Entry #2 Today we again worked with Dr. Santosh Gupta, this time in the outpatient setting. The first patient we saw was a sad case; a 20 year old male who had had Type 1 diabetes since the age of 11, but had never had adequate insulin regimens to control his diabetes. The patient suffered from polyuria, polydipsia, and clearly malnutrition. This young man, at the age of 20, weighed 31 kg and was 5 foot 1 inches tall, with a BMI of 13. He was in the low-normal range of growth for a 9 year old male in the United States. The patient was being fed an adequate amount of food, but his body could not effectively use it at all. The patient was coming in today to, rather than use 16 units of 70/30 insulin once a day, start a basal/bolus regimen. The problem with such severe diabetes is that these patients are not able to work, impeded by polyuria and extreme fatigue.
The next patient was a very cute 8 year old boy who had been started on a basal/bolus regimen for about 2 years. He knew exactly how much insulin, and what types of insulin he took. His problem was low fasting blood sugar levels. His family had misunderstood and had been adjusting his nightly lantus dose by increasing rather than decreasing it. He had come with his father to meet with the newly trained diabetic educator to better adjust his insulin regimen.
The last patient we saw was a 16 year old boy who had been diagnosed with diabetes Type 1 at age 11. He has been a success story, keeping his HbA1c levels below 7, being very strict with his insulin. He now has reached his teenage years however, and has become more pre-occupied with playing cricket than taking his insulin. It seems his mother is quite upset about this, but he is fairly ambivalent, and because of this, his HbA1c h as suffered.
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