Art for charity:
Depression sent me writing poetry like mad, it released my anxiety. I started remembering many patients especially those in ICU when I was resident in paediatrics.
Here came my book, Hospitals, Patients& Poems (approved for publication), then came My Auntie’s Radio. I used to e mail a poem of the day to all staff at my work. They encouraged me to go on, but my boss advised me to write in Arabic, thanks to him, I published my first book which was sold exclusively during events of World diabetes Day 2007, and money bought strips for diabetic children in the south.
My second book will be out second week of October, but this time it will be only in book stores not with me like the first, whatever I will get from its sale will go to buy strips because in diabetes testing BG is the most important issue towards good control.
I did not send my English books for publication, my husband & my children think my English is not perfect to publish in English and they are right. I have 4 Arabic books permitted to be published soon & more to come.
Family history is not necessarily a determinant of autoimmune diabetes. Some recent items out of, I think NEJM, suggest (via mouse studies) that if a child is brought up in a relatively germ-free environment, the child’s immune system does not develop properly and if there is a genetic tendency, it will exhibit. The parents and rest of the family were probably brought up in a “dirtier” environment and developed the correct immunities.
If possible, I’d run a gene test against known monogenetic and polygenetic indicators of diabetes risk. I might also check diet history for lack of CHO in diet. I think some injuries may also contribute to this presentation.
Also, IIRC, in some genetic autoimmune diabetes, symptoms may begin while the pancreas is still producing insulin, and c-peptide and antibody levels are normal. (Honeymoon period.)
Also, is there pancreatitis involved? Liver disease of any sort?
The study was apparently published in Nature… one of the few of these I haven’t gone searching for the original. One of the non-tech reports on this study is here:http://news.smh.com.au/national/gut-bugs-may-guard-against-diabetes-20080923-4lvr.html
Thanks tmana.Actually I put the article about the gut bacteria on 24 Sept : Update.It is imprtant observation in mice…
UPDATE:
3-“Friendly” gut bacteria may be instrumental in preventing onset of type 1 diabetes.
The U.K.'s Press Association (9/22) reports that researchers at the University of Chicago and Yale University discovered that a “friendly bacteria in the gut may protect against insulin-dependent diabetes.” According to a study published in Nature, the investigators also “demonstrated the role played by the immune system protein MyD88 in type 1 diabetes.”
Schools will start 11 October:
After a long summer holiday, school will start. In holidays children reverse the awakening hours, sleep till late afternoon and go to bed near dawn, non diabetics & diabetics. I have to adjust insulin dose & time, so those on once a day Lantus, all take it 3pm all year and Aspart with meals. Those on NPH, reverse the time of the doses, with extra regular before main meal!!!
It is not easy to be a diabetologist when there is no discipline!!
Judith,
My english poems are not for publication,I put it here just for my english speaking friends like you to express my culture & ideas.
Diabetes in my family:
IDF sent us the adress of this wonderful community,grateful forever to them. When I joined I thought of my patients as diabetes is one of the conditions that patients can teach you more than what you learnt yourself.
Later I remembered when I had to go to Cairo to see my father who was diagnosed as diabetic suddenly after being shocked for the sudden death of his friend.He was put in many oral medications.Being a pediatician familial with types of insulin mostly,I thought I would leave him to his diabetologist. But I noticed many hypo and syncopes with low BP.I turned to basic physiology and basic knowledge,starting decreasing the doses,put him on mostly vegeterian medittranian food and with multiple BG checking pre & post meals,he came off all his medication in 3 weeks and for 3 years now he is on diet and lots of walking on daily basis.
It isnot diabetes,wished if it was!!!
Called yesterday morning;18 month boy in ICU,normoglycemic DKA?. The history was vague,no polyuria noticed,still in diapers!! The veiled mother asked me what is it,I replied may be diabetes,still not sure.she did not show this lost look I see in veiled kind mothers’eyes.
Then the young father came,asked me the same question,but he told me that it is not diabetes and revealed the family history,a daughter with episodic hyperventilation & metabolic acidosis but she is well,a 4 y old son who collapsed and died in one of these episodic rare metabolic disorders.
I know now from the mother’s eyes why she felt happy when I suggested it is diabetes.
Today the child is well,he will be investigated fully for inborn errors of metabolism.
I pray for him…
I’ve heard of a couple of cases of normoglycemic kids with ketones in their urine. What can cause that? (The only thing that comes to mind, and I have no idea if it’s a connection or not, is PKU, which I suspect is not all that common?)
Ketones can be detected in urine on starvation,like with episode of GE.With prolonged fasting normal people will have ketones in their urin,the mechanism to dplete fat to maintain normal blood glucose after exhusting glycogenolsis and glconeogenesis ( liver,muscles to generate glucose)
There are rare disorders that present like that
The important thing is not to miss normoglycemic DkA.
Loss of a great endocrinologist,
A very gentle,humble and caring colleague had collapsed and died within hours 2 days ago.He left all of us in shock.I cannot beleive he had gone.I am sure his patients will miss his care and his gentle personality.Dr Abdullah Al O reafy,may God bless you and take care of you, my good friend.
The sweet child is in my ward,renal biopsy came with minimal change nephrotic syndrome,a benign relapsing long condition with proteinuria,needs steroid courses.What a brave sweet child and calm relegious diabetic Mum with hypothyroidism.I felt jealous when I entered her room one morning to find her praying,head on floor for ages…What a remarkable young mother with beautiful radient smile…My patients teach me patience and support me emotionally…
Every time you treat a child, find an answer, help a family, you are both praying to Allah with your deeds, and answering the prayers of the child’s family. The answers to our prayers are not always the answers we want to hear, but often an answer is better than no answer, and you are giving the parents the strength and education they need to keep the child safe and healthy.
Each of us is given talents, and tasks to develop those talents, that we may minister to others as messengers of Divinity. We learn to invoke the Divine Presence with prayers, with thoughts, with speech, with touch, with all of our outward senses and intentions, and by invoking that Presence, bring peace and healing to those with whom we come in contact.
Your words encouraged me tmana and touched my heart.It is 7 am Saturday morning arrived to my office to find a 10 y old boy who is in DKA,with social and behaviour problems.His mother died in acute attack of asthma…He takes care of himself,under weight .The school starts today,so he chose the right tim not to take insulin to skipp school.Another challange and heart breaking situation…
Thanks Judith…
Patients in my ward today:
Two diabetics under 5 with their diabetic mothers.One of the mother just gives self mixed insulin twice,know nothing about diabetes.The other mother knows a lot of diabetes education ( she is followed up in good hospital)
Two under 5 diabetic children are accompanied by their two sweet teen sisters,one mother is dead,the other mother is with bipolar disorder
They all get togther exchanging phone numbers and befriended.
Good to know that they are befriending each other and keeping in touch. Sometimes having someone else going through the same thing you are makes you feel less isolated and better able to cope.
Making choices:
Few pumps for my patients or supplying strips for all (they were not supplied)
Well, money has to be spent wisely, so our choices were for supplying strips for free for diabetic children (begging, writing poems…) we got the strips. Result: dropping of HbA1c (1% drop counts as you know), less severe hypoglycemic episodes and less admission in DKA
Diabetes control is personal, social &political issue
"Diabetes control is personal, social & political issue"
I really like that, and I agree with you completely.
Here is the real challange:
A 10 y old girl with metabolic syndrome:
Morbid obesity
Insulin resistance
Hypertension
God help us…