Diabetes takes hard work and teamwork on behalf of patients, families, doctors and educators. The Berrie Center aims to empower patients and families to live successfully with diabetes and also to help them understand the expectations of what it takes to take control of the disease.
As we approach the new year, now is a great time to focus on your management plan. What appointments need to be booked? Is it really necessary to go to the eye doctor? Dr. Natasha Leibel, head of the pediatric team at the Berrie Center, spells it all out.
Q: What are the expectations around visits to my diabetes team?
“We follow guidelines set forth by the American Diabetes Association for the care of children and adolescents with type 1 diabetes (T1D). These guidelines are updated annually,” said Dr. Leibel.
“Diabetes is a very fluid condition - insulin needs change frequently. As children get older, they take on more independence, and sometimes diabetes might become harder to manage. For these reasons it is so important to have regular medical visits with your diabetes team.”
Q: What should my A1c be?
“The goal for children with type 1 diabetes is to have an A1c of about 7%,” she said. “For most families, it is hard to achieve this without frequent dose adjustments and collaboration with the diabetes team.”
Q: How often should I see the doctor?
“It is recommended to have visits with your diabetes doctor every 3-4 months and to see an educator at a minimum once per year. During these visits we will check the A1c, look at the blood sugar data, check height and weight and do an overall evaluation of how life with diabetes is going,” said Dr. Leibel.
“During times when the diabetes maybe more difficult to manage, you may need to be in touch with your team every few weeks,” Dr. Leibel said. “As your child gets older, it is really important for them to understand why they are doing what they are doing, and often a visit with an educator can really help to allow a young teen to begin to take more ownership of their care. The educators at the Berrie Center have tremendous insight into the day-to-day management of diabetes. Take advantage of them and make appointments!”
Q: Do I need to go see the eye doctor?
“Yes. Eye exams are done to screen for retinopathy which is damage to the retina that can occur after years of uncontrolled blood sugars. This is very rare with well controlled diabetes! A child should have a dilated eye exam by a pediatric ophthalmologist once he or she has had diabetes for 3-5 years. After the initial exam it may be reasonable to do an exam every 2 years if the A1c is close to 7%.
Please remember that children may have eye complaints for a variety of reasons such as needing glasses, so if your child is complaining about his or her vision it is very unlikely to be related to diabetes.”
Q: Why do I have to get labs every year?
“In addition to regular visits with the diabetes team, additional screenings need to be done for children with T1D to monitor for associated autoimmune conditions and other risk factors,” she said.
These essential screenings include:
Thyroid Dysfunction - autoimmune thyroid disease is the most common autoimmune disorder associated with diabetes, occurring in over 20% of patients with T1D. We check thyroid function around the time of diagnosis, and then again every 1-2 years if normal. However, if thyroid antibodies are present, we will check at least yearly. Normal thyroid function is critical for normal growth and development in children.
Celiac Disease - is more common in people with T1D as compared to the general population. We screen for celiac at diagnosis, and then within 2 years, and again after 5 years, or sooner if indicated. Celiac disease can present with abdominal complaints, but also with weight loss and suboptimal height advancement.
Lipid Testing - lipid testing is done around the time of diagnosis. The goal for T1D is an LDL under 100 mg/dL. If the LDL level is under 100 mg/dl, lipids can be repeated in about 3 years, or when the child reaches 10 years of age. If it is above 100 mg/dL your doctor will talk to you about the next steps which will include dietary management and rarely treatment with a lipid lowering medication such as a statin.
Kidney Function - is screened by checking for protein in the urine. This will be done once a child is 10 years old or has had diabetes for at least 5 years. Kidney damage is very rare in persons with well controlled diabetes!
Q: What can I do to address my mental health?
“We also recommend making an appointment with our art therapist Cara Lampron as she can help navigate the different psychological stages of growing up with diabetes,” advised Dr. Leibel. “Our team also has age-appropriate support groups, and events throughout the year that provide Berrie Center families with a great way to connect and support each other.”
Q: How can I stay on track during this pandemic?
The Berrie Center offers televisits, as well as in person visits so there is a great deal of flexibility. There is no reason to delay your visit, said Dr. Leibel. Call our office today at 212-851-5494 or go to the MyChart app to schedule your appointment in the new year.
Q: What is the Berrie Center’s policy regarding fill out school and camp forms?
The Berrie Center cannot complete school or camp forms if your child has not had a visit within the last 4 months. In addition, many insurance companies now require a visit note from within the past 6 months. If you have not had a recent visit your medications and forms may be delayed. Make sure to stay on top of your appointments!
We are all ready for a fresh start! Let’s work together to make 2021 a healthy year.