts to increase awareness and improve clinical outcomes. MUSC also supports an annual summer camp for children with diabetes.   And while these efforts have improved the lives of diabetic children and adults across the region, a troubling new trend of Type II diabetes in children threatens to swamp the healthcare system with new cases. Today, some 20 percent to 50 percent of new diabetes cases are Type II. “It historically has been thought of as an adult condition, but now it’s occurring in children,” Bowlby said. “Just a few short years ago, medical students studying pediatrics were not even learning about Type II diabetes because it was not a child disease.” Pediatricians should be on the lookout for: Symptoms of Type 1 diabetes that include excessive drinking and urination, fatigue, weight loss, headaches, blurry vision and abdominal pain. One in 400-500 children have Type 1 diabetes. The disease is often triggered by stress or infection. The two most common stages for presentation are early school age and teenage years, but it can happen at any time. A blood sugar reading over 200 is consistent with diabetes. Friday, July 14, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.