DR LUCY MUNGAI, LECTURER

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, UNIVERSITY OF NAIROBI.

CHALLENGES IN THE MANAGEMENT OF

CHILDHOOD DIABETES IN KENYA

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 DiabetesEvolution of DiabetesManagement TechnologiesManagement Technologies

Insulin Injections

Urine Test Strips

Glucose Sensor

ArtificialPancreas

1999197819221900s 1977

Urine Tasting

1776

BG Meters

Insulin Pump Therapy

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

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

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

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

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 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

OUR DREAMS FOR THE FUTURE

Bio Artificial PancreasIslets Sheet

Artificial Pancreas

”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

CENTRE OF EXCELLENCE

DONORS

DEPT OF PAED&C HUON

1ST INSULIN PUMP1ST INSULIN PUMP LATEST PUMPLATEST PUMP

AT DIAGNOSISAT DIAGNOSIS 3 MONTHS LATER3 MONTHS LATER

THERE IS HOPE