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Pediatric Diabetes: Symptoms, Risks, and Resources

Helping a child travel well through life with diabetes takes a team approach, including clinicians, diabetes educators, dietitians, and in some cases, counselors or psychologists. Family is an integral part of that care team, responsible for the day-to-day management of the child's blood glucose and general health.

To bring specialized care to Marin children with diabetes, the Braden Diabetes Center at Marin General Hospital forged a collaboration with UCSF's renowned Madison Clinic for Pediatric Diabetes. As a result, Marin families now have access to Madison Clinic pediatric endocrinologists and to specially trained pediatric nurses and dietitians who are also certified diabetes educators.

In this segment, pediatric endocrinologist Dr. Saleh Adi discusses the importance of continuity of care and a diabetes home base for children to get consistent medical oversight as they grow.
Pediatric Diabetes: Symptoms, Risks, and Resources
Featuring:
Saleh Adi, MD
Saleh Adi, MD, is the Director of the Madison Clinic for Pediatric Diabetes at UC Benioff Children's Hospital, and an Endocrinologist at the Braden Diabetes Center at Marin General Hospital.

Learn more about Saleh Adi, MD
Transcription:

Bill Klaproth (Host): When you think of diabetes, you don’t think children first, but it does touch many families. What do you need to know for the health of your children? Here to talk with us about pediatric diabetes, the symptoms, risks, and resources, is Dr. Saleh Adi, Director of the Madison Clinic for Pediatric Diabetes at the Benioff Children's Hospital. He is also a Pediatric Endocrinologist and a member of the medical staff at Marin General Hospital’s Braden Diabetes Center. Dr. Adi, thanks for your time. First off, how prevalent is pediatric diabetes in the Bay area?

Dr. Saleh Adi (Guest): Great, thank you. For the prevalence of type one diabetes in the Bay Area is actually very similar to the national average, which is around 3 per 1,000 children. As for type two diabetes, that’s different. We actually have a much less prevalence in the Bay area compared to other places in the nation simply because of the demographics we have in the Bay Area. We don’t see as much obesity, and we don’t see as much type two diabetes.

Bill: Well, that’s good news. Are there certain risk factors that we should know about when it comes to pediatric diabetes?

Dr. Adi: Definitely. Diabetes in children is really a very, very different disease than it is in adults because of their increased sensitivity to insulin, increased sensitivity to exercise. The nature of their behavior as children, it’s not predictable always what they’re going to do, what they’re going to eat, and if they are going to finish all of the food that they’re going to take, so adjusting their insulin doses and their medication can be very challenging.

Bill: So it’s harder for parents to manage this as well then?

Dr. Adi: Very, very challenging for parents and for teachers and everyone else who takes care of those children.

Bill: Well, let me ask you this, Dr. Adi. How is treating pediatric patients with diabetes different from treating an adult?

Dr. Adi: Yes, diabetes in children – I always like to say that it’s actually almost a different disease than it is in adults. As we alluded to, the nature of children’s behavior, the unpredictability, and the increased sensitivity to insulin and exercise, which is not what you see in adults where they have a certain routine, they eat at certain times, and they eat almost repeated meals every single day – many adult people eat the same breakfast every day more or less, or two or three different breakfasts that they choose from. That is not the case in children. And then their exercise and activity can be quite unpredictable, and we need to – the parents need to adjust their insulin doses and their eating based on their level of activity as well.

Bill: And what symptoms should parents look out for in their children? For example, like a sudden drop in blood glucose from too much activity?

Dr. Adi: Sure, that’s a great question. Actually, I would like to answer it in two different ways. One is symptoms that should alert the parents or the physicians to the possibility of the diagnosis of type one diabetes in children before they’re even diagnosed. That is super important in recognizing the early symptoms of new onset diabetes in children. Most importantly, increased thirst and increased urination, decreased weight, loss of weight, decreased energy, and in very, very young children, infants and toddlers, sometimes a diaper rash – the persistent diaper rash can be the only symptoms that is indicative of very early onset of diabetes.

The second part to your question is the symptoms of what happens after a child has been diagnosed during the treatment. The symptoms of low blood sugar are super important to recognize, not only by the parents but also by the teachers and the coaches, etc. Those symptoms can be as subtle as just sitting down and not being very active, losing interest, lacking energy, feeling hungry, having a headache. Being confused and dazed sometimes can be very subtle. The parents will actually learn eventually to know, just by looking at the child’s face and they say, “I think your blood sugar might be low, and we need to check it and make sure that we treat that appropriately.”

Bill: Technology is helping in the fight against diabetes, that’s so good to hear. And Dr. Adi, can you explain the relationship between UCSF, and Marin General Hospital, and the Madison Clinic?

Dr. Adi: Sure. The Madison Clinic is the Pediatric Diabetes Center here at UCSF in San Francisco. In the past couple of years, we’ve actually been partnering with the Braden Center, which is the Adult Diabetes Education Center at Marin General Hospital. This partnership led us to open a satellite clinic for the Madison Clinic at the Braden Center at Marin General Hospital so that we can provide care for children with diabetes in Marin County and the other counties north of Marin, as well, which helped a lot for those families not to have to travel all the way down to San Francisco.

Bill: Right, and speaking of that, can you tell us why having resources close to home is important for patients?

Dr. Adi: Yeah, the management of type one diabetes is something that’s ongoing all of the time. Unlike many other conditions in which a family, or a child, or a patient can go to the doctors’ office, get their care, and then they go home, and they take whatever they need to take, and then come back three, or four, or six months later for another visit. Type one diabetes in children is very different. It’s an ongoing condition that needs ongoing care and guidance. The care for type one diabetes in children occurs mostly in between the clinic visits, not during the visits. Parents and patients constantly have questions that they need to ask or they need answers to because new situations arise as they are living their life and they need to ask an expert on, “What do I do now, and how do I handle this situation?” whether it’s travel, or a sports tournament or sports exercise, et cetera. It’s really important for parents and patients to have access to experts in a clinic whether to call them and just get some guidance or even to just come in on an ad hoc basis -- without having an appointment, just walk in and say, “I have these questions, I need this repaired, or I need this replaced.” I think it’s really important to have a so-called diabetes home in the community that’s not too far, that’s very accessible for parents to go and walk into and talk to someone.

Bill: Well, that convenience is so important without having to make that drive to San Francisco to make an appointment. Dr. Adi, you were telling us earlier about the difference in treating pediatric diabetes patients and adult diabetes patients. Can you tell us a little bit more about the age-appropriate materials, books, websites, apps, and other things the team at Braden Diabetes Center has done, including the Outreach Programs with teachers, principals, and the support staff at local schools?

Dr. Adi: Yeah, yeah. The Braden Diabetes Center is really an adult diabetes center, as I mentioned, which means that they had been seeing mostly adult patients with diabetes, whether it’s type one or type two. When we introduced the Madison Clinic Operation in there, these are all children. I was fortunate and actually grateful for the Braden Diabetes Center to set aside a day for just children to walk in there and not necessarily see or intermingle with all of the adult patients. It has a different pediatric feel, and everybody is getting into the mindset of working with children and families. They put certain toys, drawing materials for children to be occupied. We have then setup certain computer software and programs to deal with only children. I think they’ve actually created an environment that’s very friendly for children and families.

Bill: Well, that’s much more comforting for children and the parents, too. And Dr. Adi, through your collaboration with UCSF, pediatric patients now have access to specially trained pediatric nurses and dieticians, who are also Certified Diabetes Educators. Can you briefly tell us about that?

Dr. Adi: Yes, at the Braden Center actually, they were so eager to working with us and working with children that virtually everyone on their staff – all of the diabetes educators, and the dieticians, and the nurses, and the nurse practitioners – really wanted to come and shadow with us and spend a whole day in our Madison Clinic in San Francisco so that they can learn a little bit more about how we interact with children and families and why and how is diabetes in children different than adults. They were quite eager and excited to learn more about pediatric diabetes and add that to their knowledge so that they can help us take care of the children with diabetes.

Bill: Thank you again, Dr. Adi, for your time today. For more information about pediatric diabetes care in Marin, please visit MarinGeneral.org/BDC, that’s MarinGeneral.org/BDC. This is the Healing Podcast, brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.