Misdiagnosis of type one diabetes is all too common a topic of the message boards and “street” conversation. Medical professionals of all types assume type two diabetes or they ignore the symptoms all together until the patient ends up in the emergency room in diabetes ketoacidosis (DKA).
Sometimes it is understandable. Primary care physicians only receive a few hours of diabetes training and have little else to guide them beyond the American Diabetes Association (ADA) consensus statements. For some reason, the symptoms that seemed clear to the emergency room doctors who diagnosed me in 1976 are not clear to all physicians – especially in adults.
What boggles my mind is how anyone could miss the symptoms of a child, especially a small child. To use a cliché, the symptoms stand out like a sore thumb! How do sudden and dramatic weight loss, dehydration, vomiting, excessive urination (with a distinct odor and color) loss of coherence, and that horrible odor of “fruit” not translate to diabetes ketoacidosis before children die? Why do those symptoms not automatically translate to at least a finger-stick based glucose check?
Well, according to yesterday’s article by Henry J. Rohrs III in Endocrine Today, those symptoms frequently do not translate to an accurate diagnosis in a timely fashion. In fact, according to International Diabetes Federation and the World Health Organizations, “DKA is the major cause of death in children with type 1 diabetes. In fact, the mortality of patients diagnosed with DKA is approximately one in 100, and most often this is a result of cerebral edema.”
Apparently, many training programs now offer or require an “advocacy” month as one of the rotations in medical students’ curriculum during internal medicine, family medicine or pediatric residency. However, it seems a considerable number of pediatricians do not have the tools to perform these simple and perhaps life-saving tests in their office. They do not glucose meters, lancets, glucose strips and urine glucose and ketone strips.
I have to ask – where are the ADA and Juvenile Diabetes Research Foundation (JDRF) in all of this? According to Rohrs, in 1999, Vanelli et al published a paper detailing how a prevention program that educated teachers, parents, students, and general pediatricians about the early and late signs of type 1 diabetes impressively reduced the incidence of DKA in new-onset type 1 diabetes. Yet, the two leading advocacy groups have apparently not promoted programs to provide the appropriate education and tools necessary for timely, positive-resulting diagnosis. Children continue to die of DKA before even having an opportunity to live with diabetes. What are we going to do about that folks?