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The Division of Pediatric Endocrinology at the NewYork-Presbyterian/Phyllis and David Komansky Center for Children's Health has further enhanced its program and services with the addition of two new pediatric endocrinologists: Zoltan Antal, MD, who specializes in the care and treatment of children with diabetes, and Saroj Nimkarn, MD, who brings particular expertise in adrenal disorders.

In this e-newsletter, Dr. Antal will discuss the management of type 1diabetes in children. In the April edition of the e-newsletter, Dr. Nimkarn will address growth disorders in children.

About Dr. Zoltan Antal

Dr. Zoltan Antal earned his medical degree from St. George's University School of Medicine in Grenada, West Indies. He went on to complete his residency in Pediatrics in Brooklyn, New York at SUNY Downstate Medical Center and Kings County Hospital, where he later served as chief resident. After his residency, Dr. Antal remained in New York City and completed a fellowship in Pediatric Endocrinology at the Children's Hospital at Montefiore in the Bronx. During his fellowship, Dr. Antal also conducted research at the Albert Einstein College of Medicine in the immunology of diabetes.

Dr. Antal developed his interest in pediatric endocrinology while still in medical school. "I realized that I like long-term follow-up with a patient," says Dr. Antal. "I also like to focus on a variety of different areas of the body the entire physiology and not limit myself to just one organ. That's what endocrinology offers the study of hormonal effects on the entire body."

Understanding Type 1 Diabetes

Dr. Antal's focus on type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) developed after seeing a large population of children with the disease during his training and from having studied the immunology of diabetes during his residency. Type 1diabetes is an autoimmune disease in which the body destroys insulin-producing cells in the pancreas. The body requires insulin to use glucose, the simple sugar that most foods are broken down into by our digestive system. Without insulin, the body starves to death. People with type 1diabetes must inject insulin by using shots or an insulin pump.

Some 200,000 children throughout the United States have type 1 diabetes, with 15,000 children diagnosed each year. "Typically the disease becomes apparent at the onset of puberty, when hormones are particularly antagonistic to insulin," says Dr. Antal. "Another common age group is toddlers 3, 4, 5 and 6 years of age.

"A diagnosis of type 1 diabetes can be overwhelming at first," continues Dr. Antal. "Suddenly, a parent and his or her child depending on their age must learn how to give injections, count carbohydrates, and monitor blood sugar. These children require so much attention, not only medical, but also social and other kinds of help. I saw that I would be able to get really involved with patients and their families and get to know them well over the long-term. And while there are inherent challenges in dealing with this often lifelong illness, I believe that by emphasizing family involvement, while simultaneously promoting a child's individuality, growth, and independence, often results in excellent outcomes."

Recognizing Type 1 Diabetes

According to Dr. Antal, recognizing the signs and symptoms of type 1 diabetes is sometimes difficult. "This is because the symptoms are not specific," he says, "and very often they are missed by both the most astute clinician and parent. The children are tired, thirsty, and urinating excessively. All kinds of things then come to mind; they're drinking too much so they must have a urinary infection or it is a behavioral issue. The last thing anyone thinks of is diabetes, so the diagnosis is often missed."

Other symptoms include:

• extreme hunger
• weight loss
• irritability or unusual behavior
• blurred vision
• dry, itchy skin

Treatment for Type 1 Diabetes

Children with type 1diabetes need to monitor and carefully control their glucose, checking their blood sugar levels several times a day by testing a small blood sample. They must then give themselves insulin injections, have an adult give the injections, or use an insulin pump a small, computerized device about the size of a small cell phone that releases a steady flow of insulin into the body. "We are fortunate to live in this era of treatment," says Dr. Antal. "Today we have short-acting and long-acting insulins with pumps to deliver them. And if the child uses the injections, they are small, thin and relatively painless needles, prefilled into a pen device. The treatment modalities have come very far."

Comprehensive Approach to Managing Type 1 Diabetes

The Division of Pediatric Endocrinology at the Komansky Center for Children's Health provides state-of-the-art care to children and adolescents with diabetes and pediatric endocrine disorders, incorporating the expertise of pediatric endocrinologists, a diabetes educator/pediatric endocrine nurse, and a pediatric nurse practitioner, who is also a diabetes nurse educator. In addition, the Division has access to nutritionists, social workers, and other specialists in the Department of Pediatrics.

"Right now the latest technologies allow us to download information from an insulin pump to print out, analyze and discuss with the child and their parents," says Dr. Antal. "Patients and their families learn a lot from those print-outs, and it helps us manage their care better.

"Although type 1 diabetes requires consistent care, the advances in blood sugar monitoring and insulin delivery have improved the daily management of type 1 diabetes in children," adds Dr. Antal. "With proper treatment, children with type 1 diabetes can expect to live long, healthy lives."

Faculty Contributing to this Article:
Zoltan Antal, MD, Pediatric Endocrinologist, Division of Pediatric Endocrinology, NewYork-Presbyterian/Phyllis and David Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Assistant Professor of Pediatrics, Weill Cornell Medical College