The Pediatric Diabetes Clinic at the Alberta Children’s Hospital wants to remind you that most pediatric diabetes patients in the province are actively followed in a diabetes clinic. This means they have been thoroughly assessed and receive ongoing education to help them manage their diabetes.
“If your patient is being followed by a diabetes centre, you can be confident they are receiving ongoing care,” said Allison Husband, Registered Nurse and Certified Diabetes Educator (CDE), Alberta Children’s Hospital. “Most children with type 1 diabetes either have a pediatric endocrinologist or will be followed by a diabetes centre with pediatric expertise.”
That being said, pharmacists play an important role in caring for pediatric diabetes patients. Every visit to the pharmacy is an opportunity to ask questions and ensure patients are using their medications in a safe and effective way. Allison offers some sample questions to help guide your conversations with patients and their parents/caregivers:
- Have you received instruction on how to use your pen or meter?
- Are you confident in using your meter or insulin pen?
- Do you have any questions about giving insulin injections?
- Do you understand how your insulins work?
- Do you know when and how to use your glucagon emergency kit? (if prescribed)
- How often do you have low blood sugar? How are you treating your lows? Do you carry treatments? Do you wear a medical alert?
These questions will also help you assess if more education is needed and how you may be able to assist your patient.
Prior to making any changes to a diabetes prescription, it is best to consult the prescriber. Disposable insulin pens are convenient and commonly used by adults, however they are not appropriate for young children who are on small doses of insulin. For this reason, pediatric centres usually provide ½ unit insulin pens.
“Think twice when recommending a different blood glucose meter,” said Allison. “When a diabetes education centre dispenses a meter, the family has been instructed on how to use it, and a lab to meter comparison is done to ensure that it is within the acceptable 15% range.”
All health care professionals working with individuals with diabetes are familiar with the goal of “treat to target” to help prevent debilitating long-term complications. Diabetes Canada (formerly known as the Canadian Diabetes Association) has recommended target A1c values for the pediatric population.
“These targets are treatment goals, and for most patients and families, are challenging to achieve,” said Allison. “Most families are aware of their child’s A1c level. At each clinic visit, strategies are explored to help maintain or lower it.”
In some cases, a multi-disciplinary team that includes a social worker and psychologist is needed to identify and address the issues that may be impacting diabetes self-care.
“We are all working to empower patients and families to manage diabetes well,” said Allison. “And to this end, it is important not to give conflicting messages. If you have any recommendations, questions or concerns about a shared pediatric patient, contact his or her pediatric team. It takes a village to raise a child—especially one who lives with type 1 diabetes.”