Pediatric Grand Rounds resumed in September for the academic year. The presentations are at 8:00 a.m. on Friday morning in Lied Auditorium. The schedule is available on our website, www2.kumc.edu/kids. We have had many interesting presentations and more scheduled. If you have any suggestions or requests please contact Lisa Gilmer, the Grand Rounds Coordinator, at (913) 588-5908. Everyone is welcome at this teaching conference.
This time of year is interview time for residency applicants for the pediatrics and medicine/pediatrics training programs. We have many outstanding applicants from our region as well as other parts of the nation. We have six pediatric and four medicine/pediatric positions and are looking forward to an outstanding group of new recruits. Approximately 20% of our graduates go on for further subspecialty training whereas the majority goes into practice in this region.
Professor and Chair.
An 11-year-old female with Type 1 Diabetes for two years began developing high and low blood sugars with no good explanation. Adjustments of her two injections per day did not seem to help. She was changed to LantusŪ insulin plus injections of HumalogŪ prior to meals, after she had learned to count carbohydrate points and give just the amount of insulin she needed. Her highs and lows disappeared, her hemoglobin A1C decreased from 8.5 to 7.6% in 3 months, and her fasting blood sugars averaged 110.
A 15 1/2-year-old patient with Type 1 Diabetes for five years had several hospitalizations for severe diabetic ketoacidosis (DKA). After consultation, and several classes to learn how to use the insulin pump, insulin was delivered by this device, worn on her belt. It provided her basal insulin and the proper insulin boost prior to eating meals. After several months, her hemoglobin A1C had dropped 3 points. She has not had any further episodes of hyper- or hypoglycemia, and no hospitalizations.
These two forms of insulin treatment — the insulin pump and Lantus (glargine) insulin plus Humalog — are being used more and more commonly in children. The results at this point appear to be excellent and seem to be superior in many cases to other insulin treatment plans. Patients are chosen carefully, making sure that the patient is motivated, desires more intensive therapy, will keep good records, and will attend clinics on a regular basis. So far, the University of Kansas Pediatric Endocrine staff is very impressed with these two forms of insulin therapy.
Until recently, Type 2 Diabetes Mellitus has not been considered to be a pediatric illness. However, across the country, and at KU Pediatric Clinic, an "epidemic" of cases with Type 2 Diabetes has been occurring. The incidence has increased tenfold over the last ten years.
Clinical characteristics of Type 2 Diabetes in children involve the following: the person usually shows a rapid weight gain, sleepiness or lethargy, amenorrhea or dysmenorrhea, and acanthosis nigricans. This last is a skin rash that occurs in almost all children with Type 2 Diabetes, consisting of a velvety hyperpigmented patch found on the back of the neck, axillae, and under the breasts.
Risk factors for the development of Type 2 Diabetes in children include, race (African-American, Hispanic, and Native American children), puberty, obesity, and a strong family history.
KU Pediatric Endocrine clinic has an increasing number of patients that have been evaluated over the past year for Type 2 Diabetes. Several have frank diabetes with high blood sugars.
Therapy involves exercise, emotional support, weight loss while ensuring proper nutrition for growth, and in some cases medication. While the oral medication Metformin (Glucophage®) has been approved for children 10 years of age and above, children may need insulin in times of stress, when blood sugars can skyrocket.
If you have any questions regarding the management of diabetic children or for referrals please contact: KU Pediatric Endocrinology Clinic at 913-588-6326.
Pediatric Endocrinology.
Pediatricians and other health care providers are seeing health care changes as a result of new and rapid increases in genetic knowledge. With the publication of the Human Genome Project in February this year, over 30,000 genes have been mapped and sequenced. These genes are associated not only with rare genetic disorders, but also with susceptibility to common diseases. This information will have tremendous impact on pediatric health care, disease prevention, and health promotion. Because some of the most up-to-date information necessary to practice genomic medicine are found on the Internet, it is essential that pediatricians have knowledge about medical genetics Internet resources.
Pediatricians increasingly see families who have researched symptoms, diagnoses, management, treatment, and research prior to clinic visits through Internet searches. There are many genetic sites with current information to help practitioners keep up with information about diagnoses, practice guidelines, treatment, management, DNA testing, and research.
These resources are linked off the web pages of the Genetics Education Center at the University of Kansas Medical Center (www.kumc.edu/gec/geneinfo.html) with resources for patient care, research, and education. Some links include the following:
With the plethora of information available, search engines using keyword searches are invaluable (e.g., Google, AltaVista, etc.). Tips for using search engines:
The quality of information on the Internet varies widely; ranging from highly technical professional articles to anecdotal information on personal home pages. Information may or may not adhere to established guidelines, peer-review, indexing, and cataloging standards of published medical literature. The quality of information continues to improve as governmental agencies, educational institutions, research centers, and clinics add informative materials.
Numerous organizations have published criteria for assessing the quality, reliability, and validity of health information on the Internet. For example, the Health on the Net Code of Conduct (HONcode), is displayed on sites that indicate author, respect information privacy, display date modified, reference scientific sources for health treatments and benefits, provide address of site manager, and identify sponsorship and funding. URL: www.hon.ch/ Additionally, web sites should utilize people-first language, and be easily used by those who have difficulty with color vision, use voice recognition software, or use other adaptive devices. See www.kumc.edu/gec/support/advocacy.html
If you have any questions regarding genetic resources or for referrals please contact:
Debra Collins, MS, CGC
3901 Rainbow Blvd. (4023 Wescoe)
Kansas City, KS 66160-7318
913.385.0585
dcollins@kumc.edu
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The University of Kansas Medical Center