Hello. My name is Joel Steelman. I am a husband, a father, and a pediatric endocrinologist at Cook Children’s Medical Center in Fort Worth, Texas. As an endocrinologist, I study hormones and treat the diseases and illnesses associated with them.I chose pediatrics as a specialty because I have always enjoyed caring for children. The subspecialty of endocrinology appeals to my inner detective. I have to be an investigator and researcher, sometimes taking very subtle complaints and then track them backwards to diagnose an underlying condition.
My work is rewarding in the way it can improve the lives of children with endocrine disorders and their families as well. During my training, I was instructed by a pediatric endocrinologist whose calm demeanor and willingness to teach made a profound impression on me. It is with that inspiration that I decided to start this blog. My goal is to help families better their lives by sharing meaningful information and innovative solutions for the special healthcare needs of children.
In my medical practice, I treat a number of patients with type 1 diabetes mellitus, also known as childhood onset insulin dependent diabetes, a serious illness that affects roughly 2 in every 1,000 children in the United States. This type of diabetes occurs when the pancreas makes little or no insulin (a hormone that lowers the level of glucose, a type of sugar, in the blood.) Insulin helps glucose enter the body’s cells where it can be used for energy or retained for future use. Children with type 1 diabetes and their families require comprehensive healthcare and support from a team of specialists, working in concert, that includes a pediatric endocrinologist, a dietician, a pediatric nurse practitioner, and a nurse diabetes educator.
This disease is treatable, but there is no cure, and the management of it affects patients’ daily lives in multiple ways. They must be able to accomplish three core activities: take multiple daily injections of insulin, monitor their blood glucose (blood sugar) with a blood glucose meter, and manage their diet. Diet is one of the biggest misconceptions in the treatment of type 1 diabetes in that we prescribe the same nutritious, well-balanced diet for a child with this illness as we would prescribe for any other healthy child. The main difference is the need to match the amount of carbohydrates (the component in food that affects blood sugar) with insulin (a hormone that lowers the level of glucose, a type of sugar, in the blood). Parents and caregivers are the first bastion of defense when it comes to supporting children in their lifelong journey with diabetes.
Because these skills are necessary for the optimum management of a child’s diabetes and to insure good long-term health, our team of specialists at Cook Children’s Medical Center works closely with our young patients, their families, and caregivers to teach them how to manage this illness. Poor long-term control of type 1 diabetes can cause debilitating complications for children when they reach their 20s or 30s, including heart disease and damage to the kidneys, eyes, and nerves.
Most children receive injections of insulin as well as finger pricks to check blood glucose at least four times a day. Continuous Glucose Monitor Systems (CGMS) are a promising recent technological advance in type 1 diabetes care. The system provides more information on blood sugar levels throughout the day and reduces the frequency of finger pricks needed to monitor blood glucose. CGMS was first approved by the Food and Drug Administration (FDA) in 1999 and has been available in doctors’ offices since 2003. It is now becoming more widely available as a tool to help children and their families better manage type 1 diabetes.
Rebecca Meester, a nurse diabetes educator within my practice, says, “We work with families to help them understand how to use the system and to interpret the data. It is complicated, can be overwhelming, and it does take time to learn, so we try to help them with realistic expectations. With determination can come rewards. Recently, a mother of a five-year-old told me she is finally able to send her child to daycare without being afraid that they will miss a low blood glucose reading. And the father of a 14-year-old girl told me that the system helps his daughter remain accountable because she can see exactly what the foods she eats are doing to her blood glucose.”
CGMS involves the use of a catheter-type sensor that is placed under the skin to measure the glucose level of interstitial fluid (the small amount of fluid that normally circulates just beneath the skin). We train children and their families how to place the catheters at home, and the catheter sensor device remains under the skin for a period of 3 to 5 days. The system reads the glucose level once a minute and displays this information either on a receiving device or on the display screen of the child’s insulin pump.
CGMS is not yet considered a complete replacement for finger pricks to monitor blood glucose levels. The FDA currently recommends using readings from CGMS to make decisions on what to do for abnormal blood sugars or for dosing around meals. At this time, most CGMS systems require finger pricks to check blood glucose at least twice a day, but the system is not foolproof. If the glucose level is rising or falling, it can take about 20 minutes to register in the interstitial glucose, causing variations in the readings.
On the horizon, I see the development of a closed loop system that combines an insulin pump and CGMS. This innovation will allow for a higher level of blood sugar control with less variability and an even better quality of life for children with type 1 diabetes.
As a father, I can imagine that learning of a diagnosis of diabetes in one’s own child would be a scary thing, but in my practice, I see that most children are resilient beings who are flexible, quick to learn, and have a great capacity to adapt to new ways of doing things.
**I have no financial interest or consulting agreements with any company mentioned in this post.