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Diagnosed with Diabetes
10/13/10

The Test Results are In and Your Child Has Diabetes: Now What?

For parents facing the lifelong diagnosis of diabetes for their child, the news can be devastating. But specialists at Maria Fareri Children's Hospital at Westchester Medical Center are here to help.

Through careful monitoring and intensive instruction on the latest treatments and lifestyle changes for children with diabetes, our specialists can greatly improve a child's quality of life.

Every family gets the full support of a multidisciplinary team of experts: physicians, nurse practitioners, dietitians, psychologists, counselors and certified diabetes educators. While not all children with diabetes are diagnosed in an emergency situation, many of our patients are very sick when they arrive and go immediately to the Pediatric Intensive Care Unit. Others may be stabilized in the Emergency Department and later moved to a regular inpatient bed to start mastering disease management.

Once a child has been admitted, a diabetes educator comes to the bedside to meet with the child and family. An educator might spend up to four hours on an initial consultation, explaining the disease, answering questions and teaching skills such as how to use a glucose meter, inject insulin and count carbohydrates at meals. Educators follow up each day until a child is discharged. Dietitians meet with every family as well, while psychologists are available as needed. The medical team also consults with a child's regular pediatrician to review each patient's medical history and plan follow-up care.

The Right Approach
For children with diabetes, Westchester Medical Center uses state-of-the-art insulin pumps and glucose  sensors, which spare some children from multiple daily injections. At Maria Fareri Children's Hospital children stay for two days to receive education and pump training.

That comprehensive approach is a blessing for patients like Jessica Kroner of Nanuet, N.Y., a 15 year old who was diagnosed with type 1 diabetes at age 5 ½. "We left the hospital thinking, 'OK, we know what we're doing,'" says her father, Evan Kroner. Adds Jessica, "If there's ever a problem, you know they're going to figure out how to fix it. It makes me feel confident."

The Disease
More than 186,000 children and teenagers have been diagnosed with diabetes nationwide. That means they can't produce or use insulin, a hormone needed to convert sugars in food into the energy needed to live. If not well managed, diabetes can cause complications such as heart disease, stroke and blindness.

Type 1 diabetes, usually diagnosed in children and young adults, strikes suddenly and creates a lifelong need for injected insulin. Patients must monitor their blood sugar throughout each day and balance food intake with insulin dosages to prevent dangerously high or low blood sugar.

More children and teenagers also are developing type 2 diabetes, or resistance to insulin, an illness once found almost exclusively in adults. Some children even have symptoms of both forms of the disease, further complicating treatment. Doctors blame rising obesity rates and a lack of exercise as parts of the reason for this new "epidemic" of diabetes.

Maria Fareri Children's Hospital's diabetes team takes an individualized, nurturing approach to care, treating patients as children first and diabetics second. "So much of managing diabetes is mental," says Richard A. Noto, M.D., Chief of Pediatric Endocrinology. "You can tell patients what to do, but it won't happen if you don't motivate them.

So while it's important to keep up with all of the latest science in diabetes care, you can't lose the art of medicine. Everything can't go in a square box, especially with kids."

The Unexpected
Many families are in shock over the diagnosis. While Jessica Kroner did have symptoms - headaches and stomach aches - her symptoms were not the most common ones, such as constant thirst and frequent urination, so no one expected a blood test would show diabetes.

"Our reaction was, 'How? There's no way. No. We don't believe it,'" Evan Kroner says.

Today, Jessica is a 15-yearold honors student with her disease well under control, few limits on her daily life and dreams of becoming a doctor. Her insulin pump delivers extremely precise doses of insulin, and a glucose sensor gives continuous blood sugar readings. If levels are too high or low, an alarm sounds.

The technology allows Jessica to live a fairly normal life. She still goes to parties, for example, and can even eat the occasional piece of cake - as long as she counts carbohydrates and adjusts her insulin pump. "Diabetes has not stopped Jessica, or even slowed her down," her father says.

Maria Fareri Children's Hospital's two diabetes educators, registered nurses Joanne Conlin-Kurylas and
Catherine Hemsley, say easing fears is a big part of their job. "There is a lot of misinformation out there," Conlin-Kurylas says. "Many people have known someone who had a terrible outcome, but there are so many newer technologies and newer types of insulin now. If you take care of yourself, the risk of complications is much lower than it was years ago. Also, families are taught problem-solving skills to live with a chronic disease."

Dr. Noto gives his young patients that same message. "With diabetes, you get to decide what happens to you," he says. "If you do everything right, you're going to have a good outcome. I tell all my patients, 'You can do this.'"

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