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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.

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CHALLENGES IN THE MANAGEMENT OF CHILDHOOD DIABETES IN KENYA

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  1. CHALLENGES IN THE MANAGEMENT OF CHILDHOOD DIABETES IN KENYA DR LUCY MUNGAI, LECTURER DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, UNIVERSITY OF NAIROBI.

  2. 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

  3. 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

  4. 1922

  5. 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 insulinNaturalArtificial

  6. Phases-1900 – 1920 Invented in 1907 by the USphysician 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 Urinalysis (Avicenna's Al-Qanun) physician examining a sample of urine. Noted sweet taste of urine in patient with recurrent infection, wasting of body and foot gangrene.

  7. ESTABLISH A PAEDIATRIC DIABETES CENTRE FOOD INSULIN NEEDLES SYRINGES GLUCOMETERS GLUCOSTRIPS LANCETS TRAIN NURSES , CLINICAL OFFICERS AND DRS

  8. 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

  9. Modern Testing GlucoWatch

  10. INSULIN PENS

  11. Tryingtobe as natural as possible

  12. 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 day Insulin Requirements When Not Training:55 units per day

  13. 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

  14. Treated for constipation

  15. Treated for typhoid

  16. Treated for Pneumonia

  17. Florid candidiasis

  18. 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

  19. 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

  20. OUR DREAMS FOR THE FUTURE

  21. Artificial Pancreas Bio Artificial Pancreas Islets Sheet

  22. ”Negative vaccination”Injection of GAD mayInduce tolerance by educating the educator cell Educator cell presents GAD as own antigenafter vaccination vaccinated • Cytotoxic cells • directed at GAD • are inactivated • by the • Educator non vaccinated GAD

  23. DONORS DEPT OF PAED&C H UON CENTRE OF EXCELLENCE NAKURU

  24. 1ST INSULIN PUMP LATEST PUMP

  25. THERE IS HOPE AT DIAGNOSIS 3 MONTHS LATER

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