It is interesting and rewarding to be a pediatrician & endocrinologist,easy, but to be a diabetologist it is like a war you wish to win.
I will tell you about tens of stories with my dear diabetic children & their families every now and then.
Denial:
The four y old Abdulla was diagnosed with diabetes 7 y ago.
The father came rushing one morning to my office,Abdulla was given his insulin by his mother,and sent with his uncle to the farm without eating his brekfast,The mother gathered all Abdulla"s clothes in the hall,and sat in a horibble state,a nervous breakdown.
Hypoglycemia during math class:
Safia,a 14 y old diabetic complained of loss of cosciousness around 9 am at school,she has to go home more frequently lately.
Investigating all causes of hypoglycemia ( miss breakfast…to addison ) It tuned that Safia hated her math teacher,she went injecting her insulin in calf muscle the days she had math classes
Recurrent admissions in DKA:
1-12 y old girl with multiple admissions in DKA.She went stopping insulin injections for 2 days,admitted just to see her divorced Mum.
2-15 y old girl with recrrent admissions in DKA: just a way to get her boyfriend sympathy whenever things got bad between them
3-15 y old girl with recurrent admissions in DKA ,missing insulin doses just not to gain weight
Psychatrist& team was involved and problems were solved through counselling and family support
Desparely seeking help!:
The 14 y old girl missed 2 appoitments,lately herA1c was getting higher.The mother started saying the family went through bad time,3 fires to their house,and by chance my quiet patient by accident were off school,she would evacuate her little siblings and then ring 999.
I looked at my patient,she looked down,I asked her why my dear you set the house on fire?
She was depressed,her father was seriously sick and she was frightened to death of whatever fate planned for her family.
The bedouine who lived in a tent:
The 10 y old boy who was diagnosed with diabetes had to buy a fridge to keep insulin.In the desert there are no sweet shops and he has plenty of sun& Vit D. His AIc was normal and still normal!!! My best patient lives in a tent in a desert.
My best patient lives in a tent in a desert.
That really made me smile for some reason. Thanks for sharing
Councelling our diabetic patients& their families:
Here on this site I am learning a lot from you,but when culture is different there are different ways of communications.
For the very upset parents after diagnosing their child with diabetes,I have to screen the personality and background to offer my words of support.Usually as a moslem we have to thank God and to try to accept our fate,then I reassure them that our team will be supportive all the way to give the best care.
The patients themselves with time will have their worries: why me,what will happen to me,will I ever get married……………
I am learning from you…
Today I sat with my pateints &their Mums in the ward for the exam!!!
3 newly diagnosed diabetics in one room,a sort of camp,no tears no this lost look that kills me.They were together,big table they sat around it,educator.dietician.social worker,and me to know what they learnt.I talked about you my friends and I set your standard as their standard.Today I felt happy,mothers& children were happy…
Diabetes & nephrosis:
Admitted last week,4 y old boy:
potprandial hyperglycemia after high CHO meals for 18 months,BG more than 200-300mg/dl for a week,with polyuria & polydepsia
Family History:
His Mum& his sister are diabetics.Mum’s side many are diabetics ( 3 generations)
Serum albumin 7 gm/dl, cholesterol : 12 mmol/L urine positive for protein.
Gad 65 antibodiea,insulin antibodies: positive
Type1 diabetes & nephrotic syndrome for renal biopsy tomorrow.
Which type of diabetes?
For years it is type1 for 99% of children I treat,few with MODY,neonatal diabetes,thiamine dependant diabetes. But not anymore.Type2 in children is emeging with the epidemic of obesity,and ADA recommended screening of obese children 10 y or above who came from susceptible community or show signs of insulin resistance.
We have children who presented in DKA,obese,with strong family hx of type2,negative for antibodies.Treatment: insulin & metformin ( which has to be discontinued if sick or vomiting as it can precipitate lactic acidosis& DKA.
There are children who present in DKA with negative antibodies,not obese and no family history of diabetes type1 or 2??? Type1b??
Autoimmune diabetes & others,we just have to control it.but United Nations is addressing diabetes as a disease of modern civilization, a terror we have to unite to tackle it in every way.The Gulf countries are leading( UAE) other countries just because life style has changed there.Governments have to pour money to screen,diagnose & treat diabetes. All nations were alerted to start tackling the problem.
I constantly think about this, while I struggle everyday to provide my own child with the best food I can. I mean, I know the theory… I even love to cook, and we enjoy eating healthy.
However it is hard, with little time to do all the cooking, cleaning and planning for every single day, I find myself packing a ham and cheese sandwich for lunch more that I wish I did… I try to balance, and in comparison we probably are not as bad. At school the lunches are just packed with carbs… even the healthy choices are yogurt with fruit, and juice… it is that or peperoni pizza. The protein is almost nowhere. And considering the prices of groceries it is just overwhelming.
I think a good place to start is the lunches at school… not an easy task nevertheless. I hope we can get there, that will benefit many, many…
Yes Andreina,let us start awairness campaign LOOK AFTER YOUR CHILDREN.
In Saudi Arabia school health department banned soft drinks from schools years back,fighting now to improve sort of snacks sold at schools.Lots of surveys are going on to assess the prevelance of metabolic syndrome in our school children.At the same time our time pass in a hot country is moles with thousand of fast food stores,Some open for 24hrs ( reminded me when Toni Blair opened pups for 24 hours for teenagers to hang on there all night!!)
It is going to be a war for the sake of our kids& grandchildren,the enemy is our new bad habits!!!
It is not easy but many battles are won in USA,banning new fast food shops in Los Angles,the legal battle with some known fast food chains,the transfat % and more…
look at this article Judith:
EPA seen as unlikely to regulate chemical in tap water that may lead to thyroid problems.
The Washington Post (9/22, A9, Eilperin) reported, “The Environmental Protection Agency (EPA), under pressure from the White House and the Pentagon, is poised to rule as early as today that it will not set a drinking-water safety standard for perchlorate, a component of rocket fuel that has been linked to thyroid problems in pregnant women, newborns and young children across the nation.” In “a near-final document,” the EPA “estimates that up to 16.6 million Americans are exposed to perchlorate at a level many scientists consider unsafe.” But, “White House and Pentagon officials oppose” regulating the chemical. The Post noted, “Some perchlorate occurs naturally, but most perchlorate contamination in U.S. drinking water stems from improper disposal by rocket test sites, military bases and chemical plants. A nationwide cleanup could cost hundreds of millions, if not billions, of dollars.” According to the Post, the EPA document was “heavily edited by officials of the White House Office of Management and Budget,” eliminating “key passages” and medical studies. The editing resulted in a proposal “which assumes the maximum allowable perchlorate contamination level is 15 times what the EPA had suggested in 2002.”
The New York Times /AP (9/23, A23, Werner) adds that the chemical “has been found in 35 states at levels high enough to interfere with thyroid function and pose developmental health risks, some scientists say.” In the draft document, however, the agency stated that “mandating a clean-up level would not result in a ‘meaningful opportunity for health risk reduction for persons served by public-water systems.’ The conclusion was denounced by Democrats and environmentalists, who said the agency had reacted to pressure from the Pentagon.”
UPI (9/22) noted, “Environmentalists and child safety advocates have been battling for six years to force the EPA to set drinking water standards for perchlorate, saying 20 million to 40 million people are exposed to the chemical at levels that some scientists consider unsafe.” UPI, citing the Post article, reported that studies have also shown “how exposure to perchlorate can affect IQ and behavioral problems in children.” AHN (9/22) reported on the Post article.
Aim for tight control…check your retina first!!
what I learnt is whenever I aim for better control of a diabetic patient,normalising his BG and HbA1c, I have to send him to ohthalmologist first to check the retina for any retinopathy before we start.
Managing diabetes in poor countries:
My greatest endo who taught all of us decided to go home in Africa, a professor with unique compassion and experience. Invited to give a lecture in Riyadh, we were very pleased to see him. He told us about looking after very poor diabetic children back home, no blood glucose checking at all, once per day insulin, cannot afford its price
Life for a child charity will be supported world wide,we promise
Normoglcemic DKA, cerebral edema with transient diabetes insipidus, the 9 y old girl :
She was referred as GE with severe metabolic acidosis, given sod bicarbonate & fluids for 3 days, blood glucose were normal. She arrived from the faraway local hospital looking severely dehydrated and in semicoma.Blood glucose on arrival 250 mg, bicar 19, sodium 177, large urine output. Meet the professor session in endocrine society presented normoglycemic DKA
She was ventilated at once, petressin, I had to give, small dose of insulin. She was a challange, thanks to merciful God, she recovered. She was not DIDMOD by the way. I proved it later
Counseling the VIP:
Years back while doing my fellowship in the best hospital in our region, I was asked to go to VIP clinic to see 8 y newly diagnosed diabetic, with royal family is her family. Admitted the nice girl with her mother& nanny, the young father was in shock promising he will look after her, take her to Mayo clinic soon and… He broke my heart, I took him to another room and asked him to go home, lock himself in his room and cry!!! I told my consultant what I told him, she was shocked, and how I can say to someone royal that!!1
The young father came next day feeling better, he told me in the shower he cried & cried then he went prayed & thanked God. He & his wife still look beautifully after their adolescent daughter.
The tale of two brothers!!!
The quiet gentle 10 y old was not doing well lately, blood glucose was always high, looked for food, exercise, insulin dose, all were studied and corrected but it was still high.
Here all of a sudden the child burst crying when I asked him, if he was unhappy at school. Every thing came out, his rift with his elder 12 autistic brother who was always favoured by his parents……
Referred both to behaviour clinic with parents.
On world diabetes day, both brothers chaired my session on celiac disease (diabetic children chaired the public session and it was amazing).Both brothers appeared on TV with me that day.