My nine-year-old daughter was diagnosed with type 1 diabetes (T1D) five days ago. We are a military family currently stationed in South Korea. We are with very few English resources in the area. It looks like we will get an emergency move to our next duty station in El Paso, TX, in a couple of weeks. How do we find quality care in a foreign country, manage an international move with a child with T1D, and find quality care to deal with a new diagnosis?
First, let me reassure you from my own experience. I was diagnosed with T1D at age 12, and I’m now a healthy 54 years old. I grew up through the “dark ages” of diabetes control and treatment, and I can attest that all of the new technology that is now available for managing T1D can make this new issue in your precious daughter’s life much easier to deal with.
I am also an ex-military wife. My husband put 30 years into the United States Air Force and now does management work at the Air Force Personnel Center, so we both have lots of experience with T1D and military life. Here are some suggestions:
1. This is not the most important detail, but I’ll say it first because I don’t want to forget it. Most military pharmacies carry fairly large-size needle-syringe units. I am a tiny woman, and the large needles used for other people with diabetes are too large for me. They bruise and go too deep, penetrating muscle because I don’t have much body fat. You can request small-size needle syringes—the size that I use and that most small children use is 31-gauge, 5/16-inch long. At some military bases, these needles would be special-ordered for me, but some pharmacies carry them as well. Military health insurance usually covers the cost with a small copay.
2. All U.S. military bases have medical clinics. However, military spending cuts have been happening for many years now, and smaller clinics may not have pediatric endocrinologists on staff. All branches of the military have the Exceptional Family Member Program (EFMP), established specifically to help military families with special medical needs get the care they need. If there is no endocrinologist at your base, your family will probably be assigned to a primary care physician. Make an appointment to see this doctor and request a referral for your daughter to see a pediatric endocrinologist. If you run into any difficulties, go directly to the EFMP or the health insurance office and insist that your daughter be assigned to an endocrinologist. The staff there can then help you find an endocrinologist and get the necessary referral moving forward.
3. I would strongly suggest that you reach out to other moms like you—both military moms and moms of children with T1D. Most bases have spousal support groups or other, similar services available for you to make connections with others who understand what it’s like to be married to the military. And JDRF offers Juvenation, a website where people whose lives are touched by T1D can communicate with one another, tell their stories, ask important questions, and find support. Also, I would be happy to put you in touch with your local JDRF chapter (there is an El Paso Council), which can send you the JDRF Bag of Hope, a “starter kit” for newly diagnosed kids that includes educational information about T1D; Rufus, the teddy bear with T1D; a blood glucose monitor; and more.
4. In addition to the right to health care that all military families have, you also have rights regarding your child’s T1D management at school. It is particularly important to know these rights if and when your family is restationed and your daughter is faced with entering a new school. Under Section 504 of the Rehabilitation Act of 1973, you have the right to develop what is called a Section 504 Plan with your child’s school, spelling out the accommodations the school and its staff will make to ensure that your daughter’s T1D management continues uninterrupted during school hours. Any school that receives federal funding must comply with Section 504 laws. For more information on creating a 504 Plan, and dealing with other issues you may face at school, JDRF has a School Advisory Toolkit, a comprehensive resource that you can download free by clicking here.
5. Some military families move frequently, and you have a move coming up imminently, so let me offer some advice on how to handle the move. Primarily, keep some small snacks or juice boxes handy while movers are packing your goods. Keep them in a designated place that your daughter can get to easily, and make sure the movers know not to pack them. Moves can be stressful, even on little ones who aren’t doing the heavy lifting, so keep an eye on your daughter’s stress levels. Many people with T1D find that their blood glucose level goes up during stressful situations, while others experience hypoglycemia because of the increased activity involved in an event such as moving. Speak to your doctor about the best way to handle your daughter’s blood sugar highs and lows during the moving process, but first and foremost, make sure to test her blood sugar level frequently. Lastly, because of Transportation Security Administration (TSA) rules about liquids, you cannot carry juice or other beverages through airport security. Make sure to have snacks on hand for any long waits you may experience while checking luggage or waiting on the security line. Once you’re through security, you can purchase beverages at airport concessions. Liquid medications—like insulin—are the exception to this rule. You may carry whatever medical supplies you need through airport security; just show them to the TSA officials and you’ll be fine.