Winter 2012 newsletter.pub - Joslin Diabetes Center

Newsletter of the
Pediatric, Adolescent
and Young Adult Section
A Day in the (Child) Life
Volume 8, Issue 1
Winter 2012
The Pediatric Newsletter, along with news of pediatric events, is distributed by e-mail.
To sign up for e-mails, go to: http://www.joslin.org/phs/pediatric_e-mail_signup.html
It’s 2pm on a Monday and the playroom is busy. Two kids
are at a table drawing pictures, a few are at the play cash
register, another is sprawled on the floor building a train
track. Micaela Francis, CCLS, one of Joslin’s two Child
Life Specialists, holds out green “dollar bills” and some old
credit cards. “I’m going shopping,” she says. “Who wants
some money so they can come shopping with me?” Several
kids run up and take the dollar bills out of her hand. A
girl looks shocked: “But they took all your money!” “That’s
okay,” responds Micaela, “I have these credit cards, and
each one has a million dollars on it.” That gets the attention
of the whole room. She picks up a doll baby and a box
of diabetes supplies. “I have to buy some things for my
baby. What diabetes supplies should I buy to take care of
her? “A finger pricker!” one child shouts to Jen Griffin, MS,
CCLS, the other Child Life Specialist.
Describe a typical session with a patient.
Micaela Francis: We try to engage patients and siblings in
activities that incorporate diabetes education first so we
can gain a sense of how they are coping with this complicated
illness. We can use the precious time while they are
in the playroom to correct any misconceptions, fears, or
worries they may have about diabetes through medical,
therapeutic, and expressive play.
Jen Griffin: Play allows children to take control over a
situation where they don’t have a lot of control.
March is National
Child Life Month
This year’s Teddy Bear Clinic
will take place on Saturday
March 17, 2012, from 10AM-
12PM at Joslin. Children can bring
a favorite stuffed animal or get a new
bear to care for as they visit various
medical stations related to diabetes
and general good health. RSVP to
Jen Griffin at
jennifer.griffin@joslin.harvard.edu
or call 617-309-4529.
Can you give
an example of
how you correctmisconceptions?
MF: Sometimes
a child
will try to put a
syringe in a
doll’s head.
We’ll ask
things like, “Do you get your medicine in your head like
that or does mom and dad put your medicine in your
belly or bum?” What does it feel like?”
JG: We let the kids take the lead, allowing them to play
through their understanding.
How do you use conversation to educate?
MF: We try to keep it casual. We’ll ask “How’s school?
What sports do you play?”
JG: Then we may direct the child to talk about their
peers. “What do your friends ask about your diabetes?
Do you bring a friend with you to the nurse’s office?”
MF: We want the children to see the playroom as a
safe and nonthreatening environment so we do not
pressure them- that opens the door for the kids to tell
us about their thoughts and feelings.
What made you decide to become a Child Life
Specialist?
JG: When I was in high school, a friend of mine was
diagnosed with leukemia. I had a hard time figuring out
how to interact with him when he was in the hospital. I
started bringing games with me to visit him. I studied
Psychology in college, and when I went to an info session
on what to do with a Psychology major, I learned
about child life.
MF: In high school, I volunteered at a summer camp
for children with life threatening illnesses and their
families. It was there that I learned about the child life
profession. I always knew I wanted to work with children,
and I loved the medical field. When I found that I
could combine my two passions, I knew Child Life...
Continued on p.3….

PAGE 2
Pediatric, Adolescent and
Young Adult Section Team
Endocrinologists
Lori Laffel, MD, MPH
Section Chief
Joan Mansfield, MD
Assoc. Clinical Director of Pediatrics
Cielo Alleyn, MD
Angelina Bernier, MD
Allison Cohen, MD
Michelle Katz, MD, MPH
Sanjeev Mehta, MD, MPH
Alyne Ricker, MD
Clinical and Research Fellows
Josh Borus, MD
Elvira Isganaitis, MD, MPH
Nurse Educators
Cindy Pasquarello, BSN, RN, CDE
Nurse Manager
Deb Holtorf, MSN, MPH, PNP, BC-ADM
NP Manager
Ashley Atkins, RN, MSN, CPNP
Joyce Keady, MSN, RN, CPNP
Kerry Milaszewski, BSN, RN, CDE
Lisa Rasbach, MSN, RN, CPNP
Melissa Williams, RN, MSN, PNP
Administrative Staff
Louise Crescenzi
Manager of Pediatric Operations
Georgia Feuer, BA
Stephanie Holloway
Medical Assistants/Phlebotomist
Stephanie Ellis
Yosaris Rodriquez, CMA
Christopher Wilkins
Child Life Specialists
Micaela Francis, CCLS
Jennifer Griffin, MS, CCLS
Dietitians
Laurie Higgins, MS, RD, LDN, CDE
Heidi Quinn, MS, RD, LDN
Behavioral and Mental Health
Debbie Butler, MSW, LICSW, CDE
Jessica Markowitz, PhD
Research Staff
Lisa Volkening, MA, CCRP
Assoc. Director, Pediatric Research
Margie Lawlor, MS, CDE
Leah Bellman, BA
Kaitlin Gaffney, BS
Emily Fisher, MA
Marcy Hudson, MA
Christina Kelley, BA
Maureen Malloy, BS
Suzanne Mickey, BA
Roxanne Phillips, BS
Camille Ratliff, BA
Tina Roth, BA
Brittany Ryan, BA
Alan Schultz, BS
Insulin Pump… Is it for you?
Classes held from 3:30pm-5:00pm
on the third Wednesday of every
month
For more info, call 617-732-2603
NEWSLETTER OF THE PEDIATRIC, ADOLESCENT AND YOUNG ADULT SECTION
Meet the Newest Members
of the Joslin Pediatrics Team
Alan Schultz, BS – Research Assistant
Alan graduated from Boston University in
May 2011 with a degree in Human
Physiology. He spent the summer after
graduation working at Camp Joslin. He
enjoyed his experience at Camp Joslin so
much that he applied to Joslin Diabetes
Center for a job after the season ended.
Alan is an Eagle Scout, and he once
organized a drive to collect tools from his
community to give to farmers in Nicaragua.
He loves working with kids and being
around their positive energy.
Q&A
Yosaris (Yosi) Rodriguez, CMA - Medical Assistant
Before she knew she wanted to do nursing, Yosaris
studied Criminal Justice at Massbay Community
College. She took a 9 month Medical Assistant/
Phlebotomist course and decided to pursue the
medical field further. She is currently studying for her
RN degree from Laboure College for Nursing and
gaining experience working at Faulkner Hospital ER
and Harvard Vanguard in Braintree in addition to
Joslin. She moved to Boston from New York about 6
years ago to find better health care for her sister, who
suffers from seizures and developmental disabilities.
In her free time, she loves to play sports, volunteer,
and spend time with her 4 year old daughter.
Chris Wilkins - Pediatric Phlebotomist
Chris moved to Cambridge this September after
working as a lab assistant for Mid Coast Hospital
in Brunswick Maine, where he grew up. He is an
Eagle Scout, and in his free time he enjoys video
games and life action role-playing games
(LARPS) that involve reenacting Medieval
scenes. He is continually impressed by the
maturity of the patients he sees here at Joslin.
When should my child start doing his/her own diabetes tasks?
That is a great question to ask your child’s healthcare team, because the
answer is different for each child. While some children may be physically able
to handle some diabetes tasks at a very young age, we still prefer that the parents
help with these tasks. We encourage family involvement for diabetes tasks during
childhood and even during adolescence. We recommend parents check in with their
child and ask how they can help. By sharing the responsibilities, you ease the burden
of diabetes on the child and hopefully help reach glycemic control targets. Diabetes
is hard work, and no one should be expected to do it all alone. When you go to your
clinic visits, talk with your health care team about what are realistic expectations for
your child. You can also consider meeting with one of our family support specialists,
Debbie Butler, LICSW or Dr. Jessica Markowitz, PhD.
-Debbie Butler, MSW, LICSW, CDE

VOLUME 8, ISSUE 1
Teddy Bear Clinic at ADA Diabetes Walk
On October 22, 2011, the ADA held their annual Step
Out: Walk to Stop Diabetes on the Boston Commons.
Following the walk, children and their families had the
opportunity to visit the Joslin Teddy Bear Clinic. Each
child who visited the clinic got a new bear to care for
at each medical station while the child learned about
diabetes and overall health. The children checked
their bear’s blood glucose, gave them pretend insulin
injections, and learned about eating healthy meals.
PAGE 3
Events
Diabetes Education Program for School Nurses:
Saturday, March 31, 2012 at Joslin
��One-day program to provide school
nurses with up-to-date diabetes information
��Contact: Georgia Feuer,
georgia.feuer@joslin.harvard.edu;
617-309-4530
Halloween Party
On October 29, 2011, patients and families gathered at
Joslin for our Annual Halloween Party. Everyone came
dressed in costume, including staff. Patients and their
families enjoyed painting pumpkins, visiting the Haunted
House, and watching the magician perform magic tricks.
Other games and activities included pin-the-hat-on-thewitch,
pumpkin bowling, and ghostly darts. Everyone had
a great time! -Jen Griffin, MS, CCLS
��6.25 Contact Hours. Individual price:
$125. Groups of 3+: $95/person.
Includes breakfast and lunch. Registration
form available at
www.joslin.org/education_program_
for_school_nurses.html
A Day in the (Child) Life, continued from p.1
was my calling. Everyday I continue to love what I do.
Are there any techniques you’d like to share with families to try at home?
MF: If the child is nervous about pump site changes, have everything ready beforehand and provide the child with
some distraction while changing the site– like a stuffed animal, sing a song, or practice saying the ABC’s. Offer the
child options and provide the child with some control.
JG: For example, let the child count to five before the insertion, or let the child clean the site area.
MF: Don’t misrepresent diabetes visits or treatment tasks to the child. If he/she asks if he/she’s going to get a blood
draw at the appointment, rather than say “no,” mention the doctor or nurse will decide what is needed. And remind the
child there are many ways to get help and support at the visit.
JG: Also, we’re always happy to talk to older kids and teens about their worries or
concerns.
Is there anything in particular that the Joslin playroom needs?
MF & JG: Markers, coffee filters, construction paper, glitter, colored pencils, fun
Band-Aids, foam projects/shapes, games (Sorry, Candyland, etc.), decks of
cards, yarn/ribbon, Amazon gift carts, and of course donations of money to the playroom
are always appreciated!
One by one, kids enter the playroom and immediately choose an activity,
helping themselves to markers, toy cars, or the play doctor equipment. One little boy
plays by himself for awhile, but as soon as the cash register is free, he runs over and
sits in front of it, next to Micaela. “What do you want to buy?” he asks. When his parents
come to take him home, he gives Micaela a big hug and blows her kisses as he
and his family walk away. “He used to never want to come here,” Micaela says. “Now
he runs straight to the playroom every time.” For more information on the services
that Joslin’s Child Life Specialists can provide, feel free to call the clinic and ask for
Jen or Micaela, or visit them in the playroom.
-Georgia Feuer, BA

PAGE 4 NEWSLETTER OF THE PEDIATRIC, ADOLESCENT AND YOUNG ADULT SECTION
Research Opportunities at Joslin
The BodiMojo Study
Description: The BodiMojo study will explore how to help
adolescents and young adults set lifestyle goals and follow
through with them. The study requires one visit that can be
on the same day as an already scheduled clinic appointment.
During this visit, youth and parents will be asked to
fill out questionnaires, and youth will set exercise and nutrition
goals. The intervention group will also receive daily text
messages for the span of one month. These messages will
encourage healthy living and ask if the participant is meeting
their goals. The usual care group will receive an informational
packet with tips to improve health through nutrition
and exercise. After one month, both groups will receive
questionnaires via email that can be completed online.
Recruiting: Individuals 16-21, who have either type 1 or
type 2 diabetes, have a cell phone, and receive care at
Joslin.
Contact: Alan Schultz at 617-309-4510 or
alan.schultz@joslin.harvard.edu
Type 1 Diabetes Risk Assessment
The Natural History Study — TrialNet
Description: This study aims to identify youth and adults
at risk for type 1 diabetes by testing for diabetes-related
antibodies in relatives of people with type 1 diabetes. It
involves a single blood test. People who test positive will
be eligible for further testing and may be eligible to participate
in prevention trials.
Recruiting: Parents, children, & siblings, ages 1-45, and
cousins, grandchildren, nieces, & nephews, ages 1-20, of
people with type 1 diabetes
Contact: Hui Zhang at 617-309-4739 or
hui.zhang@joslin.harvard.edu
Research on DNA and Type 2 Diabetes in Youth
We are looking for people who were diagnosed with Type 2
Diabetes when they were less than 18 years of age to participate
in a National Institutes of Health Study, entitled “TODAY
Genetics Study”, to help scientists better under type 2 diabetes
in youth.
This study requires one visit to the Joslin Diabetes Center
that will last about 1 hour and includes a blood draw and an
interview about your family and medical story.
Eligible participants must have been diagnosed with type 2
diabetes when they were less than 18 years old and meet the
following criteria:
�� Diagnosis of Type 2 Diabetes by American Diabetes Association
(ADA) criteria
�� Patients under 18 must have a family member or guardian
willing to be involved in the consent process
If you have any questions about this study or are interested in
taking part in the study please contact Maureen at: 1-800-
322-6323 or Today@joslin.harvard.edu
CGM Improve Diabetes Study
Description: The purpose of this
study is to find out how to make it
easier for children and teens with
type 1 diabetes to use continuous
glucose monitors (CGM) over a long
period of time. The study involves 12
visits over a 24-month period with
additional phone contacts between visits. The extra three
visits occur during the first six months of the study: the rest of
the visits will occur at routine clinic visits. Families randomized
to the intervention group will receive a family based behavioral
intervention providing support and education regarding
use of the CGM. Families in the usual care group will receive
this information at the end of the study. Youth in both
groups will wear a CGM device throughout the study. Families
will be asked to complete surveys at various intervals
over the course of the study and labwork will be collected for
the youth in the study.
Recruiting: Children and teens, ages 8-17 years, who have
had type 1 diabetes for at least 1 year and who are receiving
care at Joslin and their parents or legal guardians
Contact: Emily Fisher at 617-309-4644 or
emily.fisher@joslin.harvard.edu
The Tolerance Study
Can Glucose Monitoring
Improve
CGMi Study
Description: This study is trying to help us better understand
what causes type 1 diabetes to help find new ways to
prevent or reverse the disease. The study is being done
with researchers at Harvard Medical School and is funded
by the Juvenile Diabetes Research Foundation. The study
visit includes the completion of questionnaires and a blood
draw.
Recruiting: Individuals, ages 18 years and older, both with
and without type 1 diabetes
Contact: Roxanne Phillips at 617-309-2481 or
roxanne.phillips@joslin.harvard.edu
T1D Exchange
Description: The Type 1 Diabetes (T1D) Exchange is a nationwide
registry collecting information about children and
adults with type 1 diabetes. The purpose of the registry is
to gather information about people with type 1 diabetes to
help better understand the natural course of type 1 diabetes
and the effectiveness of current treatments. Participation in
the registry involves completion of a questionnaire about
medical and family history including diabetes diagnosis and
treatment and laboratory test results. Annual updates of
information are also part of the registry.
Recruiting: At the Joslin, individuals being followed in the
Pediatric, Adolescent and Young Adult Section may be eligible
to participate in this registry.
Contact: Camille Ratliff at (617) 309-4477 or
camille.ratliff@joslin.harvard.edu

VOLUME 8, ISSUE 1 PAGE 5
Snowman on a stick
(Adapted from familyfun.com)
Yields 12 servings; 17 g carb per serving
�� 3 medium bananas
�� 12 red grapes
�� 1 small carrot cut into
thin slivers
�� 2 apples
�� approx. ½ cup mini
chocolate chips
�� 24 pretzel sticks
�� 12 bamboo skewers
For each snowman, you will need three thick slices of banana (about 1/3 of 1
banana), a grape, and a triangular piece of apple (tip: poke a hole in the
apple piece with a bamboo skewer first to make it easier to assemble).
Slide the fruit onto the skewer, beginning with the 3 banana slices, then the
apple and then the grape; garnish with a sliver of carrot for the nose,
chocolate chips for the buttons and eyes, and pretzel sticks for the arms.
RESEARCH UPDATE
Olivia Proffitt was diagnosed with
Type 1 Diabetes in July 2011. Following
her diagnosis, Olivia, her siblings,
and friends held a neighborhood lemonade
stand and raised $34.25 to
support diabetes research at Joslin.
From left to right: Emma Proffitt, Max
Verheijen, Liesbeth Verheijen, Olivia
Proffitt, Olivia Corina Gencarelli,
Carolyn Gencarelli.
Mark & Meghan Foisy were ambassadors
at the ADA annual Step Out Walk.
They have been active advocates for the
ADA since 2006 and they will continue
to advocate, raise funds and educate
through the ADA. Shown here with
Vince Wilfork of the New England
Patriots. Donation Spotlight and Other
Kudos continues on p.6...
A number of
providers from the
Pediatric, Adolescent and Young Adult Section attended the annual
conference of the International Society for Pediatric and Adolescent
Diabetes in Miami, FL in October, 2011. Dr. Lori Laffel was one of
the organizers of the meeting and chaired multiple sessions. Dr.
Sanjeev Mehta presented a talk entitled, "Update on Nutritional
Management: To Carb Count or Not to Count, That is the
Question". Laurie Higgins, RD, presented a workshop
called "Continuous Glucose Monitoring: Utility of CGM for Improving
Diet, Insulin Adjustment, and Glycemic Control." Dr. Jessica
Markowitz presented a poster entitled, "Disordered Eating
Behaviors Endorsed by >40% of Youth with Type 1 Diabetes
Transitioning to CSII at Baseline and After 6 Weeks; Diminished
endorsement of disordered eating behaviors 6 weeks after starting
insulin pump therapy.” Dr. Josh Borus presented a poster entitled,
"Momentary Sampling Using Personal Digital Assistants (PDAs) to
Assess Adherence in Teens with Type 1 Diabetes (T1D):
Feasibility, Burden and Acceptability.
The conference included participants from all over the world. The
conference will be held in Istanbul, Turkey next year.
-Jessica Markowitz, PhD and Laurie Higgins, MS, RD, LDN, CDE
What do I need to
remember to do if my
child is sick?
�ALWAYS give insulin – the
dose may need to be changed with the
help of your diabetes healthcare team
�Vomiting: always check blood glucose
AND ketones (regardless of the blood
glucose level)
�Have your child drink fluids to prevent
dehydration
�Check blood glucose every 2- 3 hours
�Check blood or urine ketones every 2-
3 hours
�Give additional fast-acting or rapidacting
insulin based on your diabetes
healthcare team guidelines
�Call your diabetes healthcare team for
support and guidance
When should I contact my diabetes
healthcare team?
�Your child is ill and you need to review
Sick-Day Rules
�Blood glucose remains elevated and/
or ketones are present
�There is persistent illness for over 4-6
hours: frequent diarrhea, vomiting more
than once, refusing fluids
�Your child has signs of dehydration –
dry lips and mouth, sunken eyes, dry
skin, and weight loss
�You need advice on how much insulin
to give
�Hypoglycemia resulting from illness or
treatment
-Ashley Atkins, RN, MSN, CPNP
Get Connected
The Joslin discussion boards are moderated by
Joslin staff and offer a safe place to ask
questions about diabetes and to interact with
other parents or teens living with diabetes.
�� Teens boards: http://forums.joslin.org/
JoslinDiscussionBoards/41.aspx
�� Parent boards: http://forums.joslin.org/
JoslinDiscussionBoards/42.aspx
�� Joslin Blog: http://blog.joslin.org/
If you would like to find a support group in your
area, you can check with your local American
Diabetes Association chapter (contact: Anna
Floreen, afloreen@diabetes.org) or your local
Juvenile Diabetes Research Foundation chapter
(contact: Lauren Shields, lshields@jdrf.org).
If you are a college student living with diabetes,
you may want to join the College Diabetes
Network at www.collegediabetesnetwork.org/ to
connect with other students living with diabetes.

PAGE 6 NEWSLETTER OF THE PEDIATRIC, ADOLESCENT AND YOUNG ADULT SECTION
Donation Spotlight Madison Melendez and her family have hosted a Halloween Party for their friends and
and Other Kudos family for the past five years. Each year the Melendez family generously donates the
money they raise from this event to support and improve the Joslin playroom. This
year Madison and her family donated over $1,100 for activities and supplies for the playroom.
�Vivian Hope Hanson, the granddaughter of Louise Crescenzi, Manager of Pediatric Operations, helped raise
awareness of what it is like to live with diabetes. She collected $131 for pediatric research at Joslin by running a
crazy sock day at her school, where students paid 50 cents to wear crazy socks for the day.
�Daniel Bender Stern was the Fund a Cure
speaker at the JDRF 29th annual Hearts &
Heroes Gala. At the Gala, Daniel delivered a
speech about his personal experience living
with diabetes.
�Lily Jeswald, Miss Preteen Massachusetts,
collected 1,000 pounds of clothes and sold
them at local consignment stores. A portion of
the proceeds were donated to the Joslin Clinic.
The remainder of the money helped send Lily
to two national pageants this past August.
�Benedict Hensley was a presenter at an educational Lily Jeswald
panel about diabetes that was sponsored by the Westborough
Rotary Club. Benedict spoke about diabetes from a young
person’s perspective. “As long as I do what I need to do, diabetes will
never hold me back.”
�Meghan Gabel held a Diabetes Awareness week and fundraiser at
her High School. Meghan & her team have been participating in the
JDRF Walk to Cure Diabetes for the past five years. This year
Meghan’s team raised $150,000 for diabetes research.
�Joslin’s Pediatric, Adolescent and Young Adult Section organized a
Toys for Tots drive for Joslin Clinic and collected 11 boxes of toys to
donate this holiday season for kids in need.
If we missed your accomplishments, call the Pediatric, Adolescent and
Young Adult Section at 617-732-2603 and ask for Child Life.
Summer Camp Sign-up: Registration information for summer
sessions at Clara Barton Camp and Camp Joslin is available at
www.bartoncenter.org or call 508-987-2056. Sessions fill up quickly, so
register soon!
Valentine’s “Sudoku”
Each column, letter, and row must contain
the letters “L” “O” “V” and “E”
(from www.activityvillage.co.uk)
See the Child Life Specialists for solutions
Each column, letter, and row must contain the
letters “H” “E” “A” “R” “T” and “S”
Questions, comments, or suggestions?
E-mail Georgia at georgia.feuer@joslin.harvard.edu
Ashley Atkins, RN, MSN, CPNP Jen Griffin, MS, CCLS
Debbie Butler, MSW, LICSW, CDE Laurie Higgins, MS, RD, LDN, CDE
Georgia Feuer, BA
Heidi Quinn, MS, RD, LDN
One Joslin Place, Boston, MA 02215
Alyne Ricker, MD — Medical Advisor
Pediatric, Adolescent and Young Adult Section: (617) 732-2603
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