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My thirteen-month-old niece was diagnosed with diabetes two weeks ago. She is currently under the care of a pediatrician at a rural hospital in a small town in Ontario, Canada. The town does not have an endocrinologist or a specialist in diabetes. The parents are debating whether to take the baby to either Toronto or London, Ontario, or continue with the pediatrician in their hometown. Both the aforementioned cities have Children's Hospitals with juvenile diabetes clinics with experienced pediatric endocrinologists.

We're not sure if the baby is receiving the appropriate treatment at the local clinic. If not, which of the two previously mentioned diabetes clinics would you recommend?

Worried Aunt
(who's living in the same small town in Canada, and who's also a Registered Nurse).

It is our very strong feeling that all kids under two who have diabetes belong under the care of a Diabetes Team specializing in infants and toddlers, as well as having access to a pediatrician or family practitioner. We feel that it is safe to assume that any Children's Hospital with a diabetes program is probably more familiar with these potentially very complex cases than any general physician, and will have more resources available to help the patient and the worried parents and relatives.

Sometimes it's tough to decide which of two different towns to drive to. Occasionally, if the parents have friends or family in one town, that would become the deciding factor. Or perhaps the health insurance rules will pretty much dictate which specialty hospital and clinic to use (especially in the United States these days!).

The parents should talk things over with their daughter's pediatrician, and ask which Children's Hospital he/she usually refers complex cases to. Or, since you're interested in helping and also an R.N., maybe you could call the programs at both of the Children's Hospitals, and ask to talk to the Diabetes Nurse Specialist who's working at that hospital's program. Ideally, that nurse would have a Master's degree, and be a Certified Diabetes Educator, and have lots of experience, and be open and honest about the hospital's expertise with little kids with diabetes.

We'd expect that any general physician caring for a little kid with diabetes should be very happy to have superspecialists help out. After all, the child will continue to need followup from a local physician, and a collaborative effort should prove worthwhile to improve the care of the child.

Original posting 4 Jan 96


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Last Updated: Tuesday April 06, 2010 15:08:52
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