A 13 year old girl came to Kivunge Hospital having felt unwell and generally weak. Tests were taken which showed that she had a very high sugar level and she was diagnosed with diabetes. Her prolonged high sugar levels have interfered with her normal fat metabolism resulting in acid released into the blood and ketones in the urine. This means that she is at risk of becoming incredibly unwell, very quickly.
The best management for this patient would be to assess the acid levels in her blood, put her on a continuous infusion of insulin, and to keep an exact eye on her hydration status...
Unfortunately, we're unable to take any of these steps at Kivunge Hospital due to a lack of available resources and man hours.
We therefore manage the case in the best way that we can in the circumstances. We encourage her to drink, give her three doses of insulin a day and educate her parents about the danger signs. This is all in the knowledge that she will not be able to continue to receive insulin when she is discharged as it is not available in the community, so this is a patient that we anticipate seeing time and time again.
She currently remains on the ward, no better, but no worse. We continue to keep an eye on her sugar and ketone levels and hope that she starts to make an improvement over the next few days and will be able to go home soon.