Does anyone, in any specialty, have experience in treating pediatric patients with diabetes?

Did your patients have any unique presenting compliants?

Did you have any special considerations in regards to follow up?

In this patient population, clinicians are less likely to observe the significant lower extremity complications of diabetes, such as peripheral neuropathy and musculoskeletal deformity, which are commonly observed in older patients living with diabetes.

When pediatric patients do present with pathology, it is my experience this is often  digital infections secondary to paronychia or local trauma such as puncture wounds.  When treating these conditions, it is important to remember the pharmacological concerns associated with the management of the pediatric patient.  Some medications, like marcaine for example, should not be used in the pediatric patient;  other medications, such as certain antibiotics, such as the quinolones, are also contraindicated in pediatric patients.

In the pediatric patient population, the impetus must be upon developing a dialogue on the necessity of appropriate glycemic management.  In this way, the clinician can work with the  patient and patent's family to create long-term diabetes management paradigms will can become "habit" in the patent's life in an attempt to prevent  the long term consequences of hyperglycemia as child grows into adulthood.

A Diabetic story… she weighed only 12kg, despite being 5 years old. She had eruptions all over her face and body, and looked emaciated and ill. Her mother was unable to pay for her laboratory tests and when she learned that she needed hospital admission to treat the chicken pox that she had developed and to keep her diabetes under control, she kept insisting that she wanted to take her child home. She needed urgent admission and prompt treatment and it would have been a crime to let her go home with her mother. Her condition demanded that she be admitted at once and her treatment started, and so it was decided that she would stay.  Before being diagnosed with type 1 diabetes at the age of 5 in March 2002, she was admitted to a government hospital with symptoms of vomiting, dehydration and shortness of breath. Tests were carried out and she was diagnosed with type 1 diabetes. At that time her father was unemployed and her mother did not go to work. The family was in a severe financial crisis, which only got worse when she had to be admitted to several government and private hospitals. They reached a point when her mother had to sell most of the household items simply to pay the hospital bills.

At the time of her diagnosis, her family was unaware that children could be

affected with the disease. Although her paternal grandmother and aunt both had

diabetes and were on Oral Hypoglycaemic Agents (OHA’s), they kept telling her

parents that she could not have diabetes. Her aunt had had diabetes for many years and had never accepted it, nor taken any treatment or followed any dietary advice, with the result that she died in her late thirties due to diabetes complications.

According to her mother, when she was admitted to hospital during the initial

stage of diagnosis, her glycemic control was kept under control, but as soon as she was discharged, her condition deteriorated. She would sleep all day, be irritable and miserable. At no stage of her treatment was she prescribed insulin for use at home and she was not given any dietary advice nor educated about her diabetes and its management.

The diabetes educator and the dietitian had several sessions with the family. Her mother was particularly eager to learn about insulin, blood glucose meters, and

a diet plan for her. The Department of Dietetics and Diabetes Education (D & E) at the hospital arranged to provide a blood glucose meter for her and she was supplied with insulin and syringes from a charity fund.  She has experienced episodes of uncontrolled blood glucose levels, followed by food poisoning.

For the past four years now, she has grown into a healthy, happy and confident 9

year-old girl. She proudly told me that she can check her blood glucose levels all by herself using the blood glucose meter and draw and inject her own insulin. This is no small accomplishment for a young child that sees older people with diabetes

hesitating to prick their finger to check their blood. This feeling of empowerment has helped her to gain confidence and she has learned to live her life with diabetes.