Type 1 Diabetes Mellitus | Concerns and Care


(quietly intense futuristic music)>>The pediatric diabetes program at Johns Hopkins Children’s
Center offers a comprehensive, multi-disciplinary team
approach to the care of our children and their
families with diabetes. We care for all kinds of
diabetes, including Type 1, Type 2, cystic fibrosis-related diabetes, steroid induced
hyperglycemia, or diabetes, neonatal diabetes, and mody diabetes. Our comprehensive,
multi-disciplinary team approach encompasses both the inpatient and out-patient hospital experience. Our approach begins at the
time of diagnosis for children with diabetes, during their
inpatient hospitalization. Our comprehensive care includes
our diabetes providers, our pediatric endocrinologist,
as well as nutritionists, our behavioral health or psychology team, as well as our diabetes nurses, who provide a lot of our education. We provide a supportive environment during the inpatient hospitalization,
as well as an out-patient, and from the time the patient is discharged from the hospital, we speak with our
families every single day; going over blood sugars
and allowing them to ask any questions that have come
up since their hospitalization, as a way to provide support until their first follow-up visit, which is usually within
two weeks of discharge. We provide a comprehensive
diabetes care approach at two locations, one at the Johns Hopkins Children’s Center downtown, as well as at Mt. Washington
Pediatric Hospital. Both of these sites have a
comprehensive team including medical assistants,
diabetes nurse educators, nutritionists, psychologists,
and their diabetes provider being a pediatric endocrinologist, or diabetes nurse practitioner. Everybody has a critical role in the care of our patients with diabetes. Our medical assistants
help us with downloading insulin pumps, continuous
glucose monitors, and doing a point-of-care A1c,
which means that the child can have their hemoglobin
A1c level checked with just a finger stick
as opposed to going to the laboratory to
have their blood drawn. Our diabetes educators
provide a lot of support and resources, answering questions on the day-to-day management of diabetes. Our nutritionists are
available at every visit, to provide additional
education and coaching on carbohydrate counting, meal planning, dealing with different age ranges, toddlers who might be picky eaters, as well as adolescents who
are thinking about doing a lot more carbohydrate
counting on their own. We also have a unique component, which is the Kennedy Krieger
Institute behavior health team, who provide psychology support
at our diabetes center. At the time of
hospitalization for diagnosis, they provide a lot of guidance on coping and managing a new chronic
disease, and then throughout the care of a child with
diabetes, they are there to support for diabetes
distress, as well as anxiety, depression, other mental health disorders that may arise throughout childhood. Finally, our diabetes
providers provide an oversight to the medical team and help
with adjusting insulin doses, screening for complications,
and making sure that the child is, and the
family are, working toward to optimize glycemic control, meeting the American Diabetes
Association guidelines of having a hemoglobin
A1c of less than 7.5% so that we can keep our
children healthy, forever. (quietly intense futuristic music) The incidence of Type
2 diabetes in children has increased by over
30% over the last decade, with a prevalence rate of over 15% now in youth and adolescents. This has changed significantly, concurrent with the obesity epidemic where more than 18-20% of kids
will be overweight or obese. Our diabetes center, again, takes a multi-disciplinary approach providing a lot of resources
and lifestyle modifications to help our children with Type 2 diabetes. That is a critical
component of their care, and our nutritionists spend
a lot of time with them working on creating a healthy diet, improving their lifestyle,
and the whole team approach is to motivational interviewing,
to stimulate the patient to take on responsibility and
to set easy, feasible goals, that they can reach in order
to improve their lifestyle. The other component of this
is that with the increased risk for obesity, we are
also seeing a lot more pre-diabetes in children. You know, they don’t
have full-blown diabetes, but they have elevated blood
sugars and they require the same interventions in terms
of lifestyle modification. So, we have opened up our
practice to seeing a lot of children with pre-diabetes,
in order to help provide additional resources to
them, to help them prevent the onset of Type 2 diabetes. Unfortunately, children
with Type 2 diabetes are also at risk for diabetes
complications in a shorter time course than our children
with Type 1 diabetes. So, we always screen for those
complications immediately after the time of diagnosis,
and we do a lot of that in our clinic, again by checking labs, doing their blood pressure,
as well as screening for diabetic retinopathy in our clinic, at the time that they are
there, making it a convenient, comprehensive visit for our patients. (quietly intense futuristic music) As a division, we are very involved with the Juvenile Diabetes
Research Foundation, as well as the American
Diabetes Association, and multiple diabetes camps
throughout our local region. The Juvenile Diabetes
Research Foundation, or JDRF, hosts many events throughout
the year that we encourage our families to be involved in, including the JDRF walk, the JDRF gala, as well as the Type 1 diabetes summit that occurs once a year. Last year, together, we
co-sponsored two events with them. We had Ryan Reed, a NASCAR
driver with Type 1 diabetes come to Johns Hopkins
to speak to our children and he was very inspirational
and motivational to them, in knowing they could achieve
whatever their dreams were. Additionally, we hosted the
first Off to College diabetes transition event for our
children transitioning from pediatric to adult diabetes care and going off to college, and
we co-sponsored that event with the JDRF and the
College Diabetes Network. Additionally, we are involved with the American Diabetes Association. I am personally a member of their Camp Medical Leadership Committee, and we work on developing
policies and procedures for diabetes camps throughout the nation. With that in mind we are joining forces with the EDA this summer and we’ll be starting
the first diabetes camp for children with diabetes
in Baltimore city, Camp Charm City, and we’ll be working very closely with them on that. In addition, our staff
and our team participates in other diabetes camps in the region. Last year we participated
in Diabetes Destiny, and a lot of our patients also
attend Camp Possibilities. So there’re a lot of
opportunities and we hope to increase the access to these resources by having our own camp in
Baltimore city next summer. (quietly intense futuristic music) Technological advancements
in diabetes have made significant changes over
the last five to 10 years. All of our diabetes
providers, diabetes nurses, and nutritionists are very well versed and knowledgeable in all the devices that are constantly
changing for our patients. Insulin can be provided and administered in several different ways. It can be with a syringe
and needle, as an injection, you can use an insulin
pen, which looks like this, with a needle on top, or an
insulin pump, which looks like, this is just one example
of an insulin pump. The benefit of insulin pumps
is that instead of having to do four to five injections every day, you put it on once every three days. So it gives the benefit
of fewer injections, we can have more fine-tooth
control of diabetes, offers a little bit more
flexibility in terms of eating and exercise, and
it has been associated with fewer hypoglycemic episodes,
or low blood sugar events. We also support our patients in using continuous glucose monitors,
which is a very small device that you wear on your skin that has a very small wire that sits subcutaneously and reads the blood sugar
at a continuous rate. So, it provides blood
sugar monitoring 24/7, and sends that data to a
receiver that can actually go to a phone or even a smart
watch, so you can monitor blood sugars remotely with that. The benefits of these
devices is that it even shows the direction that the
blood sugar is moving and has alerts for highs
and lows, so that it helps prevent low blood sugars in our children and pediatric patients with diabetes. There are several systems
on the market that integrate the continuous glucose
monitors and the insulin pumps, and we support our patients in
using these new technologies, and as a team, stay up-to-date
on all of them so that we can provide as much information
as possible to our patients. (quietly intense music) We offer opportunities to
our patients to provide in research studies related
to diabetes as our institution as well as national and
international research studies. We are a site for TrialNet, which includes Pathway to Prevention, so family members of
children with diabetes can be screened for antibodies that may predispose them to developing diabetes. We are also a site for the
Pediatric Diabetes Consortium, and we run studies using
new medications in the care of children with Type 2 diabetes. In the field of cystic
fibrosis related diabetes, one of our providers is
doing research on the genetic and metabolic components
of that and how it develops as a complication of cystic fibrosis. We also have several Type
2 diabetes studies going on and as a way to improve our clinical care, we also are doing a study
on the implementation of point-of-care diabetic
retinopathy screening in children with diabetes at our center. (quietly intense, futuristic music) Our diabetes transition program
for our pediatric patients transitioning into adult
care begins at the beginning of high school and spans the four years leading up to graduation from high school, where they meet certain
milestones, or goals, throughout that period to
make sure that they will be independent in their
diabetes management by the time they are through
the transition program. In addition, we have several
providers that provide transition care to adult diabetes care, and this occurs at both Mt. Washington, as well as at our downtown location, and we are able to transition
a lot of our patients to our adult colleagues
within the same institution, to allow continuity of care
between, within the institution. Additionally, we host a diabetes
transition off to college event for our juniors and
seniors who are getting ready and starting to think about college, to prepare, not only them
as students, but also their parents for the time
when they will transition to being out of their house,
potentially, and living on their own and making
sure that everybody feels ready and comfortable for that transition. (quietly intense futuristic music) We offer a state-of-the-art,
comprehensive approach to the care of diabetes, both in the inpatient and out-patient setting. Our goal is to make things
easier for our families by providing all the resources they would need in one visit. Additionally, and the
most important thing, is that we can help our children manage their diabetes while also maintaining their normal childhood routines,
which is our main goal. (quietly intense futuristic music) (children laughing)