Insulin

There are a few ‘big’ things that I want to write about, like how the hospital has health insurance, and how that can work in a setting like this, and about youth friendly services.

But this week (the last few indeed) have been so busy as I find myself on the wards six days a week, in meetings, with a study proposal to write and then, at weddings!  So instead, here’s a brief glimpse of my week.

I would always like to tell you all about my patients, of course, but I can’t say too much out of respect for their confidentiality.

But there is one girl who stands out in my mind that I must tell you about. She is 14, and a few years ago, she was diagnosed with type 1 diabetes. This is the kind of diabetes that most often starts in childhood, where for some unknown reason the body attacks it’s own pancreas so that the pancreas stops working. The pancreas has several functions, but amongst these are making insulin. Insulin is essential to life. It is the hormone that allows the body to take the the sugars from our diet, and parcel them off into the body tissues that need them to give us energy. Without insulin, the body’s tissues are starving, the person loses weight and starts to break down their muscles and tissues to make energy instead. And the bloodstream is swilling with sugar which has all sorts of terrible effects. Untreated, type 1 diabetes kills. The treatment is with insulin, but insulin is a dangerous drug. Take too much, and your blood sugar levels fall too low and you might fall into a coma. Take too little and your body enters that starvation state again and you become extremely ill. If you spend more energy (because you go and play football for example) you need less insulin, more if you have a bigger meal. It’s tricky stuff. In the UK, when children are diagnosed with insulin, there is heavy investment in support for the child and their family in learning how to monitor their blood sugar levels and adjust their insulin doses and food intake accordingly. One of the key tools is a glucometer – a little monitor which can use a drop of blood to measure and give a reading of a blood sugar level. Here, we don’t have the possibility of such intense support.

So, back to our girl. She came in the hospital in diabetic ketoacidosis – her blood sugar levels had got dangerously high, possibly because of stress or an infection, and she came in drowsy and her body in an acid state. We have a marvellous paediatrician here Dr Isaac, originally from South Sudan (that’s another story) and he stabilised her, but because of her age, she came to our adult ward. Over the days, she was weaned off her insulin infusion and her drip and we started to get her ready to go home. But how could she go home safely with insulin? Thank goodness for a donation of glucometers from a charity. We gave her one, and showed her how to use it, and a book to record her sugar levels. Isaac and our chronic disease nurse spent a long time talking to her and her mother about her insulin, and we agreed she would come back to the ward after a week with her book to see how she was getting on. Her family were worried about the cost of transport back to the hospital for the clinic. We said the hospital would pay.

She didn’t come back.

Three days after the scheduled clinic date, she did return, but quite unwell. Not as bad as the first time, but needing admission. Her blood sugars were very high. We asked what food she had been eating. Only Matoke and ‘’irish’’ (potatoes) – veg, beans and meat (proteins) were not on the menu. These are foods that are very high is fast sugars and alone, are not enough to sustain a growing body. We asked to see the record book of her blood sugar measurements that came with her glucometer. It was empty. Why? It turns out that, at 14, this young lady still doesn’t reliably know her numbers to 20, and certainly not well enough to read them from the meter, and make sense of them.

Education is crucial to being able to enjoy good health.

Where on earth as health workers do we start?

We’ve had a few ideas. Such as giving patients like this very simple mobile phones and credit so we can call them to follow up, and having a young diabetics group that can meet at intervals for mutual support and education. And making pictogram advice sheets. There is lots of work to do!