The Diabetes Clinic provides comprehensive care for children and adolescents with type 1 or type 2 diabetes mellitus, as well as other types of diabetes.
Visit Schedule for Children Diagnosed with Type 1 Diabetes
First visit: 1-2 weeks after leaving the hospital. This appointment is 3-4 hours. We want to make sure all is well with the diabetes management and adjustment, as well as the prescriptions. We will examine your child and answer any questions. Read our welcome letter for more information and what you should bring to the clinic.
After your visit, please complete our Post-Discharge Diabetes Clinic Worksheet.
Second visit: 1 month following the initial visit. Often the child is in or entering the honeymoon period, and adjustments and further education are needed (see below).
Subsequent visits: Every 3 months; sooner if there are problems.
In each visit a resident/fellow physician in training may see the child first, prior to the attending physician. A nurse, social worker and dietitian are available. Separate outpatient meetings with the dietitian or nurse alone are possible to book.
The Honeymoon Period for Type 1 diabetes
A few weeks following the diagnosis of type 1 diabetes, insulin doses are lowered, while maintaining excellent blood sugar levels. Is the diabetes going away? No! This is the honeymoon period, a period of excellent control, with very low insulin requirements. A few children may even be able to skip at least one insulin injection. The honeymoon period may last from a few months and up to a year or longer, depending on the amount of insulin-producing beta cells left in the pancreas. Therefore, children who are diagnosed early are less sick and without DKA usually have a longer honeymoon period.
High blood sugar levels that are present prior to diagnosis are toxic to the remaining beta cells, and prevent those cells from producing insulin effectively. Once insulin injections bring down the blood sugar levels and give the remaining beta cells some rest, those beta cells return to function. The beta cells are able to help-out by secreting insulin whenever there is a need, allowing for lower insulin doses. It takes a few weeks to enter the honeymoon period because initially most children eat a lot in order to regain their lost weight and strength, and the remaining beta cells have not yet recovered.
Unfortunately, the autoimmune process continues to gradually destroy the remainder of beta cells. When there are hardly any beta cells left, the honeymoon period ends. It ends gradually, marked by gradual increase in insulin requirements. Keeping active and avoiding excessive weight gain may help reduce the demand for insulin, and prolong this period for a bit longer. Prior attempts to manipulate the immune system and prolong the honeymoon period have not been useful. There are research trials addressing this that are currently ongoing, and those can be discussed with our physicians.
Diabetes Treatment Goals
1. Maintain blood glucose levels (and A1c) as close to normal, while avoiding low blood glucose levels (hypoglycemia). This requires frequent blood sugar checks, at least 4 times daily in patients on insulin, before meals and at bedtime. Better control of blood sugar levels results in less long-term complication and slower progression of complications, should they develop. Hemoglobin A1c is a blood test done from a finger stick every three months, which measures the average blood glucose levels over that time, and helps guide therapy and home blood glucose monitoring. Continuous glucose monitoring is now also available,
2. Have diabetes revolve around a child’s life, not visa versa. Towards that goal, a qualified and experienced diabetes team is available to constantly tailor the treatment plan (insulin regimen and diet) to the individual’s needs. These revolve around the daily schedule, meals, and family needs. To address these issues, our team includes certified diabetes educators, nurses, dietitian, social worker and physicians giving 24-7 coverage. Good communication and education are key to good outcomes.
An insulin pump is a useful tool to achieve some goals, but requires responsibility and a dedicated effort in managing diabetes. In addition, certain basic skills need to be learned before a pump can be prescribed. Good preparation is the key to success in the dozens of patients who are doing great with the insulin pump. We use three major brands of insulin pumps, and the ultimate choice of which pump to use is individual.
3. Promote healthy weight and diet. This is important in controlling blood pressures and lipid levels such as cholesterol and triglycerides. Preventing further weight gain or achieving moderate weight loss in obese patients with type 2 diabetes often helps control blood sugars and prevents other complications associated with obesity.
4. Monitor for complications and other conditions associated with diabetes, during each visit to the clinic and through periodic labs.
- Height and weight to monitor growth. Growth can be affected by diabetes or conditions associated with diabetes: abnormal thyroid or adrenal glands, or celiac disease.
- Check blood pressure at each visit. Hypertension is particularly harmful in diabetes and advances other complications more rapidly.
- Monitor the thyroid gland on exam and yearly thyroid blood tests.
- Monitor urine for protein leak (urine microalbumin), as a sign of kidney complication due to diabetes. If left untreated this can lead to kidney failure and dialysis in adulthood.
- Perform dilated eye examination — done yearly after 5 years duration or as needed. This is to monitor for diabetes damage to the small blood vessels at the back of the eye, which can lead to blindness if left untreated.
- Ensure good foot care and sensation. Along with building good habits for adulthood, this helps to preventing ingrown toenails and infections.
- Monitor lipid levels (cholesterol, LDL, HDL and triglycerides), especially in type 2 diabetes, and treat as needed. This is crucial since abnormal lipids results in earlier heart disease and infarctions.
Written by Rady Children’s Division of Endocrinology/Diabetes