For those people living with diabetes, every day requires around-the-clock monitoring and management.
So says Jason A. Klein, MD, a pediatric endocrinologist who heads the Pediatric Diabetes Program at NYU Lutheran and who also works collaboratively with colleagues at the Hassenfeld Children's Hospital of New York at NYU Langone Medical Center and its Pediatric Diabetes Center.
"In order to successfully manage blood sugar levels, those living with diabetes must perform fingerstick checks, keep records, monitor food intake, keep up their physical activity, and calculate medication doses based on past trends. Needless to say, day to day monitoring can become tedious and at times exhausting for patients, and so it is important that they stay motivated," the diabetes specialist adds.
This daily monitoring can be a particular challenge for young people who also have to be attentive to when and what they eat and drink, as well as their activities at home, in school or while hanging out with friends. Even a minor ailment like a cold may require changes in the medical regimen because of the effect inflammation has on the blood sugar.
But diabetes is not the "death sentence" that Klein says many of his patients and their families seem to believe.
"Although there is no cure at this time, treatment options have significantly improved over the years," assures Klein. "With insulin pens, pumps, and modern devices that allow more precise and continuous day and night monitoring of blood sugar levels, we can make small adjustments in the dosage of insulin to prevent sugar levels from rising or dropping too fast. Excellent glucose control gives patients and their families peace of mind."
The routine followed by people with diabetes is all too familiar to Klein. At age 14, he was diagnosed with monogenic diabetes, a rare form of the disease caused by a faulty gene.
The care he received as a teenager, coupled with his desire to help young people with a similar condition, inspired him to study medicine at SUNY Downstate and to follow in the footsteps of his own doctor, Pavel Fort, who became his mentor through seven years of training including a fellowship in endocrinology at the Cohen Children's Medical Center/North Shore-LIJ Health System.
To help allay fears, Klein does not hesitate to share his story with patients and their families. A mother once told him "but you look normal," as if a person with diabetes should look a particular way.
"There are many misperceptions of diabetes. One of the most common misunderstandings is that people get diabetes solely from eating too much and gaining excessive weight. While type 2 diabetes -- most common in adults but certainly present in children and adolescents -- does develop due to weight gain, it is also genetically based. And though we always promote healthy lifestyles, the much more common diabetes in the pediatric age range -- type 1 diabetes -- does not develop secondary to poor eating habits; it is an autoimmune disease that prevents the body's normal production of insulin, a hormone produced by the pancreas that is responsible for regulating the blood sugar levels of the body," explains Klein.
"Regardless of the type of diabetes a patient may have, education of the patient and the family is extremely important. We treat the whole family not just the person who has the diagnosis of diabetes because it affects everyone in the family."
Kidney problems, blindness, amputations and cardiovascular disease are among the most serious and most widely known long-term complications of diabetes. And given the prevalence of the condition, Klein says that when patients are given a diagnosis of diabetes, many families can only picture unfortunate outcomes for their kids. "We begin with listening to what the families and patients know about diabetes, since many of their fears are based in old or incorrect information," Klein says. "With good blood sugar control and use of modern treatments and technologies, patients today do not have to have overly rigid lifestyles in order to life long, healthy lives free of complications."
At his office in the NYU Lutheran Family Health Center at 5610 Second Avenue, Klein makes clear to patients and their families about the need for a healthy diet, avoidance of sugary drinks, and a good amount of physical activity or exercise. "Moderation is key," he says. Some signs that a child may have high blood sugar include increased thirst and frequent urination.
For patients who already have diabetes, Klein directs kids to get involved in their treatment and continues to motivate them when they become adolescents. He focuses on engaging patients in their own diabetes management, developing good habits and awareness in order to prevent complications.
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