Let’s start off by telling us more about yourself and why you choose to follow the career path of a CDE?
My name is Rachel Calendo- I am a pediatric endocrine nurse practitioner, CDE, and certified pump trainer. My passion is to work with children and their families to achieve good health out comes as well as maintain excellent quality of life. My husband has type 1 diabetes. This has greatly influenced my passion for providing excellent care to families.
How do you feel about the artificial or bionic pancreas coming out in 2017? Do you think that you will feel comfortable working with patients with an artificial pancreas? How do you think it might help the patient?
There are several versions of the bionic pancreas that are in progress. If the technology used for CGM and the corresponding algorithm can be accurate it will be amazing! Imagine a life that is much more free from the daily stressors of bg checks, carb counting precisely, site changes… the list goes on. Quality of life could only be improved for our patients. I would welcome the addition of a bionic pancreas to our treatment options!
What treatment methods do you recommend to parents with newly diagnosed kids? Would you recommend carb counting right off the bat or start them off on a sliding scale, and why?
We utilize intensive management therapy with most all of our patients. Intensive management therapy (IMT) is more physiologic then the old sliding scale methods, and is the treatment most likely to help patients achieve A1C targets. IMT utilizes both a basal and bolus insulin. Bolus insulin is given based off carbohydrate counts and also blood glucose.
One parent is concerned about her son playing soccer. What advice would you give to her to set her mind at ease?
Physical activity is a very important part of everyone’s day to day life. It can sometimes be tricky to balance blood sugar during activity. Your diabetes team will work closely with you to help figure out this balance for your son.
A parent of a 2-year-old who was just diagnosed wonders at what age should she teach her child more about their diabetes and to manage it. What tips/ advice do you have to help her move forward with this teaching?
Diabetes education will be a life-long learning process. Always talk with your children about what you are doing to care for them. When your young child has a low blood sugar– she won’t be able to verbalize this to you. Teach her that she is having a low blood sugar- and to tell Mommy or Daddy next time she feels this way. Through each developmental stage consider an appointment with your diabetes educators to learn more about the tasks you are taking on.
Can you explain to concerned parents more about ketones and why the body develops them.
Ketones are bad! They are the direct result of not having enough insulin in your body to use your carbohydrates for energy. (not having enough insulin can be for many reasons: bad insulin, forgetting a dose, sick days). When you have diabetes, and not enough insulin in your body- you will need to burn fat stores for energy. The byproduct of breaking down fat for energy are ketones. Too many ketones in your blood can lead to diabetic ketoacidosis or DKA. DKA can make you very ill and can even cause death if severe. Hospitalization is usually required to treat. Always check for ketones when blood sugar is greater than 250mg/dL two times in a row at scheduled testing times. Check every time you go to the bathroom if you are sick. If you ever vomit or have upset stomach, also check ketones.
What are some ‘sick day’ tips you would like to share with parents with flu season about to come upon us?
Have a sick day tool kit on hand that includes: Ketone testing strips, Glucagon, caffeine free soda, popsicles, Jell-O. Etc. Continue to take basal insulin (call your provider if you need help with dose adjustments based on BG readings. Check for ketones every time your child goes to the bathroom. Monitor blood sugar closely about every 2-3 hours. (Make sure to check our comprehensive diabetes sick day guide.)
School is about to start, what advice would you give to parents who are worried about sending their kids back to school in the care of someone else?
Make sure you have your provider orders signed and ready to go before school starts. Consider working with your school to put a 504 plan in place. The 504 plan outlines the who/what/where/when of the medical care that needs to happen when your child is at school. Work with designated staff to teach them what they need to know. Consider coming in for a day or two to work with the staff during lunch time.
Let’s talk about early detection, how important do you think detecting diabetes early before symptoms appear really is? Would you be for a urine test at a child’s well visit?
I think early detection is very important- it helps to avoid DKA and the effects from it. Clinical symptoms such as increased thirst and urination, weight loss can clue the primary care provider to check the urine for glucose/ketones and/or to request lab studies.
In what ways do you think the treatment of diabetes has changed for children today than it was just 10 years ago?
I think it has changed a lot! IMT has become the mainstay of treatment. Pumps have become more wide-spread in use and the technology is much improved. Options have improved as well. CGMS have improved accuracy.