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Question:

From Riau, Indonesia:

My son was diagnosed with Type 1 diabetes two months ago and is six years old now. We are from the US but I work and we all reside in Indonesia. He was diagnosed in the US during our routine physicals and has not returned to Indonesia yet. I returned for work and we are trying to make a decision whether to come back or not. We are remotely located but we have an American doctor in our camp with very limited experience. We are about 6 hours from medical facility in Singapore where a Pediatric Endocrinologist is available. We can establish contact with his doctor in Houston on a 24-hour basis.

I am trying to make an intelligent decision on whether to return to the US with my boy's health and security in mind. I am trying to get as much information as I can before I make a decision. I am trying to assess whether we have enough time to get him into proper care if an emergency arises assuming that the local doctor can stabilize him with IV's and insulin. We are tying very hard to maintain tight control of his sugars but I know anything can happen. What are the risks of having problems needing immediate care and associated with the time constraints to get him into proper care?

Answer:

I understand your plight. I serve a rural area here in northern Florida. While not 6 hours to care, it still is a long distance for some of my kids and their parents.

You will be the best doctor. Be sure to have a blood glucose meter and ketone strips, always fresh, always in date, and always with a backup.

Know the sugar. Your main enemy is a low. Have glucagon and glucose gel. Don't be too aggressive. At age 6, don't let him go to bed below 100-120.

Be sure the doctor has protocols for treating lows. Actually an EMT or nurse can start the IV.

Ketoacidosis is unlikely. You won't let it get that far.

Most importantly, don't let diabetes foil your family's dreams.

LD

Original posting 17 Sep 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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