Wednesday, January 29, 2014

A desire to gain weight

                It’s super ironic. The common theme both among friends and my patients in the States is a desire to lose weight and stay slim.  Here it’s the opposite. Everyone one wants to gain weight (even those I think look on the heavier size).
                I had a 25yo Quachua lady present 2 days ago with the usual million complaints (stomach pain, acid reflux, bloating, headache).  She also complained of weight loss despite extreme hunger and thirst.  She said she ate so much, but though she’d been 50 kg 2 years ago, now she weighed 39 kg.  I ran couple labs including thyroid tests (her heart rate was 105) and urine (because she complained of a little dysuria). Everything came back normal except for her urine had 2+ glucose.  She had already eaten and we were still awaiting reagents for HA1C test to arrived, so I had her come back the next morning to have her fasting glucose checked….  It was 291.
                I had to talk over the best management approach with Kirsten, one of the other docs here due to the complexity of her social situation. She’d come from far away. She was Quechuan (still wore the traditional dress) and so likely didn’t have a lot of money or easy medical care if she was to have complications of treatment, such as hypoglycemia (low blood glucose)---which is common with insulin therapy.  Based on her young age and thinnest she was likely a Type I Diabetic (i.e. diabetes related to an autoimmune attack against and destruction of the pancreatic cells that produce insulin).  Because it’s a problem with insulin production Type I diabetes need insulin replacement. [Whereas Type II diabetes is an issue of cells requiring high levels of insulin to stimulate them to take glucose from the blood into the cells and use it for energy.  There are various pills that T2 Diabetics can use to help their body require less insulin and utilize more of the insulin already present in the pancreas.  But theoretically these pills, though cheaper and more convenient than insulin shots, will not work for T1 diabetics.  But do to how dangerous and complicated it is to send the Quechua home with insulin and glucometers to check their glucose several times a day due to their limited access to immediate care during and emergency due to money and distance most of the doctors at Diospi try a trial of oral (ie pills) meds [evidently they’ve found that there’s often a mixed picture between T1 and T2 Diabetes and pills, diet, exercise help even the Type I’s for while].
                So I admitted my patient for trial of medications and education and fluids.  I prayed with her that her body would respond to the pills (I gave Metformin 850 three times daily and a sulfonarrhea that we don’t have in the USA 5mg twice daily).  Our prayers were answered.  Her 2AM glucose was 132 and her fasting glucose before breakfast was 171.  Her thirst resolved and her heart rate came down to the 60’s.  I then sat down with her later in the day after the nurses had had a chance to educate her on what she could and couldn’t eat and quizzed her to see how much she had retained of the teaching that she’d be able to take home and apply.  Her mom was present but her Spanish wasn’t very good, so she missed part of the conversation.  A nurse who spoke Quechua walked up, so the mom asked if her daughter could drink “gasseosa” (i.e. Coke /soda/soft drinks—depending on the part of the USA you’re from) J I guess she missed the core of the education

1 comment:

  1. They love their gaseosa in Peru. And it does taste better in Peru, in my opinion. I don't know about where you are, but where I was, there was no Dr. Pepper. It was a sad day but good, healthily thinking.
    Where you are is very different from where I was. I was in a desert city on the coast. it never rained and it was almost always hot. I would be interested in traveling south, where you are. I did stay in San Miguel, which is in the mountains (had a hard time breathing) and the women still wore the traditional garb. It was really amazing to see and be a part of. The mountain driving was terrifying though. Had to say a prayer everytime I stepped into a taxi!
    Glad you were able to help her, figure things out, and educate her. God is good.