During the past year, my blogs have discussed medically related information pertinent to my child and teen patients and their families. I discussed many different aspects of care related to diabetes medical management, research, and psychosocial support. Today, I wanted to share my personal thoughts as we enter the New Year. After grabbing my morning cup of coffee, I ran into one of my patient families who happen to live in my neighborhood on their way to breakfast. It is always a pleasure to see my patients and families outside of my usual realm and in their normal "habitat" so to speak. As is typical, when I am not working, I am dressed in casual attire (sweats), so it is kind of cool that my kids see me as a normal (well, relatively) person in their world. It is always a jolt of reality when these chance encounters occur. Why is that? Over the years, I have come to realize that our patients are part of a bigger community-a family unit/school/team, etc. They interact with their diabetes care team in isolated, episodic visits. We get a snapshot of daily life through in person appointments, phone calls, and required paperwork. It is important to understand who these kids and families are and how they relate to the big picture for me (and my healthcare team) to do our very best. Having said that, I have to get to know my patients and how they tick. What motivates them to check blood sugars, inject insulin, and follow nutritional guidelines 365 days a year? How do our families deal with the day-to-day concerns of getting through the day in terms of school, daycare, etc.? It is hard enough to get through our activities of daily living without known obstacles. How do we accomplish navigating though the labyrinth?
With hope, innovation, and care.
Hope surrounds me (in some fashion) with every child and family visit. It is necessary to believe that in my tenure as a children's diabetes doctor, a cure will be developed. Maybe not wrapped in perfect paper, but an evolving strategy to prolong insulin production and save and perhaps regenerate pancreatic beta cells. It is coming. I have abstracted multiple research articles and presented them in these blogs. Hope enables me to tell children and teens that they will have normal productive lives and contribute their multifaceted talents to their surrounding community. Hope gets me through seeing 100s of patients monthly. I need to believe as well as you do. And how do I hope? I trust my esteemed research colleagues with innovation and I trust in myself and healthcare colleagues to continue to provide the excellent care that we have available.
Innovation has been the theme in diabetes care during the last 30 years. Since my graduation from medical school (Columbia University in 1979), incredible changes have been incorporated into the care of those with insulin dependant diabetes. As a medical student in 1975, we tested glucose and ketones with "double-voided" urine specimens. "2+/negative" ( 2+ glucose and negative ketones) was considered just fine on our medical units. We only obtained blood sugars by doing venipunctures (and that was often only a fasting blood sugar once daily). In fact if the urine glucose was "negative/negative" we worried that the patient might be hypoglycemic. What we later found out was that glucose only showed up in the urine when the blood glucose was greater than 180 mg/dl. It was only after the development of blood glucose monitoring, first with chemstrips (changes of color based on glucose concentration) and finally with blood glucose meters, that we learned we were running our patients way too high. Ultimately, the Diabetes Control and Complications Trial published in the New England Journal of Medicine in 1993 confirmed what we as young attending physicians already suspected: lower blood sugars led to lower hb A1c and decreased complications. And so it goes... development of the first insulin pump, blood glucose meters, smart insulin pumps, smaller meters with tiny blood samples and quick results, new insulin analogs, insulin pens, and the continuous glucose sensor. There will be a marriage of the insulin pump and continuous glucose sensor. That union will once again revolutionize technology until our researchers come up with that curative treatment.
My contribution to pediatric diabetes is the care. It is what my team and I do. And we do it comprehensively and sincerely, ultimately trying to find out what makes our patients tick so that we can ask them to do what is, by normal standards, not fun. We need to discover how to make a patient do what is necessary based on when they are ready and motivated to learn and care for themselves and not what we necessarily think is best at the time. It is one thing to know what to do (as I always teach my medical students) and another to get your patient to do it. Therein is the secret to the care of our patients. We need to know how they relate to the "bigger" picture and after discovering the essence of that child, motivate them to succeed by taking care of themselves so their goals can come to fruition. In practical terms, you need to know what they care about now, so you do not lose valuable time. Do they want a driver's license, go to a sleepover for the first time, go to summer camp, to the prom, to college, etc? My job is to care for my children and teens and keep them healthy. And to provide them with hope that innovation leads to improved quality of life and a cure that will be in my grasp.
Have a happy, healthy, and hopeful new year.
Published On: January 06, 2009