Advertisement

4 Responses

  1. Kristin W
    Kristin W August 17, 2013 at 5:15 pm | | Reply

    Wow. Good luck, Desperate D-Dad. I don’t have any advice, either, but am hoping and praying for the best for your family.

  2. pwd doc
    pwd doc August 18, 2013 at 7:33 am | | Reply

    I would refer this person to the Diabetes Association of Nigeria – http://www.diabetesng.org for more information regarding possible resources and medical advice regarding what is available in Nigeria.

    I am also not an expert regarding diabetes care in Nigeria and of course it is important to find out what options this PWD has for medications, ability to afford blood glucose strips, and access to diabetes care professionals before recommending any new therapy or ruling out any possibilities There is probably a wide discrepancy in the quality and quantity to health care access in Nigeria (as there is to some extent even in different parts of the US). It is also good to advise this PWD about the problems with insulin spoiling when exposed to heat.

    Most importantly, you need to make sure this person is truly a type 2 diabetic and not a slowly progressing type 1. This PWD was diagnosed at age 24. You don’t know if there is a family history of type 2 diabetes or if this PWD is overweight or perhaps even losing weight without trying, or more weight than would be expected from the degree of caloric restriction. You do not know if this person has a very active lifestyle or inactive lifestyle, or anything about this person’s diet (and options for food). If this person is thin, restricting diet may not be helpful and may even be harmful. You know this person is taking 28 units a day of insulin, but you don’t know if this is basal only or mixed NPH and a fast acting insulin. You don’t know if it is once or twice a day. You only know 1 blood sugar – 12 mmol/L (216 mg/dL). You do not know if this is a fasting blood sugar or a post prandial. If it is fasting, the post prandial blood sugar could be in the 300′s or even 400′s. If this person is only taking basal insulin and truly has type 2 diabetes, it is possible this person needs either an oral agent before meals to stimulate his/her own insulin release or fast acting insulin before meals (this person may only have access to regular). You don’t know how often this person is able to test blood glucose, if this person is able to test urine or blood for ketones if necessary, or even knows the warning signs of ketoacidosis (nausea, vomiting, abdominal pain with excessive urination and thirst). If only infrequent blood sugar tests can be done, perhaps it is possible to do them at different times of the day (fasting and after meals) to get more information.

    If this person does have type 2 diabetes and good access to medical care and can afford more expensive medications, adding or substituting another medication such as a DPP inhibitor on GLP analogue might be more appropriate. (I am not providing specific names of drugs on purpose as I only know US names). There is also a push towards telemedicine where diabetes experts provide advice remotely either directly to patients or through a health care worker at a local clinic. Unfortunately, I do not now how to refer this PWD to such a service.

    In short, I think it is imperative to make sure this person is not slowly developing type 1 diabetes and could potentially develop ketoacidosis in the future if not properly treated. I think it is important to tell this person that you can’t provide advice without knowing more about this person’s present diabetes care, weight, diet, family history, pattern of glucose levels throughout the day, the options available to him/her for medications, diabetes supplies, and medical support. This person can read and write English and found this website, so might have more resources than other less fortunate individuals in Nigeria and can learn from the Internet.

  3. Amal Richard
    Amal Richard August 20, 2013 at 11:02 pm | | Reply

    Hi,

    Really a good article, it is awesome. You can also get more valuable info about diabetes and solutions to it in the link
    http://valuableinfo.blog.com/category/100-question-and-answers-about-diabetes/

  4. Amy
    Amy August 22, 2013 at 1:00 pm | | Reply

    D-Dad…I am so sorry to hear about your sons struggles and your fears. I agree with Wil, better to send him to a treatment facility and run the risk of him not talking to you. Frankly, he is in the midst of alcoholism and will say anything to not confront that. Once he gets healthy, he will be happy to have had you rooting for him and having his best interests in mind.

    best wishes

Leave a Reply