Taking care of type 1 diabetes isn’t cheap. New therapies are not covered by most insurance companies and if they are, deductibles are often high. Combine this with a bad economy plus the over 47 million uninsured in the US and you have the recipe for poor diabetes outcomes.

There is often a term used to describe what an insurer will pay for. It is couched in a vague term called “medically necessary”. Interpreting what this term mean is often left to professional groups, business types, and others who may sometimes be minimally knowledgeable about the disease in question. The groups whose opinion seems to matter the least are the actual patients or families who struggle with diabetes.

So, the Diabetes Challenge Question of the Day is simple enough: what diabetes treatments, devices, education, or care do you define as “medically necessary” and WHY? Be specific in your responses and give examples. This is really important to the future of diabetes care.

Opening ceremonies

We had an energetic opening ceremony last night. There was lots of song and dance, plus some solemn moments as well. The first coup feather was awarded as well.

Monday was very busy with oldest unit campouts and the evening activity being The Price is Right. It was a hot day, but it didn’t slow anyone down, especially at the pool. There were activities going on everywhere and lots of happy campers everywhere I went.

Why children need help with diabetes care

Once upon a time, promoting independence in self care in teens was the theme of diabetes education at camp. But a deeper appreciation for the need for emotional maturity in the face of growing complexity of diabetes has resulted in a shift in this philosophy over the past decade. But there is another reason that is often overlooked, and it pertains to the way most children and teens process complex information. Up until age 15, most children are considered “concrete thinkers”. By concrete, I mean they usually can’t consider the concept of a hypothesis (theory); they struggle to consider multiple possibilities in a challenging situation, often can’t systematically solve a multi-step problem, and can’t use combinatorial logic. Concrete thinkers often have knowledge of specific facts without understanding of their full meaning or significance. The mistake we as adults make is in believing that since a kid can tell us how many carbs are in an apple or banana, that they can effectively carb-count with their meals.

Communicating with a concrete thinker must be very specific and limited to very narrow set of options or parameters. This comes into direct conflict with diabetes care, which is in many ways abstract. Good self care requires a near constant attention to detail and a drive and motivation to succeed all the time. The majority of children and teens (plus many adults) struggle with maintaining the necessary focus to sustain good self care over time. In some ways, they might be set up to fail based on what we are asking them to do for themselves. So, when I hear parents look over to their son or daughter at camper check in and say “you ought to be doing this”, I see why so many of our campers struggle. Certainly, this is not an intentional act on the part of parents, but a lack of appreciation for the level of maturity required to really manage diabetes well.

I often show a photo of Tiger Woods, the premiere golfer of our time. I show him holding one of many championship trophies he’s won over the years. I next show Tiger’s golf bag and clubs. Next, I show a child with diabetes and an ‘in-range’ A1C (representing good control). I then insert a photo of an insulin pump or multi-dose insulin therapy and ask the provocative question: “Could you win the Master’s with Tiger’s golf clubs?” Of course the answer is “no”. So why then would you expect an insulin pump (or pretty much any other device for that matter) to all by itself result in an ideal outcome? It’s all about the person, not the technology.

The child or teen with diabetes requires a working family structure to do well. Without it, chances of success fall dramatically. So parents, listen up. If you want your camper to return from camp and take more responsibility with his or her diabetes self care, you must be at their side at every step along the way.

Texas Lions Camp

My medical team are very appreciative guests of the Texas Lions Camp. This camp had the vision to create this diabetes camping program almost 40 years ago. I’ve been lucky to be part of it each year since 1981. I encourage families to consider making donations to the camp. Every donation is appreciated and put to good use to serve the children of Texas with diabetes. The medical staff applauds Mr. Stephen Mabry, the camp’s CEO, for the quality team of individuals who operate every facet of the camp and effectively interface with my volunteer medical staff. The camp’s website is http://www.lionscamp.com. Photos of campers from this session can be purchased on the Lions Camp site.

Webinar

This week’s Parent’s Day Webinar is scheduled at 8-9 PM CST. There will be no “echo chamber” effect like last week. Updated links are posted to the webinar site. Attendees from last Wednesday night are invited to rejoin the webinar next week if you had to leave early. Also, the twitter site http://twitter.com/Dr_Steve_Ponder and this blog site form part of the alternative approach I’ve tried to develop to replace our 2 hour Parents Day program in the Rec Hall we used to have. I look forward to having the pleasure of visiting with parents over dinner on Friday evening July 31th starting at 5:15 PM. Last week, the dining hall was full (at least 350 in attendance). I hope for a similar crowd this week. If you have any questions or comments about camp, please let me know anytime at Stephen.Ponder@dchstx.org.

Diabetes Housecall

About 2 years ago I created a revolutionary new approach to diabetes care for children. It’s called Diabetes Housecall. I currently have patients with diabetes who have been seen as far away as Iowa. Texas patients as far away as 600 miles are seen just as easily as if they were in town. I encourage you to check out my website that explains how this innovative care program operates (http://www.diabeteshousecall.com) to allow me to see you in the comfort of your own home, also while having access to all your relevant diabetes self care information. The rules of participation in this exciting program are explained on the website.

I recently received good news that Blue Cross Blue Shield of Texas will be adding this program as a covered benefit to many of their members starting at the end of September 2009. This would be a first for home based telemedicine care for children with diabetes in Texas. Advantages of Housecall include 30 minutes or more of direct face to face time with the diabetes specialist. No waiting rooms, long car rides, time out of work or school, to see the diabetes doctor. Does this sound pretty good? If so, check it out at www.diabeteshousecall.com.

And for those of you who can’t get enough of Camp from the comfort of your own air conditioned home with Internet access… more pictures of kids doing what kids do best.

Last 5 posts by Steve

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This entry was posted on Tuesday, July 28th, 2009 at 7:08 pm and is filed under Behavioral, TLC 2009. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.