In most cases, a child's diagnosis day leads you to an inpatient experience at a city hospital with a pediatric endocrinology department. In some cases, families are actually sent home with insulin and directed to an outpatient training program that begins the next day. In some very rare cases, families are given a few hours of training and then sent home with the telephone number of a doctor to call for help. Which will you be? Some of it is actually in your control. If you did not have the type of diagnosis experience that sent you home ready to deal with this, it's never too late to consider starting again.

The Pediatrician

The first place most parents turn (and rightfully so) is their primary care pediatrician. This is the person you have the most comfortable relationship with; and in many cases, this is the person who must refer you to a specialist for insurance reasons. Your pediatrician has the tools to diagnose your child. He or she can do a blood sugar check and ketone urine dip right in the office and let you know if your suspicions are correct.

But can she treat your child? In most cases, the answer is yes, but that's not always your best option. Pediatricians are excellent general internists, but in most cases, they do not have the intimate knowledge of diabetes and children that an endocrinologist has. Nor does a pediatrician have a team of diabetes experts to help you with each aspect of the disease. In addition, a pediatrician usually does not have the time you'll need to speak regularly with her for at least the first few weeks (and even months) of your child's diagnosis.

Insurance may restrict where your pediatrician sends you. But if there is a hospital with a pediatric endocrinology center in your general area, expect your pediatrician to help you get referred there.

The Hospital

You'll most likely drive your child to the hospital. If you are too frightened or upset, try to arrange for a family member or good friend to meet you along the way and hop in and drive for you. If your spouse is not nearby, he or she should meet you at the hospital.

Once there, you'll go to the emergency room. In just about every newly diagnosed diabetes case, instead of sitting in the waiting room, you will be jettisoned to a treatment room where your child's health will be assessed. The hospital will be able to get real-time numbers. Most pediatricians' offices have basic meters such as the one you'll use at home that only measure blood sugars up to 500 or so, but hospital labs can get a real number. They'll check ketones right away and also perform tests on other indicators, such as potassium, to determine if your child is in diabetic ketoacidosis (DKA).

Your child will be seen by the attending physician in the emergency room first and will be given an intravenous line right away. The attending physician will then call in the pediatric endocrinology team. They will assess your child, begin the administration of insulin, and take the first steps to help you and your child begin the process of accepting the diagnosis and learning how to live with it. The attending physician and the first endocrinologist will most likely try to soothe you and your child. Many children, particularly those of school age, need to be told that their recent bedwetting and behavior issues were not their fault, and that they are going to be feeling better soon. Parents and caregivers need to be told that insulin works well and that within hours their child will begin feeling better. At that point, parents will start to learn what diabetes means. Some extremely ill children (who are in DKA) may go to intensive care for a day or so, in which case their parents can remain confused and frightened for days.

Outpatient Care

If your child's diagnosis came with a relatively low number and no ketones, you may be sent home and referred to an outpatient learning program the next day. Some parents are frightened by this; the thought of spending a night at home with a child on insulin for the first time is almost too much to bear. Others feel that even after a short outpatient training, they still are not comfortable caring for their child. If this is the case with you, call your pediatrician immediately and tell her how you feel. Ask her to work with you to find an inpatient program, or a better outpatient program, to help you build confidence in your ability to care for your child.