Planning and gear is necessary when setting off for a day of water fun, but for kids with diabetes it can sometimes feel like an Everest expedition. Their checklist can include any or all of the items below:

●Blood glucose meter

●Supplies to check blood sugar

●A cooler or ice packs to keep insulin cool

●Insulin

●Insulin injection supplies

●Insulin pump supplies

●Snacks for low blood sugars

Children and their families with Type 1 diabetes deal with additional risks on top of the typical worries that all families deal with. Some diabetes specific risks include:

●Low blood sugar

●Dehydration

●High blood sugars

●Ketones

The wisdom and experience of a parent of a child with Type 1 diabetes adds more practical value. I discovered this article on swimming with Type 1 diabetes.

I reached out via Twitter to the mom and author of the article. As the mother of two girls with Type 1 diabetes, she had a lot of good, practical advice, which I endorse and would give to my own patients.

I know it helps to here from other moms. Here are some of the thoughts and tips that she shared about her now older girls.

Importance of swim lessons

My girls passed all of their swim lessons and have reached the level that will safely take them into adulthood ... I still tend to hold the book and scan the water until both are safely drying off on my blanket. Once a mom, well, always a mom.

“Managing” blood sugars

Despite this natural maturity and necessary growth, our family is still cautious with Type 1 diabetes and swimming. We know that blood sugar management during exercise can be tricky on a good day, let alone, on a day of intense swimming, where every single muscle is engaged and active.

Here is a list of strategies that we use to help keep teenager independence while staying healthy with Type 1 diabetes.

1.Check blood sugar before you go into the water.

2.Blood sugar MUST be above 100 mg/dl.

3.If not, BEFORE swimming, eat a small protein and carb snack and do not bolus. Our girls like re-sealable chocolate milk jugs, cheese and crackers or small peanut butter and jelly sandwiches.

4.Swim with a buddy and never alone.

5.Every hour, get out of the water and check blood glucose.

6.If blood sugar is rising, which often happens due to adrenaline during exercise, reconnect the pump and take ½ of the recommended bolus amount. This also helps to avoid ketones from lack of insulin.

7.Stay hydrated. Even if you feel like you are not thirsty, drink 8 ounces of water each time you are checking your blood sugar.

8.Always bring money. If you find yourself eating through snacks, be prepared to purchase carb-laden food from the snack machine or beach shack. This happens more often than not, so I stress this often!

9.Be prepared for lows that might happen an hour or two after leaving the water. With T1d, it’s not just the first event (swimming), but the second, third and fourth events that need proper planning. For that reason, always tuck in more glucose, more meter strips and extra supplies than you think you might need. Chances are, you will need it!

I hope this article was helpful and makes for a better water safety experience.

My gratitude to naturallysweetsisters.com for sharing.

1. What Is Turner Syndrome?

Turner syndrome, named after one of the doctors who first described it, is a genetic condition in which all or some portion of the X chromosome is missing. The lack of vitals genes found on the X chromosome affects multiple organs in the body leading to the medical problems seen in girls with Turner syndrome.

The loss of X chromosome genes happens very early in fetal life. In fact, the pregnancy of many babies with Turner syndrome ends in miscarriage. The condition is one of the most common genetic conditions with an estimated 1 out every 2,500 girls born with Turner syndrome.

2. What Health Problems Do Turner Syndrome Girls Have?

The severity of health problems in Turner syndrome is variable and depends at least in part on the loss of gene activity from the missing X chromosome. Many pediatric subspecialists may be involved in the care of Turner syndrome depending on the number and severity of health problems.

Heart problems in particular can be life-threatening and may require surgery early in life. Lifelong monitoring of heart health is necessary as heart problems are the most common cause of early death in Turner syndrome.

There are two primary health problems which need pediatric endocrine care.

· Short Stature

· Ovarian Failure

Short stature is a near constant problem seen in almost 100 percent of girls with Turner syndrome. I, and many other pediatric endocrinologists, use growth hormone treatment in girls with Turner syndrome. Prompt diagnosis is necessary and earlier diagnosis is essential. Prior to the use of growth hormone treatment, the average height for Turner syndrome girls was 4’8”.

The ovaries fail to work properly in most girls with Turner syndrome resulting in inability to go through puberty. Pediatric endocrinologists often start estrogen treatment and monitor puberty progress. Women with Turner syndrome need lifelong hormone replacement therapy. The majority aren’t able to have children without assisted reproduction.

Many other health problems can occur in Turner syndrome, and lifelong medical care is needed to check for these problems and provide proper treatment.

3. How is the Diagnosis Made?

Some families learn about the diagnosis of Turner syndrome in their daughter prior to birth if amniocentesis is done. However, most girls with Turner syndrome are diagnosed after birth.

The process of diagnosing Turner syndrome begins with a careful medical history. Unexplained short stature or delayed puberty may be the first clues in the diagnosis of Turner syndrome.

Blood testing to check chromosomes is necessary to make a definite diagnosis.

4. What else do I need to know ?

I hope this article helps in better understanding Turner syndrome. An early medical check in a girl with signs of Turner syndrome such as short stature or delayed puberty may be the first step in diagnosis.

Quick Refresher

• What is the thyroid gland and what does it do
• Hypothyroidism (underactive, low thyroid)
• Hyperthyroidism (over-active, high thyroid)
• Autoimmune thyroid disease
• Congenital hypothyroidism
• Acquired hypothyroidism

Question 1: I’d never heard of thyroid problems in children until my child was diagnosed with hypothyroidism. Are thyroid problems increasing in children?

Answer: It depends on the specific thyroid problem to which you are referring.

Acquired hypothyroidism is a maybe. Autoimmune thyroid disease also known as Hashimoto disease is the leading cause of acquired hypothyroidism in adults. Research studies have definitely shown a worldwide increase of Hashimoto disease in adults, and there is likely also an increase in children.

The most scientifically validated reason for the worldwide increase in Hashimoto disease is improved iodine intake. Iodine is a very important mineral that is necessary for thyroid hormone production. Lack of the mineral remains a common cause in certain third-world areas of the world for a specific form of hypothyroidism termed endemic goiter. For some reason, however, the improved supplementing of iodine may be a culprit in triggering autoimmune thyroid disease in adults.

Congenital hypothyroidism is a yes. Researchers are trying to understand the observed increase in incidence of congenital hypothyroidism. The historic quoted incidence is roughly 1 in every 4000 new births. Current trends are showing higher incidence at roughly 1 in every 2500 births. There are a number of different theories about why this is seen. One factor is the increased number of surviving premature babies. Many of these babies have a thyroid problem termed transient hypothyroidism during their early life requiring treatment with thyroid hormone and are counted in the same category as congenital hypothyroidism .

An increase in the Hispanic population is another factor theorized to account for the change. There is a higher incidence overall in Hispanics of congenital hypothyroidism which may be influencing the incidence numbers.

Radioactive iodine exposure during pregnancy has definite negative impact on fetal thyroid activity, and exposure must be avoided. Concern was sparked in 2012 with a controversial study published suggesting a link between the Fukushima nuclear disaster and a spike in the number of cases of congenital hypothyroidism seen in U.S. Pacific Coast states.

Question 2: Why did my child develop Hashimoto disease?

Answer: Medical science doesn’t know the precise reason(s) for autoimmune thyroid disease which includes Hashimoto thyroiditis. We believe that there are factors both genetic and environmental involved.

Research suggests that genetics underlies about 70 percent of the susceptibility in Hashimoto disease which is why a family history of thyroid problems is often seen in children with Hashimoto disease. Of the various genes identified with risk for Hashimoto disease, the HLA-DR gene association is best known. The gene location is known most widely for its importance in organ transplant

Environmental triggers are the great unknown not only in Hashimoto disease but also in many other autoimmune conditions. Infection triggers seem to be the most likely candidates in this process. Hepatitis C infection and Rubella (German measles) are two infections with known links to autoimmune thyroid disease. In addition to known harmful infections, possible impact of disturbance in beneficial intestinal bacteria as a trigger in autoimmune thyroid disease as well as other autoimmune conditions is being investigated.

Smoking in adults has been linked to increased risk for autoimmune thyroid disease and is another of the many reasons to avoid smoking. More controversial theories include environmental pollutants role in autoimmune thyroid disease. PCBs and PBDEs have been linked to increased risk in some research studies mainly in animals.

Radiation exposure is a known risk in many thyroid problems in both adults and children. Childhood thyroid cancer rates increased drastically after the Chernobyl disaster. Both autoimmune thyroid disease and thyroid cancer risk are increased in cancer survivors who received radiation treatment. Fortunately, routine medical radiation exposure doesn’t appear to be linked to higher risk of thyroid damage.

Question 3: Can diet help prevent or improve thyroid problems?

Answer: Yes, to some extent

The mineral iodine is essential for proper thyroid hormone production. Fortunately, in the U.S., lack of iodine is extremely uncommon. Seafood and dairy are both good sources of iodine, and iodine is added to salt as well. Risk of iodine deficiency is very low in in children who eat a healthy, balanced diet and have no digestive problems.

Goitrogens are naturally occurring chemicals in certain vegetables such as cauliflower that can interfere with function of the thyroid. Overall, the health benefits of goitrogen-containing vegetables probably outweigh the risks to the thyroid when eaten in a balanced manner.

Question 4: What can I do to help others in my family or family friends be more aware of thyroid problems?

Answer: Awareness is the key.

Awareness of symptoms of thyroid disease is important when there is a family history of thyroid problems. An exam of the thyroid and a blood testing can uncover thyroid problems. Sharing the story of your child’s medical history with concerned friends can also help.

I hope these answers help those of you who have a child diagnosed with a thyroid issue. If you still have questions or need more help, please contact your primary care doctor or the Cook Children’s Endocrinology division.

There’s been a lot of progress in type 1 diabetes care in the last five years, and I can only expect more in 2016 and upcoming years. I offer my thoughts on three areas for anticipated progress in type 1 diabetes care.

DRUGS

Insulin has been the mainstay in type 1 diabetes care since its purification and use in 1929. We’ve come a long way from purified animal insulin. We’ve had synthetically produced human insulin now for about 20 years.

Further modifications were made to human insulin creating long and short acting insulin analogs which are used today in basal/bolus insulin plans - considered standard of care in those with type 1 diabetes.

Several new analog insulin, either released or awaiting FDA approval, could be game changers for 2016.

Long-acting insulin activity is currently around 24 hours, but having a longer range of activity may benefit some patients with diabetes. Two new long-acting insulins, Tuojeo and Tresiba, continue working beyond 24 hours and have been approved for use only in adults with type 1 diabetes.

Fast acting insulin is essential at meals to control the rise in blood sugar from carbohydrates eaten. An “ultra-fast” acting insulin faster than the current batch of rapid-acting insulins recently started the review process for approval.

None of the current long or short acting analog insulins are generic. The cost of insulin and other diabetes supplies is a significant ongoing expense. A new “semi-generic” form of the long-acting insulin analog, Lantus, received recent approval.

The release of new analog insulin offers more choices, and research will be essential to see how these insulin can be used in children. Also, the number of insulin and increased choices will hopefully mean lower prices for vital medicine in the future.

DEVICES

Technology continues to move forward in its role helping children and families co-pilot type 1 diabetes.

Continuous glucose monitoring (GGM) continues to move into mainstream as a vital tool giving children and families real-time blood sugar information and better managing the highs and lows in blood sugar.

CGM in the clouds refers to the technology allowing remote monitoring of blood sugars. CGM sensor information is broadcasted via a smart phone to a server where it can be retrieved by using another smart phone or internet connected device. Parents can be hundreds of miles away and still have the comfort of monitoring their child’s blood sugar.

All the major insulin pumps have or will shortly have CGM integration allowing the most efficient use in these two tools together. The ultimate pairing of these tools, the artificial pancreas, continues in development.

The artificial pancreas holds the promise to lessen the work in diabetes care and help children have more stable blood sugars by allowing the insulin pump to use CGM information to make adjustments in insulin delivery.

Recent major funding received from the National Institute of Health and other sources will help fuel continued development and improvement.

Ditching the needles

Needles and sharp things are tough reality in diabetes care. Shots and finger pokes are a daily necessity in diabetes care. There’s been talk about non-invasive, needle-free monitoring in diabetes care for decades, but little progress has been made. Although CGM represents major progress, a needle is still needed to insert the device.

Wouldn’t it be great if monitoring of blood sugars or insulin treatment could be done without needles?

2016 has the potential to move forward in this area.

Inhaled insulin was recently approved for use only in adults with type 1 and type 2 diabetes. Further study is needed to see if inhaled insulin has a safe, effective place in treating children with type 1 diabetes.

Google’s glucose-sensing contact lens is probably the most recognized in the effort of various companies developing blood glucose checking without the stick. An ear sensor is being tested by two different companies.

The hormone glucagon is essential in the body to work against insulin and keep blood sugars up. Glucagon treatment, given as an injection, is an emergency measure used in type 1 diabetes when severe low blood sugars happen.

Nasal glucagon development is progressing and will probably reach the market soon with the promise of one less shot needed in an emergency situation of low blood sugar.

Defeat Diabetes

Removed first part For all of us in the field of endocrinology, defeating diabetes is the ultimate goal. For now though, I think 2016 offers the promise of new technology making those the life of someone with type 1 diabetes easier.

Research is also ongoing in re-creating insulin producing cells for re-implantation in the body which is the ultimate in defeating diabetes for good and what a great story that would be as we look ahead to 2017.

Halloween can be a particularly challenging time of year for families and children dealing with diabetes. Whether a family is dealing with type 1 or type 2 diabetes, there are important health decisions to be made about handling the seasonal free flow of candy.

Type 2 Diabetes

Recent stats report 23 million people in the U.S. have type 2 diabetes. While most of those people are older adults, there are still many children who are at high risk for developing type 2 diabetes.

Obesity is a central problem in type 2 diabetes. With all the tempting treats, it’s no wonder that the average adult weight gain from Halloween until New Years is estimated at 5-7 pounds.

Therefore, it is essential to have a healthy game plan in preparation for Halloween and the other end of the year holiday.

Type 1 Diabetes

Obesity is not as often a central problem in children with type 1 diabetes; however, healthy snack/candy choices are still of prime importance. There’s a common misconception that people with type 1 diabetes can’t eat candy or other sweets. Those with type 1 diabetes can eat candy, but they must take insulin for the carbohydrates in the candy. Finding the right balance between healthy snacking and insulin dosing for candy is a real challenge for children and families dealing with type 1 diabetes.

Asking a veteran type 1 diabetes parents about their approach to Halloween is always a good idea. Amy Ohmer (@NatSweetSisters), a mother of two children with type 1 diabetes was kind enough to share some advice.

There are several wonderful ways in which families can handle Halloween. I prefer to tell parents to continue previous traditions, post diagnosis, expecially with older children or children with older siblings. First, this sends a message that type 1 diabetes will not change anything and secondly, there is no better time than the present to practice some real life carb counting/dosing skills.

If the plan is to go trick-or-treating, remember that the goal is to amass as much candy as possible, not necessarily to eat all of it. After bringing home the candy, counting the amount, and choosing their favorites, our kids are ready to part with much of it. There are several organizations that accept leftovers from food banks to senior centers.

Another great reminder is that Halloween candy is the perfect carb snack for low blood sugar treatment. A running joke amongst our parenting group is that this is the time where we can stock up on free carb snacks!!!

One year, our children sold candy back to us in exchange for "Halloween bucks" to buy things at a silly store that we set up in our living room. Every ten pieces of candy, provided a Halloween buck. At the end, they received a book, some dollar store items and a new Barbie doll. They loved that even more than the candy.

Finding the Balance

Not all candy is created equal. A quick check of nutrition breakdown on different Halloween candies helps children and adults pick “healthier” candy.

A recent research study gives some needed perspective for parents on children’s eating habits. The research examines different strategies to help children manage their food choices. Eating strategies that included structure, consistency, and clear communication between parent and child created the best success in helping children make better food choices long-term.

The lifelong goal for children and families is making consistent healthier choices in both the kinds and amounts of food eaten.

Halloween should be a fun time for all children, including kids with diabetes. Once again I’ll go back to Amy for good advice for us all:

No matter what parents choose to do with their children, they should take a deep breathe, relax and enjoy the event, whether it is trick-or-treating, bobbing for apples or enjoying donuts and cider. Halloween is truly a fun family event.

They could all learn a lesson from a young woman named Marissa Heintschel.

I learned about Marissa during one of my recent searches for news about my field, pediatric endocrine. The news story featured students in the Frisco high school independent study and mentorship program.

One of the students in this program was Marissa, who had chosen pediatric endocrinology as her focus of study. I reached out to her via Twitter to learn more about her experience in the program and was very impressed by her story.

Like many in my field, she had a personal connection to pediatric endocrinology, having been diagnosed with Type 1 diabetes at 7 years old. She shared with me her passion for medicine and her experience she’s gained and the research that she did during her year in the program.

I asked how her experience had changed her view of children living with a chronic condition such as Type 1 diabetes. Her answer gave me a fresh, personal perspective on challenges of life with this chronic condition:

“I have always made it very public that I had Type 1 diabetes,” she said. “I went through the whole phase of trying to hide it away from people. I wish I would’ve realized sooner the importance of taking care of myself because when I was 14 or so I was stupid and thought that if I ignored my diabetes it will go away and that I could run away from my problems.

I wear an insulin pump. I’ve been called things like a robot and people in random places will just stare at me.

There was once this kid in my class sophomore year that I started to become really good friends with. One day I asked where he went and someone said that he went to go take his shot because he was diabetic. It was so surprising to me because no one really knew he was diabetic.

So then I started talking to the kid more and more about his diabetes and he just opened up to me and was able to talk about his problems that only people like us could understand. After he opened up to me, he told me how thankful he was that we had grown closer because he now felt he had the confidence to tell people about his diabetes.”

Marissa’s story got me to thinking about the importance of sharing about having Type 1 diabetes and how difficult it can be. I, and others on the Cook Children’s diabetes team, speak to children and their families about sharing about their diabetes when we meet with them at Cook Children’s during the difficult period of initial diagnosis.

• Support
• Safety

These are the two important reasons for S haring with others about having diabetes.

Sharing opens the opportunity to understand better the routine (checking blood sugars, taking shots, meal planning, etc.) that someone with Type 1 diabetes must do daily. Sharing opens up opportunity for support and encouragement. In Marissa’s case, it may be the opportunity to encourage and support someone else with Type 1 diabetes.

Marissa’s story also shows that sharing does open up vulnerability and risk. I asked Cook Children’s endocrine clinical therapist, Kim Cox, how she talks to children and families about sharing about diabetes.

“I usually talk to them about how ‘secrets’ tend to make other kids think it’s a bigger deal.

Why don’t they want others knowing? Are they

…. embarrassed?

... afraid of bullying?

... etc.

Being honest (but brief) about answering peers questions seems to work best. For example, I have diabetes, I have to take medicine when I eat now. We then discuss those issues.”

I use the example of a kid who gets glasses in school. In the beginning, you notice every time you see them, peers will comment and possibly even say mean things, but as time goes on, their glasses just become part of them and you only notice if they don’t have them on. Other kids move on to something else.

Safety is important because even in the best of cases diabetes care is unpredictable. High or low blood sugars affect mood and behavior. In particular, a low blood sugar can cause erratic behavior and eventually unconsciousness. Knowing about the diabetes allows others to have the advantage of understanding and help someone with Type 1 diabetes.

Marissa has a future of opportunity ahead of her and will be starting college at my alma mater, Texas A&M, where she will major in biomedical engineering and pre-med. She told me that she chose biomedical engineering because the potential that technologies such as stem cell research and tissue engineering for a cure for diseases such as diabetes. Being a doctor is her dream, and I think that she has learned a lot from her experience that will help her in the long journey to a field in medicine.

And now the next time you see a mom looking at her smartwatch, she may be monitoring her child’s blood sugar levels.

Progress in diabetes care has mostly come from the medical community and medical industry. However, this changed recently when a new innovation came from a people on the very front line of diabetes care – parents.

Who better to understand the pitfalls in diabetes care and be the best advocates for kids with type 1 diabetes?

I think that most people not affected directly by type 1 diabetes would probably guess that the multiple daily insulin shots is the hardest part in diabetes care.

But, I think (and perhaps many others touched by type 1 diabetes would agree) that the complete uncertainty about blood sugars is the true hard part of diabetes.

There are an infinite number of questions or worries surrounding the blood sugar:

• How does my child feel when his or her blood sugar is high or low?
• How will illness affect my child’s blood sugar?
• How will activity impact my child’s blood sugars?

Right now, most parents and children are flying blind in between blood sugar checks, not knowing for certain which way blood sugars are heading – up or down.

But they don’t have to any longer because glucose monitoring now lives in the cloud.

Continuous glucose monitoring

Anyone can see that the daily constant attention and mental energy needed for good diabetes care is immense. Any progress in diabetes care that reduces this strain right now is worth it.

Continuous glucose monitoring (CGM) is a technology useful in diabetes care. I wrote about the technology several years ago. The technology uses an IV-like catheter placed under the skin which constantly samples the blood sugar (glucose) level in minute amounts of body tissue fluid in the area between skin and muscle. A larger sensor attached to the catheter sits on the skin and beams the blood sugar reading to a receiver device. It allows families and children to see blood sugar trends in between finger pokes. Below is an illustration of the technology:

A number of barriers in the past such as size of the unit, wear comfort, sensor/receiver communication problems, and insurance coverage made wider use of this promising technology in children with type 1 diabetes a challenge. Fortunately, there has been progress and today there is wider use of the CGM use in children.

The proximity problem…..

Previously, a child wearing a CGM must be in receiver range (a max of 20 feet) to see blood sugar readings, and factors such as walls may further affect the ability of the receiver to detect the blood sugar readings.

Why can’t there be remote diabetes monitoring?

Today’s mobile technology makes it possible to shop or surf the web virtually anywhere in the world.So the thought process was, “Why couldn’t this same technology be used to make remote diabetes monitoring possible?”

Starting roughly 18 months ago, that’s exactly the problem that parents of children with type 1 diabetes solved.

Two tech-savvy dads who had children with type 1 diabetes pieced together a CGM receiver with a cell phone and they were able to transmit the CGM data into a cloud-based database. A basic set-up is shown below:

.#wearenotwaiting

The twitter hashtag speaks to the commitment of the group and other advocates for improvement in type 1 diabetes care to strive for innovation and progress right now in type 1 diabetes care.

The movement has evolved from a core of interested parents sharing with other parents to a Facebook group to now a nonprofit called the Nightscout Project.

The group continues to look at ways to move diabetes care forward with support of innovation, FDA device discussions and collaboration with other non-profits.

“People focus on the cure, but we want to focus on tomorrow. The cure is the future.”said James Wedding, Nightscout Project.

CGM in the cloud.

Once in the cloud, the blood sugar information could be accessed by any Internet enabled device (smartphone, tablet, smartwatch, etc.).

Families and children now have access to real-time blood sugar info whether their child is right beside them or half a world away.

The help and peace of mind has probably been immense as parents have access to blood sugar at field trips and sleepovers.

Parents can have date nights again and not worry about their babysitter monitoring their child’s blood sugar. They can now do it at the dinner table.

Quick blood sugar info is available with a glance at the smartwatch, and children never miss a bit of fun at the beach.

* Photo from beach, courtesy of Jasmine Cruz-Bohren.

About the author

Joel Steelman, M.D., is an endocrinologist at the Cook Children's Endocrine and Diabetes program, which treats infants, children and teens with conditions that are caused by or affect the hormonal balance of the body. We understand the importance of working together and that's how we approach the care of our children.

A recent announcement of a new smartphone app by Eli Lilly for glucagon use instructions reminded me specifically of the growing number of smartphone apps in diabetes care. A recent survey showed that the average smartphone user has 41 apps loaded on his or her smartphone. Apps powered by Internet connectivity affords users many options ranging from productivity to entertainment. I use my smartphone multiple times per day for various tasks ranging from checking email, reading medical news briefs, or entertaining my daughter with Angry Birds.

Health related applications loaded on smartphones along with other devices such as tablet computers represent a growing new trend of mobile health (Mhealth). Mhealth is a term used for the practice of medicine and public health supported by mobile devices. Mhealth currently provides a number of useful services including access to health information, real-time patient monitoring, and communication with the health care team. Many health care organizations, now have apps providing families with useful health information. A growing number of diabetes care apps are appearing to meet the needs of children and families dealing with this chronic condition.

Caring for type 1 diabetes involves a great deal of daily work: recording essential information such as blood sugars, insulin doses, carbohydrates eaten at meals, exercise, and illness. The diabetes education received by children and their families in the Cook Children’s pediatric diabetes program stresses two key skills of organization and interpretation of the daily flood of information. An organized system for capture of information is vitally important to give children and families maximal control over type 1 diabetes. The “old school method” for organization is a paper logbook carried everywhere with all information recorded. This system remains the best overall method helping both families and the pediatric diabetes care team to make important medical treatment decisions.

I know that many children and families struggle with maintaining a high level of organization. Diabetes smartphone applications present the potential to meet the needs of a mobile, tech-savvy population seeking a step beyond paper logbooks. I think this population is already comfortable with downloading and using apps from either iTunes or Android Market (Google play) and is willing to experiment with new methods of managing diabetes information.

Diabetes apps lend themselves to the necessary skills of management which include:

· Recording blood sugar readings

· Recording carbohydrates eaten at meals and snacks

· Looking up food carbohydrate content

· Calculating insulin doses

· Recording other information such as exercise or illness

· Communication with the diabetes care team

The growing number of diabetes apps (free and pay) makes it hard at times to determine which app is best for diabetes care. There is technology, such as IBGstar, that was designed to specifically integrate with Apple devices such as the iPhone or iPad. Other applications, such as Wavesense and Glucose Buddy, work with both Apple and Android devices. Newer apps also include allowing the user to link his or her social media accounts such as Facebook or Twitter with the app. A recent entry into diabetes apps designed by a pediatric endocrinologist, Endogoddess, offers another twist by rewarding care efforts with points.

I believe that technology advances such as diabetes apps and glucose sensors are part of the continuing forward progress in diabetes care. As with all new technology, I strive with families to make the best use of the tools available to improve diabetes care.

Chemotherapy and radiation treatments used to treat cancers often damage several endocrine systems in the body. The diagnosis of endocrine problems may occur at any stage in a child’s cancer treatment, and it’s particularly important to search for late effects appearing years after cancer treatment. Studies have shown the growing recognition of these late effects of childhood cancer treatment such as obesity and metabolic syndrome. Damage from the silent presence of these problems may take years to appear.

I created the clinic because I believe that endocrine evaluation and care has a lot to offer childhood cancer survivors.  I’m not alone as many endocrinologist are recognizing their role in the care of survivors. A report published last month detailing information learned from a large scale Scandinavian study of childhood cancer survivors further emphasized the important role that endocrinology should play in the care of survivors.

The study showed that children who survive cancer have a five times greater risk of developing an endocrine disorder late in life. The risk was highest in young survivors, but continued on into adulthood. Even by the time a patient was 60 years old, they had a 42 percent chance to develop an endocrine disorder.

Survivors of leukemia, central nervous system tumors and Hodgkin’s lymphoma were at the greatest risk.

Three primary endocrine problems were seen in the study.

• Hypopituitarism
• Hypothyroidism
• Gonad (ovaries/testes) failure

The Childhood Cancer Survivor Study (CCSS), a multi-center study sponsored by the National Cancer Institute has been ongoing since 1993 in the United States and provides valuable information comparable to the recent information from Scandinavia. The detailed information and guidelines from the CCSS prove very helpful in my care of young adults who have survived cancer.

I understand that many survivors and their families desire to put the stormy period of cancer treatment behind them and not to think about, but it’s important to remain engaged in health care and follow-up. I have provided endocrine support for Cook Children’s Life After Cancer Program (LACP) and Neuro-oncology program  now for five years and have found this role very rewarding in improving the quality of life of childhood cancer survivors. I look forward now to further expanding that role.