A1C and at what age to switch to an adult endocrinologist

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mef Posted: Thu, May 7 2009 6:09 PM

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my son is 17 and was diagnosed at 13. his a1c is 10 and he does not stay consistant with writing down numbers etc. he uses the pen and will not consider a pump. every doctor's appt is a lecture which i understand, but sometimes i wonder if he would relate more to someone who will treat like an adult and not a child. any comments or advice?

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lebrecht replied on Thu, May 7 2009 6:37 PM

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At 17 years I think he would appreciate an adult endocrinologist. ALL endocrinologists are for adults and children was my understanding.  So I assume he is now in the care of a pediatrition?

SWITCH NOW!  Is my advice.

Anne

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Spirit replied on Thu, May 7 2009 7:04 PM

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I do not have a diabetic child, but I did switch my daughter to our family physician when she entered her late teen years because I felt that an adult approach would be more in keeping with her increasing maturity.  Just not having to sit in a waiting room full of kids was a rite of passage for her. 

Aside from a new doctor, are there any teen diabetic groups around your son could join?  During these years the feedback from peers carries W-A-A-A-Y more weight than parents or doctors or any other adults.  Barring that, perhaps there is a cyber group your son could involve himself with.  This group has been invaluable for us as members.  Teens are even more tuned into techno groups than we are, so he might be amenable to checking out some sites (maybe through Joslin?)  One caveat...lots of urban legands out there and not all advice over the Net is sound.  An agreement for you both to have the password for the site might be a good way for you to check in on what is being discussed. 

Another suggestion I might pose isn't about doctors, but about knowledge and making it their own.  How about a subscription to a magazine like Diabetes Forecast in your son's name only?  When it arrives, just toss it in his room and forget about it.  I tried this with books and articles when my daughter was your son's age.  She seemingly and pointedly ignored them.  Now that she is an adult, married and in graduate school, she has finally admitted that she devoured them all advidly, but would have died rather than admit it at the time. "Stealth Parenthood" can sometimes be effective during the teen years.  He can absorb lots of info from this magazine, even if it doesn't directly address teen issues.  It DOES, however, address diabetic issues such as A1c's above healthy goals.  Your son is undoubtedly smart; he can make the connection for himself.  In this way he can "own" his diabetic management, which is such an important concept for these developing years.  You can't impose it; he has to embrace it himself. 

The teen years can be weird for them and for us.  Sometimes it takes a weird approach to hit the right button.

But, be assured, this too shall pass!

Spirit 

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Jorgie replied on Thu, May 7 2009 7:12 PM

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Does he understand how very serious Diabetes can be? People lose limbs, go blind, have heart attacks and strokes and many other "nasty" things. Maybe it's time to "hit him between the eyes" so to speak with a baseball bat to get his attention.

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mef replied on Thu, May 7 2009 9:23 PM

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your comments are not constructive. please do not respond to my posts

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mef replied on Thu, May 7 2009 9:26 PM

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thanks for the advice

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John replied on Thu, May 7 2009 11:01 PM

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better treat as an adult. The A1C is really too high, means a bad blood glucose control. better <7.

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Melissata replied on Fri, May 8 2009 8:31 AM

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Hi, I have two adult kids with type 1 and I did change them to an adult endo when they were 17, which is the age that most will accept them. The ped endo's for me were not in line with my thinking, but it seems that you have the opposite problem. Adult endo's are a lot tougher though and he may listen to them. It is certainly worth a try. My son always wanted to keep his A1c as low as possible, so we had issues with that because he is hypo unaware and had a lot of lows. When he was under my roof though, he had to follow my rules, including the d care. You may want to try some tough love and for sure go to the endo with him. Good luck.

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mef replied on Fri, May 8 2009 11:04 AM

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melissata-

thanks for the feedback. i will talk with my son

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Debbie Butler replied on Mon, May 11 2009 11:47 AM

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Hi, sorry for my delay in replying to your posting but I was out of the office on Friday.  I know you have gotten a lot of advice already but I wanted to let you know what has helped a lot of the teens that I work with at Joslin.  I think it might be a good idea for your son to consider switching doctors if he feels that he is getting a lecture at every visit.  I usually recommend that 17 year old patients continue to see a pediatric endocrinologist, but I know some 17 year olds that do see an adult endocrinologist.  I think what is most important is for your son to find a doctor that does not lecture him and who can talk to him about what is hardest for him about having diabetes.  So it may be more important to find a doctor that he can relate to vs focusing on whether they are a pediatric endocrinologist or adult endocrinologist. 

I do not believe in forcing teens on the pump. If he is not ready for the pump I would not push it - but maybe at some point he will be interested in the pump in the future.  If your son has a bad experience on the pump now he may never consider utilizing pump therapy in the future. If he would like to stay on pens then I would listen to that.  The pump is a very visible sign of diabetes so I have heard a lot of teens that are not interested in the pump.

Also I wonder if he would let you help him with any diabetes tasks? I usually suggest that parents do all the logging.  Would he let you do the logging if you went through his meter memory? Then you are helping him and you also know what is going on with his blood sugars. 

I do not believe in a "tough love" approach with teens when it comes to diabetes tasks. I think if his A1c is 10 he needs some help.  Diabetes is a very hard disease to manage particularly during adolescence.  I also don’t believe in scaring teens with complications. Developmentally teens do not worry about the future so I find it is more helpful to talk to teens about how a lower A1c will help them right now day to day- ex. it may help their performance in sports, it may help them concentrate better in school, it may make their skin, hair and nails healthier, etc.   I wonder if you and your son would ever meet with a family support specialist (clinical social worker or psychologist) to talk about diabetes stressors and how to bring the A1c down? At Joslin we are lucky to have a mental health staff that works with patients and their families on these very same issues. I hope my advice is helpful. Good luck!

-Debbie Butler, LICSW, CDE

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12mkbarr replied on Mon, May 18 2009 1:37 PM

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Hi,

I now have two children with diabetes and just wanted to touch base with you.  My youngest daughter was diagnosed at 10 (now 18) and my older daughter 19 was just diagnosed a week ago.  Very hard news.   My youngest still has not been able to get her blood sugar under control (even with my constant support) and now with two, I feel an endlessness to blood sugar readings.  Not to sound negative, but my other two children where tested when my daughter was diagnosed and it was negative so this came as a huge shock to us all.  How do you cope?

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Melissata replied on Mon, May 18 2009 6:42 PM

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The second diagnosis is harder than the first, because you know what is ahead. I have actually found that my son and daughter relate to each other better now than they did before. My son is on his own and living his life despite the diagnosis. He has really been helped by the CGM and it has lessened my worry a lot as well for both of them. My daughter is special needs, so much of her care is up to us. She does what she can, but needs a lot of help. The CGM has allowed both of them to test a lot less and we can see what the bg is every single minute of the day if we want to. Actually, you set the alarms to go off at certain numbers and forget about it most of the time.

   What has been the problem that your daughter can't seem to get into control? Maybe she needs more support or education, or more tools to help her. How often are they testing? What insulins are they using? I would like to help if I can. I know how tough it can be, especially in the beginning with the second one.