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"He is experienced with almost any kind of childhood medical condition and has invaluable advice. But, when it comes to diabetes, as miserable as it may sound, he is absolutely totally helpless".
There are many excellent pediatricians that have pretty much seen it all,
from the flu, viral and bacterial infections, childhood diseases to even rare complications, been there, done that, they will easily diagnose and most of the time successfully treat any symptom. Our pediatrician is one of them, the kind that doesn't prescribe unnecessary antibiotics or rush your child to take unnecessary further tests. He is also familiar and experienced with almost any kind of childhood medical condition and has invaluable advice. But, when it comes to diabetes, as miserable as it may sound, he is absolutely totally helpless. Throughout the many years of his clinical experience I guess he hasn't seen many diabetic patients so far. I hope he doesn't represent a big share of his fellow colleagues population in terms of diabetes knowledge and ironically our pediatrician back home was also an endocrinologist, yet my daughter was diagnosed by the less knowledgable one... Though we were the ones that asked to perform a urine test in the first place, only we suspected a urine tract infection (from the excessive urination) and not diabetes (well, I did have a sneaky suspicion but I was really hoping it was just my hypochondriac tendency cueing). So I think we at least deserved getting these news from the pediatrician himself and not his 20 year old trainee who in a by the way kind of speaking asked if we ever heard of a disease called diabetes. After that we were sent to the ER which was the right thing to do but looking back, it could have been handled in a more sensitive way. He also diagnosed her with a severe ketoacidosis, (although urine test showed only moderate ketones and in real ketoacidosis the levels of ketones in urine would he VERY high, but we didn't know much then) which added some more unnecessary panic and turned out that at least this part of his
diagnosis was incorrect (thank god!).
That didn't prevent us from coming back to him since we now have an excellent diabetes team to take care of my daughter's diabetes stuff so we can still use his great pediatrician skills for the more common issues and again we showed up suspecting a urine infection but this time with totally different symptoms and some fever. It happened about 5 months ago but I still get my blood pressure up just from thinking about it. We took a urine test and were asked to wait in his office. Again one of his trainees shows up, she looks very concerned and asks many questions that would usually point they are suspecting a central nervous system damage, and as a former neurobiologist I know too much of it. I am starting to lose my patience (and that doesn't usually happen) and ask to see the doc right away because I am also starting to get really worried. His assistant shows up in the room with a blood sugar meter, a prehistoric one if I may add... This doc hasn't been updating his diabetes equipment in his clinic lately. "Hi sweetie" she turns to my daughter. "this is a device that checks the amount of sugar in your blood" she explains as if we hadn't been using THIS device (well, a newer version of it) at least 4 times a day for the last 3 years... "I know" my daughter smiles politely at her. "We need to check your blood sugar, we just need a small drop, it will only take a second and you almost won't feel a thing" she explained slowly. Luckily my daughter has a good sense of humor so by that time she was really holding herself not to laugh out loud, giving me the 'is this woman crazy or what?' look. "Why is it necessary?" I interrupted the fascinating talk. "Doctor's orders" she said. "We checked her blood sugar just an hour ago and it was fine (compared to a diabetic child with a fever, as viral and bacterial infections are very known blood sugar raisers) and she just finished eating a pack of gummy candies in the waiting room so I am guessing it's going to be a little high and the test won't be too informative" I explained. So she went to ask the doctor and he insisted on doing the check anyway. The health tech or whatever her position was insisted on performing it by herself although my daughter is SO much more experienced in checking her blood sugar by herself, that's how diabetic kids get, but the tech was determined and my daughter couldn't really care less after having go through this at least 3659 times already so I just gave up (unlike me but I was exhausted and just wanted to know what it was all about). The tech of course failed to draw the blood and load it on the test strip and finally let my daughter do it, which she impressively did in less than seconds. The meter showed 250 mg/dL (normal would be about 70-100, diabetic normal would be around 150 for a child her age and a diabetic child on a sick day after a pack of gummy candies I was kind of expecting over 350 mg/dL so for me it was a pleasant surprise). Than the doc had finally decided to show up and I demanded to know what was going on. So he sat down and with a very dramatic look on his face he said: "We found sugar in her urine". I sighed with relief. "Well, of course you would, she has DIABETES" for crying out loud!!! You'd think an experienced pediatrician would know that... "I understand, but we were afraid she was getting into ketoacidosis which could be a cause for her frequent urination" (that explains the central nervous system questions earlier). "Did the you find high level of ketones in her urine?" I was getting concerned again. "Oh, not at all, she didn't have any ketones" he answered. "So why would you suspect she was getting into ketoacidosis?!" I was starting to lose my patience yet again. Our diabetic team communicated with this pediatrician on a regular basis, at least 3-4 time per year. He has every single copy of all the tests and follow ups, beyond ignorance in my opinion it shows lack of responsibility. A primary care physician that has diabetic patients, even just one diabetic patient should really be responsible enough to educate himself in order to avoid situation like that. Turned out it wasn't even a urinary tract infection, just a strange flu. My daughter thought the whole incidence was just hilarious, so I am lucky to have such a witty girl and I hope to find a better pediatrician that knows a little more about the physiology of a rare disease called type 1 diabetes.
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