The best laid plans....
My plan was for this post to be titled: 233 days of Guardian. That's what today is. My 233rd day. I was planning to share all kinds of new tips and tricks I've learned while I was on sabbatical. I've got a bunch of them. I'm also all alone in Albuquerque; having been sent here by my clinic for three days of Medicaid training. Yes, it is every bit as boring as it sounds.
As hookers are not in my budget right now, my plan was to spend my nights catching up on my blogging.
Well sorry folks, but that's not going to happen. And it's nothing to do with hookers....
It has to do with an 8-year-old boy. Because of HIPPA rules and regs I can't tell you his name. His Grandmother is one of my patients. And she decided to test her grandson with her meter. The boy clocked a 234. Fasting. Yeah. That would have been enough for a Dx if it had happened at the clinic.
The boy's mother came to me in a panic. I quickly scrambled the schedule and told her to bring the boy in. Right. Now.
Here's the story: he tells me that no matter how much he drinks, he is always thirsty. He's peeing all the time. The mother tells me he's even started wetting the bed. He's become moody. Grumpy. Doesn't like to play with other kids anymore.
I do a random BG on him and he clocks in at 144. This is one hour after eating a slice of pizza. I run an A1C in our lab and get a 4.9
Hmmmm.....Whatever is going on, it just started.
The kid is fat, but not HUGE. But he is not active at all. I set them up with a meter and instructions to test every AM and come back on Monday. I'll run C-peptide and islet cell anti-bodies, but he just doesn't feel like a Type-1. I'm thinking he might be our first case of juvenile Type-2. I knew this was a growing problem in our country. I knew we'd have one sooner or later. I just didn't expect one quite so young.
As all this was happening the good folks at Bayer brought me 48 glucometers for our patients (thank you good folks at Bayer). So I was making room for them in my office by throwing out old phone books, out dated PDRs, software on 5 inch discs, and other debris left on the book shelf by the previous occupant of my office. As I was quickly “editing” the contents of the book shelf, a thin little red book fell out and landed on the floor at my feet. Not a finger print on its glossy cover. Never been read. The title is: Type 2 Diabetes in Children & Adolescents. A guide to diagnosis, epidemiology, pathogenesis, prevention, and treatment. From the ADA. And only a few years old. Much newer than the phone books I just threw away.
So instead of filling you in on my new Guardian knowledge, I am instead filling my head with knowledge to help my youngest patient.
I know that you of you will all understand.
As hookers are not in my budget right now, my plan was to spend my nights catching up on my blogging.
Well sorry folks, but that's not going to happen. And it's nothing to do with hookers....
It has to do with an 8-year-old boy. Because of HIPPA rules and regs I can't tell you his name. His Grandmother is one of my patients. And she decided to test her grandson with her meter. The boy clocked a 234. Fasting. Yeah. That would have been enough for a Dx if it had happened at the clinic.
The boy's mother came to me in a panic. I quickly scrambled the schedule and told her to bring the boy in. Right. Now.
Here's the story: he tells me that no matter how much he drinks, he is always thirsty. He's peeing all the time. The mother tells me he's even started wetting the bed. He's become moody. Grumpy. Doesn't like to play with other kids anymore.
I do a random BG on him and he clocks in at 144. This is one hour after eating a slice of pizza. I run an A1C in our lab and get a 4.9
Hmmmm.....Whatever is going on, it just started.
The kid is fat, but not HUGE. But he is not active at all. I set them up with a meter and instructions to test every AM and come back on Monday. I'll run C-peptide and islet cell anti-bodies, but he just doesn't feel like a Type-1. I'm thinking he might be our first case of juvenile Type-2. I knew this was a growing problem in our country. I knew we'd have one sooner or later. I just didn't expect one quite so young.
As all this was happening the good folks at Bayer brought me 48 glucometers for our patients (thank you good folks at Bayer). So I was making room for them in my office by throwing out old phone books, out dated PDRs, software on 5 inch discs, and other debris left on the book shelf by the previous occupant of my office. As I was quickly “editing” the contents of the book shelf, a thin little red book fell out and landed on the floor at my feet. Not a finger print on its glossy cover. Never been read. The title is: Type 2 Diabetes in Children & Adolescents. A guide to diagnosis, epidemiology, pathogenesis, prevention, and treatment. From the ADA. And only a few years old. Much newer than the phone books I just threw away.
So instead of filling you in on my new Guardian knowledge, I am instead filling my head with knowledge to help my youngest patient.
I know that you of you will all understand.
posted by Wil | 9:25 PM
5 Comments:
Wow... Type 2 and he's only 8.
Wil, this post gave me chills.
Don't worry about us-- we'll be here -- you just do what you have to do.
Sounds like this boy is lucky his Grandmother has such a dedicated CDE.
Software on 5 inch disks.... man, that's some OLD stuff....
Funny how you just happened to be cleaning the shelves and that book just happened to fall out, right after you happened to get a patient that it might be useful for.
I personally don't much believe in coincidences...
My money's on a T1 diagnosis in the end, based on the 234 fasting, the rather sudden change in mood, and the noticeable thirst. As T1 develops, it's not uncommon for kids to have wide-ranging blood sugars, including many in the 'normal' range.
Are you a doctor? If not, have you referred this family to a ped endo?
If there were no HIPPA rules, would you have told us his name? Or would good manners & sense have applied?
That's great work you're doing, Wil. I sure hope you guys get this kid on a good regimen soon. He'll feel years younger (er, better...)
Thanks for sharing!
Thanks for your comments all!
I'm not sure if Scott is accusing me of creative license or if he's suggesting grand design, hand of God and all of that....Well, things really do happen like that sometimes....
Catherine--I wish I had the time to properly respond to you, but I don't. So let me just try to quickly re-assure you, and to point out a few facts of life where we live. Rest assured there is a lot more to the story than I had time to detail. Ped Endo? You're kidding, right? Our state has only a handful of endos in the first place. Most don't take new patients, much less indigent ones.
I'm the Diabetes Coordinator for a CHC (Community Health Center), one of only 13 in our state--which is the 5th largest in the nation in terms of geographic size. My center covers a 500 square mile area. We've got a hell of a medical team, and we do what we can. But we don't have a Ped Endo. In fact, I'm not even aware of one in the state at all; and if there were one the family could not afford to drive to our largest medical center to take the child there. Recently one of the Endo's in the capital "dumped" all of his Medicaid/Medicare patients onto the CHC system. Apparently he wasn't making enough money from these folks.
But let's not get ahead of our selves here. We haven't even Dxed him yet.
But rest assured my weekend research was fruitful. I've learned a lot about Type-2 in kids; and a whole battery of tests that can either rule in or out Type-1. I've also been corresponding by email about the case with real-live Ped Endo's in other states.
And if there were no HIPPA rules I would have shared his first name only. Just to put a human face and feel on an otherwise sad and generic story. Or maybe at the last moment before posting I would have deleted it in an unaccustomed bout of good manners and sense. If you read me much you'll notice I rarely use anyone's names outside of my family.
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