Living with Diabetes

Update — my student

Written by

kathleen

in

I wrote about a little gal in my class I was worried about and I have some good news.

During “Meet the Teacher” I had a few minutes with momma and I told her that I was worried since her daughter had shared her blood sugar with me.  I told her when I was diagnosed, I felt very ill, was very hard to get along with and was fairly certain that the daughter felt the same way. 

Well that Friday and the next Monday, my student was absent.  When she came back on Tuesday she let the whole class know she had been in the hospital and knew all about diabetes now and was on insulin.

Apparently if you are diagnosed Type 2, they put you on insulin probably because they are not real sure what the oral medications will due to teenagers.  She’s the second kid I’ve had from the Parkland Diabetes clinic who was a Type 2 and both were put on insulin.

I really do think she feels better already.

Comments

2 responses to “Update — my student”

  1. Stephen Ponder MD, FAAP, CDE Avatar
    Stephen Ponder MD, FAAP, CDE

    I live and practice pediatric endocrinology about 400 miles south of Dallas. We serve all of South Texas (overall, an area the size of South Carolina). As of August 31st of this year, 47% of ALL new cases of children’s diabetes seen in my practice and at my children’s hospital were due to type 2 diabetes. I’ve written and spoken frequently about this epidemic and its management over the years. I can tell you two things here: 1) about 15% of cases of what appear on the surface to be type 2 diabetes actually have evidence of the same process that causes type 1 diabetes (autoimmunity directed towards the beta cells). The implication of this finding is that we may be talking about a blended disease process: that is, insulin resistance (the inciting cause of type 2 diabetes in most persons) combined with a destructive process driven by the patient’s own immune system (the underlying cause of type 1 diabetes in most persons). Ironically, the government funded study investigating the best management of type 2 diabetes in children excludes these children from study. Second, we have extensive experience with managing type 2 diabetes in children. There are good oral medications that can work. Metformin (also called Glucophage) is remarkably safe and I have hundreds of children with type 2 diabetes using this medicine both safely and effectively. However, at diabetes onset, some children with type 2 diabetes need insulin to stabilize their blood sugar control until the metformin can begin to help them. This is a common scenario and in these cases, the insulin may be weaned off rather quickly without ill effects to the child. Furthermore, insulin therapy may be associated with an unwanted side effect of additonal weight gain: the one thing most of these children don’t need. However, each case is in many ways unique and factors other than medicine will steer the course of their disease. I now see entire families with type 2 diabetes (parents and children), so the role of the family is never to be underestimated. Also, financial issues will influence the clinical course since many of our children with type 2 diabetes are on public assistance programs (Medicaid or SCHIP) and One of these is on the cusp of disappearing!

    Reply
  2. Stephen Ponder MD, FAAP, CDE Avatar
    Stephen Ponder MD, FAAP, CDE

    I live and practice pediatric endocrinology about 400 miles south of Dallas. We serve all of South Texas (overall, an area the size of South Carolina). As of August 31st of this year, 47% of ALL new cases of children’s diabetes seen in my practice and at my children’s hospital were due to type 2 diabetes. I’ve written and spoken frequently about this epidemic and its management over the years. I can tell you two things here: 1) about 15% of cases of what appear on the surface to be type 2 diabetes actually have evidence of the same process that causes type 1 diabetes (autoimmunity directed towards the beta cells). The implication of this finding is that we may be talking about a blended disease process: that is, insulin resistance (the inciting cause of type 2 diabetes in most persons) combined with a destructive process driven by the patient’s own immune system (the underlying cause of type 1 diabetes in most persons). Ironically, the government funded study investigating the best management of type 2 diabetes in children excludes these children from study. Second, we have extensive experience with managing type 2 diabetes in children. There are good oral medications that can work. Metformin (also called Glucophage) is remarkably safe and I have hundreds of children with type 2 diabetes using this medicine both safely and effectively. However, at diabetes onset, some children with type 2 diabetes need insulin to stabilize their blood sugar control until the metformin can begin to help them. This is a common scenario and in these cases, the insulin may be weaned off rather quickly without ill effects to the child. Furthermore, insulin therapy may be associated with an unwanted side effect of additonal weight gain: the one thing most of these children don’t need. However, each case is in many ways unique and factors other than medicine will steer the course of their disease. I now see entire families with type 2 diabetes (parents and children), so the role of the family is never to be underestimated. Also, financial issues will influence the clinical course since many of our children with type 2 diabetes are on public assistance programs (Medicaid or SCHIP) and One of these is on the cusp of disappearing!

    Reply

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