A Provider's Perspective on the Management of Diabetes From Preschool Through the Teen Years.

Abstract

Providing care for children with diabetes has been my passion and dream fulfilled since 1979, and I continue to learn new things every day. At the time I started in this field, there was no glucose monitoring or A1C testing to track how patients were doing. We were using the insulin pump at the research center where I worked to see if it was a feasible option, but we could not send patients home with it because there was no way to check glucose at home. That first pump was the size of a brick and weighed a couple of pounds. It needed to be plugged into the wall at night and had a flashing red light on the front (1). Many things have changed since that time. Now we have smaller insulin pumps and continuous glucose monitoring (CGM) devices to help us care for patients in a way that is much safer. Fear of hypoglycemia has decreased immensely with the advent of alarms on CGM devices that can alert the children—and often their parents, school nurses, and other caregivers—if their glucose is too high or too low. This is a function of the SHARE mode on the devices, which connects to up to five phones. My practice consists of a pediatric endocrinologist and myself, but I am the only one who cares for the 250 patients with diabetes. My background included working at a large medical center with a diabetes program managed by a team. Now, I am the team. I enjoy this most of the time, but it can be overwhelming at times. The cost of maintaining a multidisciplinary team is prohibitive for a small center such as ours. And yet, all patients have access to 24-hour care, and all have my cell phone number (2). …