Anita: Post 1

21-year-old male with diabetes: a success story.  He is showing Dr Gupta how he gives himself insulin shots in his belly.  On the bedside table are Diabetes posters in Hindi (he is also a community educator).

21-year-old female with diabetes: still a long way to go.

Entry #1 (Anita):

Today we worked with Dr. Santosh Gupta and spent time seeing two patients that had been admitted to the hospital specifically for diabetes control: one case is a success story, the other one unfortunately is not. The first patient was a young man, age 21 who had begun to have symptoms of diabetes at the age of 17. The patient, having been married at the age of 14! was able to recall when his symptoms began because that was the year of the birth of his first child.   The young man suffered from polydipsia and polyuria, keeping 5-8 liters of water by his side during the day and then also the night, and urinating every 10-15 minutes. Despite eating everything his family was able to feed him, his appetite was insatiable, and his energy level very low. He stated that none of his neighbors wanted him nearby because of the stench of his urine. The young man was seen by some local physicians who initially gave him 70/30 premixed insulin. This might have been fairly effective, except he was told by another local “physician” that he was too young to take insulin, that it was bad for him, and that it was addictive. As it is prudent to believe what an elder tells you, especially a “physician”,  he was “weaned off” insulin. The patient is quite small for his age, and had been unable to maintain weight because of his uncontrolled diabetes. He finally came under care of the physicians at RKM hospital here in Hardwar 2 years ago. Dr. Santosh Gupta was able to provide him with basal/bolus insulin (lantus/regular) and the patient has been doing very well since. He is able to have enough energy to work rather than relying on his wife to provide for the family. He has gained weight, and he is so committed to taking care of his health, and feels so well that he has become a spokesman and educator in his neighborhood. It seems to be very important to have patients go back to their neighborhood to educate other members in the community about diabetes, particularly because so many myths surround this illness. As mentioned before, it is rumored that insulin is addictive and bad for you. People also feel like diabetics are damaged human beings because of the illness, and they feel that diabetics (especially children and especially girls) are often better off dead. 

The other patient we saw today has a story with a less than happy ending. This patient, a young woman, also 21, had originally been diagnosed with gestational diabetes when she had her first child around the age of 15. She was told after the pregnancy that she no longer had diabetes, and all treatment was discontinued. The patient was married at the age of 14, and her husband committed suicide soon after. The patient’s in-laws offered their younger son to marry her, and indeed they were married, but because he was in love with another woman, he left her. The in-laws offered to pay her parents money to take care of her and their grandchild, but her parents took the money and took the patient. This obviously caused a rift between the families, and the in-laws ended up keeping the grandchild, the patient’s parents ended up kicking their daughter (the patient) out, and the patient has been an orphan ever since. She came into RKM hospital about a month ago, basically in DKA. It is unclear if she is a Type 1 or Type 2 diabetic, or if she ever really “got over” her gestational diabetes. After 1 month of care in the hospital, and extensive education for the patient to use a basal/bolus insulin regimen, the patient did not really seem to be motivated to care for herself.  Unfortunately, the patient no longer had medical indications for inpatient treatment, and it was time for her discharge. The patient was supposedly staying at an orphanage, but when taken by a hospital worker to the orphanage, it seems it was just a dirty plot of land. The patient was brought back to the hospital for further social discharge planning. The patient was given about 1 month’s worth of insulin, and when checked on again, had run away. It is certain that this patient, without social support, without a home, without a job, without anything really, will be unable to care for herself and her diabetes. It would seem this would be the least of her worries when she has to concentrate on putting food in her belly. 

It has been interesting to see diabetes care in a resource-poor setting. There are patients at Barnes-Jewish hospital that are like the first patient; poor, uneducated, but willing to make a change and take charge of their health. These patients are self-motivated, but they also usually have some social support. Other patients are like the second patient; because of their social situation cannot or are not willing to care for themselves, and bad outcomes quickly follow.