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].