The hardest part about leaving the hospital and heading home is cutting the direct cord with that medical team you met and worked with in the hospital. It can be frightening for parents to head out on their own. It's important to remember that the team might not live in your house, but they are (or should be) available to help you at any hour, not just through these crucial first weeks, but for all the time they treat your child. A good pediatric endocrinology team has someone on call 24/7 to help you, and they never question your need for help.

When to Call

Your team will most likely send you home from the hospital visit with specific orders, target range glucose levels, and guidelines on when and why to call them. Target ranges vary with the child and with age. In the beginning, medical teams aim a little higher than average for blood glucose levels to keep your child safe as you learn to give insulin and monitor blood sugar.

The insulin doses you are sent home with could change within days. In the past, children were always sent home on a mix of long-acting insulin called NPH and short-acting insulin called regular. When fast-acting insulin, such as Humalog and Novolog, was approved for children in 1998, and when the nonpeaking Lantus was introduced circa 2001, doctors had more options for newly diagnosed kids. (Insulin choices and their uses are discussed in Chapter 6.) Whatever combination your child's doctor sends him home on, expect to make changes in dose amounts as the days go on.

Your team will ask you to keep a detailed logbook of your child's blood sugars, what she eats, and what activities she takes part in. These notes will be crucial in the first weeks and in the long run as well.

You can expect to talk to your child's endocrinologist or Certified Diabetes Educator at least once in the first week, but don't be afraid to call more often. Most parents panic the first time their child is high or low, and doctors expect that call. The call will be worthwhile for you, even if it's just for reassurance.

Have Your Information at Hand

Once the first times pass, it's a good idea to look for patterns before calling your team for advice. See a relatively high number after lunch one day? Feed your child about the same meal the next day and see if it happens again. If it does, a change in insulin dose may be needed, and you'll need advice to make that decision. Seeing a lot of lows? Then it's time to call again. Your child may be getting more active or going into a honeymoon period and you'll need to cut back on an insulin dose.

Any time your child has an unexplained low or high in the middle of the night, it's a good idea to call. Any time your child tests positive for ketones, you should call your medical team right away.

Planning a first family trip? That's another good time to call your team, although nonemergency calls should be limited to regular hours, and not go to on-call doctors during off hours. The same goes for prescription refill requests. Unless you drop all your insulin on the floor and need it immediately, plan to make those benign calls during working hours. Your team will thank you for it.

What if you're just feeling overwhelmed or worried? Call them. Learning to care for a child with diabetes can be stressful, and you'll need all the professional help you can get. One day, as time ticks by, you'll find you don't need to call all the time anymore. Until then, use your resources as you see fit.