A child died of diabetes.   (June 18, 2007)

Last month, the Boston Globe ran a front-page story about a pediatrician who had a blog. The story was titled Blogger unmasked, court case upended.

Seems the blogging pediatrician (who used the pseudonym “Flea”) was being sued for malpractice, and had described at his blog in great detail his opinions about the trial. The plaintiff’s attorneys became aware of his blog, quizzed him about his authorship, and he immediately settled the case. The settlement agreement is confidential. The blog disappeared soon after. There’s lots of discussion about the pediatrician and the trial at the New York Personal Injury Law Blog and elsewhere in the blogosphere.

But what’s not discussed in great detail, and the reason for my present story, is the reason for the trial: the pediatrician apparently missed the diagnosis of diabetes in a 12 year old, who subsequently died of ketoacidosis.  As someone commented at the NYPILB website, “We don't know the medical circumstances around the Flea case, but it has been my experience and observation that far too many family doctors and pediatricians do not understand Type 1 diabetes, a common autoimmune condition. In my opinion, too many children end up with diabetic ketoacidosis or dead at diagnosis, due to doctors who don't understand how Type 1 diabetes can develop…”

The Globe states “The wrongful death suit alleged that [physician’s name deleted] … failed to diagnose that [patient’s name deleted] had diabetes on March 11, 2002, Mulvey [Elizabeth Mulvey, the lawyer who represented the parents and unmasked the pediatrician as Flea] said in a court document. Less than six weeks later, the boy died  of diabetic ketoacidosis, said Mulvey, who described the condition as ‘diabetes gone haywire.’” Or, in my words, diabetic ketoacidosis (DKA) is a complication of diabetes that can be either gradual or explosive in onset, is readily treated with insulin, fluids, minerals and supportive measures, but which is uniformly fatal if untreated. If DKA is correctly diagnosed and promptly treated,recovery is usually the norm, although there are occasional fatal complications of DKA such as cerebral edema.

How could a physician have missed the diagnosis of diabetes? Even Board-certified pediatricians (as Flea apparently is), can sometimes miss the diagnosis. If a patient presents with the classic findings such as thirst, excessive urination, hunger, fatigue, weight loss, and blurred vision, sure, it should click in any physician’s mind to get a blood glucose level and make the diagnosis. On the other hand, if the diabetes is new and symptoms not yet severe, or if the child is too young to describe how they feel, or the parents too inattentive, or the pediatrician too rushed to get to the next patient, it could easily be overlooked. And in this case, we simply don’t know what symptoms the child had six weeks before his death: they could have been almost none, or could have been all the classic findings.

It’s all rather frustrating. And sadly, a child has died of diabetes.