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DR LUCY MUNGAI, LECTURER
DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, UNIVERSITY OF NAIROBI.
CHALLENGES IN THE MANAGEMENT OF
CHILDHOOD DIABETES IN KENYA
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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
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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
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1922
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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
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Evolution of DiabetesEvolution of DiabetesManagement TechnologiesManagement Technologies
Insulin Injections
Urine Test Strips
Glucose Sensor
ArtificialPancreas
1999197819221900s 1977
Urine Tasting
1776
BG Meters
Insulin Pump Therapy
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Phases - 1900 – 1920
Urinalysis (Avicenna's Al-Qanun)physician examining a sample of urine. Noted sweet taste of urine in patientwith 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
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ESTABLISH A PAEDIATRIC DIABETES CENTRE
FOOD
INSULIN
NEEDLES
SYRINGES
GLUCOMETERS
GLUCOSTRIPS
LANCETS
TRAIN NURSES , CLINICAL OFFICERS AND DRS
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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
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Modern Testing GlucoWatch
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INSULIN PENS
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Trying to be as natural as possible
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Tim Hargrave 23 yrs
Diagnosed: 6 years
Current A1C: At goal
Years On A Pump:Less than one year
Insulin RequirementsWhen Training: 40 units per dayInsulin Requirements When Not Training: 55 units per day
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Phil Southerland 27yrs
Diabetes Details
Age Diagnosed: 7 months
Current A1C: At goal
Years On A Pump: 5.5-6.0
Insulin RequirementsWhen Training:Basal: 18-25 units per day
Insulin RequirementsWhen Not Training:33-38 units per day
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Treated for constipation
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Treated for typhoid
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Treated for Pneumonia
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Florid candidiasis
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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
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Insulin
Insulin 0.5-1unit/kg prepubertalAdolescents 1-1.4 unit/kgSports Bs <14mmol/l and >7mmol/lLack of appetite mother to adjust the timing
and dose of insulinBelow 5 years all blood sugars above 5mmol/l
and <13mmol/lAdolescents Bs between 5 and 9mmol/l
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OUR DREAMS FOR THE FUTURE
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Bio Artificial PancreasIslets Sheet
Artificial Pancreas
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”Negative vaccination”Injection of GAD may
Induce tolerance by educating the educator cell
Educator cell presents GAD as own antigenafter vaccination
Cytotoxic cells
directed at GAD
are inactivated
by the
EducatorGAD
vaccinated
non vaccinated
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CENTRE OF EXCELLENCE
DONORS
DEPT OF PAED&C HUON
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1ST INSULIN PUMP1ST INSULIN PUMP LATEST PUMPLATEST PUMP
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AT DIAGNOSISAT DIAGNOSIS 3 MONTHS LATER3 MONTHS LATER
THERE IS HOPE
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