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Clinical Management of the Child and Teenager with Diabetes.
  1. SALLY STRANG
  1. Paediatric diabetes specialist nurse

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    Clinical Management of the Child and Teenager with Diabetes. Edited by Plotnick L. (Pp 268; paperback, £20.50; hardback, £45.50.) Baltimore: John Hopkins Press, 1999. ISBN 0 801 85909 3 paperback; 0 801 85908 5 hardback.

    The evidence provided by the diabetes control and complications trial (DCCT) exerts considerable pressure on clinicians to help their patients achieve optimal blood glucose control. This book has been written to provide detailed information for primary care physicians who, due to shifting responsibilities in the USA away from specialist teams, are becoming increasingly involved with the care of children with diabetes.

    Initially, the book appears rather wordy, having few diagrams and no pictures. However, it is not always the books with the most lavish illustrations that prove most use to the novice learning a craft. This book, while not forgetting some scientific information, is about the practical aspects of managing childhood diabetes. It is written in a sensitive manner, is easy to read, and the many brief case studies provide useful and interesting verbal illustrations. I was glad to find that, despite the transatlantic differences, we share a common philosophy of care, and most of the subject matter is as relevant in the UK as in the States. Professor Plotnick’s empathy with the children and their families is evident throughout the book, and social and psychological issues feature alongside the day to day diabetes management. There are chapters by a dietitian and nurse educator, and an appendix that contains a variety of sample record forms and letters, a reading list, and web sites.

    I get the impression that American families are encouraged to work harder at perfecting their diabetes management than their British counterparts, although it was sobering to note that personal finances and insurance policies may restrict some families’ ability to do this. Much is expected of them especially where meal plans and monitoring are concerned. Detailed instructions are given for altering insulin doses, and intensive monitoring and accurate record keeping are emphasised to achieve good control. I was intrigued to learn that when blood glucose concentrations are out of target range it is possible to determine the decrease of blood glucose produced by one unit of insulin by using “the 1500 rule”. This entails dividing 1500 by the total daily dose of insulin to calculate how many mg/dl one unit of insulin will decrease blood glucose.

    Diabetes nurse educators appear to work in much the same way as specialist nurses in the UK; however, I would have liked to learn more about their teaching methods and aids with perhaps some illustrations. It was interesting to see a whole page devoted to drawings of different sizes of syringes and needles but none of pen devices that are “very popular in Europe” or pumps, which are used more by American children.

    This book will be of interest to all practical clinicians caring for children with diabetes, but more will be gained by reading it in its entirety before delving for specific information. Some phrases remain in my mind which could sum up its ethos: “thinking like a pancreas”, the “relentlessness of diabetes” and “keeping hope alive”.

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