Transcript challenges in the management of childhood diabetes in kenya

CHALLENGES IN THE
MANAGEMENT OF
CHILDHOOD DIABETES
IN KENYA
DR LUCY MUNGAI,
LECTURER
DEPARTMENT OF PAEDIATRICS AND CHILD
HEALTH, UNIVERSITY OF NAIROBI.
DEFINATION
• Type 1 diabetes is caused by an auto-immune
reaction where the body’s defense system attacks
the insulin-producing cells.
• The reason why this occurs is not fully
understood.
• People with type 1 diabetes produce very little or
no insulin.
• The disease can affect people of any age, but
usually occurs in children or young adults
PREVALENCE
 Worldwide; 347million patients with diabetes
 10% that is 34.7millions have type 1. of these
31.23.14millions are children with type 1 diabetes.
 In Kenya 3.5millions with diabetes.
 350,000pts with type 1 DM.
 ?315,000 children with type 1 diabetes mellitus
1922
Regular insulin -onset 30 to 60 minutes, peak 2 to 3
hours, effective 6 to 8 hours
onset –NPH insulin 2 to 4 hours, peak 6 to 10 hrs,
effective 10 to 16 hrs = Mixtard insulin
Natural
Artificial
Evolution of Diabetes
Management Technologies
Insulin Pump Therapy
Glucose Sensor
BG Meters
Urine Test Strips
Insulin Injections
Urine Tasting
1776
1900s
1922
Artificial
Pancreas
1977
1978
1999
Phases - 1900 – 1920
Urinalysis (Avicenna's AlQanun)
physician examining a sample
of urine.
Noted sweet taste of urine in
patient
with recurrent infection,
wasting of body and foot
gangrene.
Invented in 1907 by the US physician
Stanley Rossiter Benedict. Allows
estimation
of glucose in the urine. Solution is added,
heated then cooled. Colour compared
to a colour chart for amount of glucose
ESTABLISH A
PAEDIATRIC
DIABETES
CENTRE
FOOD
INSULIN
NEEDLES
SYRINGES
GLUCOMETERS
GLUCOSTRIPS
LANCETS
TRAIN NURSES ,
CLINICAL OFFICERS
AND DRS
Diabetes – Modern Testing
Blood glucose monitoring using a meter
a big step forward in self- monitoring
of blood glucose control
more accurate and immediate
feedback
than the urine test Prototype invented by Anton H.
Clemens in 1970s
Modern Testing GlucoWatch
INSULIN PENS
Trying to be as natural as possible
Diagnosed: 6 years
Tim Hargrave 23 yrs
Current A1C: At goal
Years On A Pump:
Less than one year
Insulin Requirements
When Training: 40
units per day
Insulin Requirements
When Not
Training:
55 units per day
Phil Southerland
27yrs
Diabetes Details
Age Diagnosed: 7 months
Current A1C: At goal
Years On A Pump: 5.5-6.0
Insulin Requirements
When Training:
Basal: 18-25 units per day
Insulin Requirements
When Not Training:
33-38 units per day
Treated for constipation
Treated for typhoid
Treated for Pneumonia
Florid candidiasis
Fluctuating insulin needs
(ii)Unpredictable lifestyles,
(iii)Irregular eating patterns,
(iv)Illness, and the
(v)Psychological and social
aspects related to age,
puberty, and weight gain
Insulin
 Insulin 0.5-1unit/kg prepubertal
 Adolescents 1-1.4 unit/kg
 Sports Bs <14mmol/l and >7mmol/l
 Lack of appetite mother to adjust the timing and
dose of insulin
 Below 5 years all blood sugars above 5mmol/l and
<13mmol/l
 Adolescents Bs between 5 and 9mmol/l
OUR DREAMS FOR THE FUTURE
Artificial Pancreas
Bio Artificial Pancreas
Islets Sheet
”Negative vaccination”
Injection of GAD may
Induce tolerance by educating the educator cell
Educator cell
presents GAD
as own
antigen
after
vaccination
vaccinated
non vaccinated
GAD
Cytotoxic
cells
directed at
GAD
are
inactivated
by the
Educator
DONORS
DEPT OF
PAED&C H
UON
CENTRE OF
EXCELLENCE
1ST INSULIN PUMP
LATEST PUMP
THERE IS HOPE
AT DIAGNOSIS
3 MONTHS LATER