Medics describe Diabetes Mellitus as a metabolism condition in which the body is unable to utilise the food one has eaten. According to Katherine Wright in her book Understanding Diabetes, the Pancreas is unable to produce a hormone called insulin (leading to Insulin Dependent Diabetes Mellitus, or Type One Diabetes), or the insulin is unable to function properly (leading Non-Insulin Dependent Diabetes Mellitus, or Type Two Diabetes) .
Carbohydrates, or starch that includes maize, wheat, sorghum, sweet potatoes; fruits and vegetables once they are broken down are taken from the blood stream into the cells as glucose by Insulin to enable the body organs to function like breathing and walking.
Under normal circumstances, when an individual has insulin, the glucose levels fluctuate between 4 and eight. For a person with Insulin impairment, the glucose (sugar) remains in the blood, and can go to 2 or 60 when a blood sample is checked with a glucometer or in the laboratory.
This makes it thick and sugary like honey, giving it the name the Sugar Disease ( ‘Ugonjwa wa Kisukari’); giving it the mistaken perception that such a person eats a lot of sweets or drinks tea with a lot of sugar. Wright says that individuals with Type one Diabetes have experienced an auto-immune attack on the Pancreas’ Beta cells that produce Insulin; it is not because they have eaten sugar.
As such, for these Individuals, they will need Insulin Replacement Therapy during their entire life. They cannot miss a dose, even for one meal; although they may take whatever they are convinced to take, it will not change the fact that they must inject insulin as prescribed by their doctor(s).
Without it, it is almost impossible to live beyond a week, at most two weeks.
Poor sugar control, leading to High Sugar levels (called Hyperglacemia) in the body in individuals living with Diabetes is the leading cause of disability – causing amputations and blindness. It also can lead to stroke, kidney failure and sudden death.
For a person living with Diabetes, medicine, food and lifestyle are important in keeping the sugar levels between 5 and 9; this enables them to function as well as individuals without the condition. Those with Type One Diabetes use Mixtard (70/30), Humilin R & N (together), or Humalog and Lantas (together).
There could be other types but these are the ones my daughter has used/is using.
Mixtard 70/30, Humilin N, and Lantas and all the other brands works in this way: 70 is for long acting Insulin - this covers 12-24 hours and takes care of incidentals consumption of sugar foods. The 30 in Mixtard, Humilin R and Humalog, and all other related are called Fast Acting Insulin and one has to injected before every meal. The amount an individual injects is determined, especially in children, on their individual body weight.
For example, my daughter who is 50 kilograms injects: Humalog: 10, 9, 8 before every meal; and Lantas 30 either in the morning or in the evening. The children have also been taught the Correction Factor.
Before injecting, they use a Gluco meter and strips to take a reading of the sugar levels. If the sugar level is above 9, they calculate: the optimum sugar level is 7, the reading is 15, so the anomaly is 8.
They then divide this by three to know the amount of insulin to add to their daily dose. Thus the child will add three units to their Humalog, or Humilin R-the fast acting insulin. With Mixtard, adding Insulin would mean at the 70/30 ratio, so usually a child has a prescription for Fast acting Insulin.
The way the Insulin is stored also matters a lot. Those with a fridge are lucky- they should keep it at the bottom compartment- the same place as vegetables. Those without a fridge are shown how to store it – they get a metal container and fill it with charcoal, then pour cold water on the charcoal to keep it cool.
Then they place another metal tin at the centre of the tin with charcoal and place then place the insulin vial inside the tin. The bigger tin is then pushed in a dark, dry place, like under the bed, to keep it away from light. If it is exposed to light for more than 30 minutes, it should not be used for injecting as it will not work.
In July 2016, 10 vials of Humalog and five of Lantas became defective due to the frequent electricity outages; my daughter went into a Hyperglycemic coma and nearly died. She was admitted at the MP Shah Pediatric High Dependence Unit for three days; afterwards Dr. Anjum advised us to throw away the entire batch and to be leaving the extra insulin at the hospital where they have emergency generators to deal with power outages.
Insulin, Gluco meter and strips are taxed; many of the over 300 parents at Clinic 23 live on below a Dollar a day, yet their children are not on the Orphans and Vulnerable Children programme. Yet, when a child is sick, the parents, some single, have to ‘stop press’ to attend to their child, spending many days at the clinic or in the wards.
These children MUST eat immediately they inject Insulin. This is because unlike the natural Insulin produced by the body, the synthetic one takes away all the sugar it finds in the blood stream. Thus, an individual with Insulin Impairment must have regular meals, and snacks at 10 am, 4pm and 10pm.
If they do not eat thus, their blood sugar levels are likely to plummet to zero, which would bring an immediate shut down of the brain, called a Hypoglycemic Coma.
Medics aver that a Hyperglycemic Coma is easier to deal with – a patient is put on emergency drip of Insulin and fluids. This will simultaneously dilute the viscous blood as well as take much needed Insulin to the brain cells.
In a Hypoglycemic Coma, a patient mostly needs Emergency Sugar. However, without information about their condition, it is easy to assume that the individual is asleep and leave them unattended. It is only by taking their sugar readings that a care giver, or a good Samaritan can know what emergency care to give before taking the patient to the nearest health facility.
Our children carry a Red Bag – inside it is a gluco meter and strips, Insulin Pens with both Fast and Long Acting Insulin, a snack and glucose. Should one fall unconscious, anyone familiar with the Red bag should quickly prick a finger of the patient, put a drop of blood on the gluco strip; it it reads above 9, then the immediate treatment is – remember the Correction factor? So you won’t know how much to inject unless you are taught. Just call for help to the nearest health facility. Should it read below 4, the immediate action is glucose.
If the person is unconscious, place a spoonful of glucose or sugar under their tongue- if they are not too far gone, once the sugar reaches their brain cells, they will recover. Then take a reading of the sugars again; if they are at 4, give a snack. If still below 4, mix half a glass of water concentrated sugar, then give the patient.
It is important that if the sugar levels are unknown, then do nothing –Take the person to the nearest health facility and if you know their medical history, inform the medic.
People living with Diabetes cannot live an extra day unless their ‘neighbor’ is taught how to intervene in any condition whether low or high blood sugars. That is why it is so important to talk about it to all and sundry. Contrally to what many may think, people, especially children living with Diabetes have been taught to live in the open with their condition.
My daughter’s 10 year old survival with Diabetes since 2008 is because she accepted it early; this means that whenever she joins a new school, she selects a few trusted friends who she teaches how to know hypos and hyper, and what to do in each instant.
She also informs her entire class, thus whenever she needs to eat a snack, or do a correction factor, or even inject herself at Lunch time, she goes to the back of the class without any eyebrows raised; only the teacher is left wondering at this ‘brazen’ behaviour, often because the school administration does not want her condition known.
It is important that all individuals who interact with a person living with Diabetes know of the condition, and what to do at every instant. It is important for every individual diagnosed with Diabetes to be facilitated to own a home Glucometer and strips. This would save many a life, it would also make the person’s sugar levels more manageable.
The International Diabetes Federation Diabetes Map 2014 indicated that world over, ‘the Diabetes’ Country is the third most populous country after China and India; it is more populated than the United States of America.
The Kenya Stepwise strategy 2015-2030 released last year indicated that there are over 750,000 adults diagnosed with Diabetes in Kenya. However, since the Strategy surveyed adults from age 18 to 69, this does not include the over 2000 children from three weeks to 22 years diagnosed with Diabetes by 2015.
Diabetes in Children, or Juvenile Diabetes is not a well-known field. By 2008, children attended clinic 17 at the Kenyatta National Hospital; Getrude’s Children Hospital and the Aga Khan Hospital would tend to the children, but still some were seen by adult Diabetologists.
In 2008, Dr Lucy Mungai came back from Italy with a Masters in Pediatric Endocrinology, and was employed by the University of Nairobi as a Lecturer; since then, she has been joined by Dr Laoingon (formerly of Getrude’s) and Dr. Anjum. From 2008, Children diagnosed with Diabetes are now referred to KNH for specialized consultation; they are seen at Clinic 23 every Tuesday from 8am to 2pm.
And that is if there is no Doctor’s strike, or Lecturer’s strike, nurses’ strike; if the lecturers are not overseeing an Examination. When a child is admitted on Level Three-the children’s wards, these three doctors will see them.
However, once they reach 13 years of age, they graduate to the medical wards on Level seven and eight; then the three doctors cannot treat them because as Lecturers, they are limited to the Children’s ward on level three. Unfortunately, by 2016, Kenyatta Hospital had not employed its own specialist for children living with Diabetes, and often the children were left without specialized care, even in prime care; I experienced that when my Daughter was in a coma in 2015.