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Parents in Canada, question

Discussion in 'Parents of Children with Type 1' started by MommaKat, Aug 27, 2012.

  1. MommaKat

    MommaKat Approved members

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    I have a very good friend in Canada (Manitoba I think), who just messaged me tonight about her son, 5 1/5 years old. For the last few weeks he's been drinking a ton, going to the bathroom a lot, started peeing the bed again (seriously, if that were going to be an issue I would have expected it to come up when she was going through the hell of chemo and radiation treatments, not when life's been back to normal for a good year.) She has ketostix from a kidney infection he had in early June, and tested his pee b/c this is happening so much this week - positive for both ketones and protein. So, she took him in and the only thing they told her was to limit his fluid intake because his urine, in addition to ketones , was very dilute. :eek:

    She's asking me what else I would suggest. As far as a parent watching a child with concern over bladder / kidney infection, and / or signs of T1D, I had some thoughts to share. However, I don't know the health system in Canada well enough to know what to suggest as a next step with the pedi. It does sound like he's been losing weight, she didn't say anything about appetite, but he also has pain in his stomach and when he pees.

    More than anything, this family needs professional support in addressing things quickly and accurately. When she was certain she felt a lump, they brushed her off for over a year. When they finally caught her breast cancer, it was stage IV of the most aggressive kind. I can't believe they were told to withhold fluids from a 5 year old!! :mad: Especially in light of the + ketones. Any ideas from Canadians familiar with the system that I can forward to her? I've given her a list of things to watch for, questions to ask, but she needs to work with a doc on this...

    TIA!
     
  2. C6H12O6

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    So the child was not spilling glucose in their urine and did not have hyperglycemia ? if these things were not tested the next step is to ask that they be tested. They can head to ER or an Urgent Care. If they are willing to wait they can head to an appointment with their GP , Ped or at a walk in clinic.

    if she goes to her GP , Ped or a walk in clinic all she needs to do is ask for a lab requisition for random glucose. they may be inclined to do a fasting but a random is preferable
     
    Last edited: Aug 28, 2012
  3. cdninct

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    Without knowing the details, I don't think this is an issue of national difference--just a question of a potentially bad call on the part of one particular doctor. Encourage your friend to find another pediatrician, go to a walk-in clinic, or head in to the ER if the situation warrants it. It sounds like she and her family have not had a lot of luck with doctors recently, and that is really unfortunate, but in this case there is really no system to work. Assuming that Manitoba is the same as Ontario, they will not be able to see a specialist without a referral from their family doctor, but there is nothing to stop them from going back to the same doctor, visiting another primary care doctor, or going into the clinic/hospital.

    I wish your friend the best of luck getting to the bottom of it.
     
  4. Helenmomofsporty13yearold

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    I would take the child to the Emergency Room of a hospital so she can be seen by the doctors there and not the idiot doctor she has. She could tell the triage nurse that she suspects diabetes. She should keep a record of just how much the child drank in one day and the other symptoms.

    I am sorry your friend's doctor did not follow up on her breast lump and am glad that she is OK today. That was not my experience. When I had a lump they did a mammogram, ultrasound and needle biopsy to confirm it was benign.
     
  5. momofone

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    This is almost our exact experience two days before my son was diagnosed. Our family doc told us to limit fluids and only dipped his urine in the office when I asked him to. Then he told us that he was spilling glucose but he wasn't concerned. He changed his lab req to include a fasting glucose but by the time the results were in, we were already in the hospital. When we went to the hospital I told the triage nurse what his symptoms were and they did a finger poke right on the spot. Not even 5 minutes later our room was full of docs. I say go straight to emerg. Thankfully, our son wasn't in DKA and only had a BS of 10.9 but this is not something to mess around with, IMHO.
     
  6. zapsmom

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    I am from Manitoba. What I would do is see if she has tested his sugar levels and if they are high with the ketones, then I will take him to the Children's hopsital. Once there I would tell the nurse EVERYTHING...Drinking alot, ketones, high sugar, lose weight, how much he is peeing. The Er thenwill more than likely do a blood test to see if he has d or not as well as to see what is what with this poor little guy. This is what I did when my DD was dx'd.I took her in and told the traige nurse why I had her there and within 15 mins, we were in a exam room and she was being tested for d. Any more questions, just pm me if I can be of any help.
     
  7. MommaKat

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    Thanks all for the advice, esp those familiar with healthcare in CA. She told me that she couldn't just go to a different primary care, and I get that. Medicaid and Kaiser here work like that - you get assigned one and one doc. Want to see anyone else? Referral necessary. But I digress.

    I spoke with her again later the same night, and she was really concerned. I said the only advice was to go the the ER, and barring that, to go out and get a meter, check his BG, and if high with ketones, to then go to the ER with meter in hand. I haven't been able to reach her since. I hope all is okay and that they're getting the help they need.
     
  8. C6H12O6

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    It sounds like they did urinalysis with reagent strips because of the reference to the child?s urine being acidic and dilute. Therefore, it sounds like they checked PH and Specific Gravity

    Urinalysis reagent strips in Canada typically check for PH, Glucose, ketones, leukocytes, nitrites, protein and blood. Therefore, it sounds like the child was not spilling glucose so their blood glucose is not elevated significantly or perhaps not at all

    a physician is more likely to wrongly assume non-diabetics do not spill ketones, rather than ignore that ketones are associated w. a type 1 diagnosis.

    I would not hesitate to take the child to ER.

    I am surprised she has urinalysis strips with just protein and ketones tests on hand. Normally, they would test for more than just those two

    Also, you can switch family doctors (your PCP) in Manitoba. You just wouldn?t necessarily be seen right away by the new doc, and there would be some work involved. You can also access ERs, walk in clinics, urgent care clinics, or primary care NPs.
     
  9. cdninct

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    She has not been assigned a doctor and can certainly go to a different PCP (assuming she does not live in a small town with only one doctor or in a place with a shortage of doctors where it might be tougher to find somebody who is willing to accept a new patient...), but as with starting with a new doctor virtually anywhere, you generally have to start with a full physical, which might take a longer time to schedule.

    If she is really concerned, keep pushing for her to head into a walk-in office/urgent care centre or the ER if things get serious. As is the case anywhere, the squeaky wheel gets the grease, so the more proactive she is, the faster she will get answers!

    Good luck to her and her son! Please let us know what happens.
     
    Last edited: Aug 29, 2012
  10. cdninct

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    Sorry for repeating information; I only just read the post from C6H12O6 (whose user name I figured out for the first time, by the way--duh!). :eek:
     
  11. wilf

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    Your advice was good. Getting a meter in this instance is a good investment, and will guide what she needs to do next.
     
  12. C6H12O6

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    There is probably a bit of a breakdown in communication here but the story does not make much sense. She has test strips that test for urine protein and ketones at home but nothing else ? that does not make sense there is no product on the market like that.

    Meters are not designed as a diagnostic tool. Like all Canadians Manitoba residents have a publicly funded health care system. There is already evidence that the child should be seen by a nephrologist (spilling protein) and is metabolizing fat for energy (spilling ketones) so the child is not adequately nourished for some reason.
    The parent doesn't need more make shift at home diagnostic tools than she already has. She is already responding inappropriately (not necessarily her fault) to the at home diagnostic tools she has .

    she needs to take the child the ER period full stop

    The child could be acutely ill with a condition that has nothing to do with diabetes mellitus. For that reason suggesting the parent purchase a blood glucose meter could just be delaying the child getting the help they need and have potential serious consequences. this is exactly why posts about - I think my child has diabetes are forbidden
     
    Last edited: Aug 31, 2012
  13. Sarah Maddie's Mom

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    ^ this.

    mts
     
  14. C6H12O6

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    How is 90 ? 100 $ on a blood glucose meter and strips a good investment when the child in question is not even spilling glucose in their urine ?

    The parent obviously has complete urinalysis strips that also test for glucose.
    If one was testing for a kidney infection which the OP said is the reason the parent has the strips they would need to test for leukocytes, nitrites, protein and blood, therefore, they would need complete urinalysis strips which would include GLUCOSE.

    Don't you think money might possibly be tight given her recent breast cancer diagnosis? Not to mention a pharmacist can't ethically sell someone a blood glucose meter and tell them it is okay to use it to diagnose a small child with a life threading illness at home. The product is not approved for such use
     
  15. MommaKat

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    I shared the info / symptoms my friend shared with me. Can't share stuff she didn't bring up. She contacted me b/c we're friends, b/c I worked peds for a long, long time, and b/c I have a child with Type 1 - diabetes wasn't her only concern, but one of them. This board is for type 1 (as I've been reminded many a time), so I kept my post here to that topic.

    She had gone to the ER based on what her dip at home showed, the excessive thirst, drinking, wetting the bed when he hasn't for such a long time. That's where she was told to limit fluids. Not good advice for any child, but certainly not one his age. Other factors not within normal limits seemed, to my friend, to have been glossed over or not addressed adequately. Her momtuition was ringing alarm bells, but she also knew from past experience that going back to the same ER would change nothing.

    She had a coupon for a free meter with the purchase of strips. I don't pretend to know the Canadian Health system, that was why I posted here with questions. I do know that I can go into walmart or target here and buy strips without an Rx if I am paying out of pocket. The Rx is necessary if I want to bill insurance. So, it never occurred to me to question if that's how it worked for her as well, but I would assume so given what she related to me.

    Haven't heard much from her since then other than that they have an appt with the family doc and his BG has been high, but not alarmingly so. I don't know the conversion for mmol to mg/dl, but she said he was running between 5.8 and 9.0 (I'm guessing that's 100 to 150ish) fasting bgs, and he's still really thirsty all the time. It was a brief email, and I simply responded that she shouldn't wait to see a doc, especially if he's still +ketones, glucose, and / or his meter readings were high. I don't think the meter was such a bad investment, even if it isn't type 1 D. (I'm fully aware that he could be +ketones, +urine glucose, +urine protein and slightly elevated BG with a kidney or other kind of infection) Either way, he needs to be seen sooner rather than later, and she clearly needed another push / motivation to follow her gut and get him in. When you've been kicked around and dismissed by your medical system for pressing the issue, it can get hard to keep doing it. Unless I hear back from her that her son was diagnosed (and I'm really hoping not), I'm going to treat this thread as dead...

    Thanks for all the great advice given earlier.
     
  16. MommaKat

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    OT - neither did I. Wasn't thinking it through until you said that. OMG, staring me in the face. Why that didn't click I'll never understand, but a clever username for sure!!
     
  17. C6H12O6

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    To convert mmol/l to mg/dl you multiply the mmol/l number by 18 :)
    You can buy meters and strips out of pocket , and you can get basically any kind of meter free when you purchase 100 strips , but the strips will run you 100$
    Hopefully her family doctor will make the appropriate referrals. If he continues to spill protein I would think he should see a nephrologist.

    I hope that if he becomes acutely ill she will not hesitate to take him to ER bc of her experience
     
  18. momofone

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    Something is just not clicking with this story. My son's BG was only 10.9 when he was diagnosed. A normal fasting BS is 3.9-5.5. If the child has glucose in his urine, ketones, and elevated BS then what else would it be?
     
  19. Sarah Maddie's Mom

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    It's like the children's game "telephone". The friend, to the OP, to our reading of it...
     
  20. Andrew84

    Andrew84 New Member

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    Hello. Could anybody help me? I'm going to immigrate to Manitoba soon and I have son with diabetes 1 type. Now he uses CGM Dexcom G4, I buy sensors to this device. As I know, Manitoba provide diabetics necessaries things. But what about Dexcom? Maybe somebody had this situation and know the answer? Thank you in advance.
     

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