Kranti hailed from remote Gulmi. She was doing her Bachelors in Education (BEd) in Tamghas, the capital of Gulmi, staying at a rented place. She noticed that she was losing weight, was dizzy and was thirsty all the time. With this she saw a doctor in Tamghas who dismissed her complaints. Unsatisfied, she saw another doctor who checked her blood sugars and discovered that it was quite high. He started her on oral medication but her symptoms kept on worsening and blood sugars kept on escalating. Seeing this response, the doctor appropriately explained to her that she has a type of diabetes requiring insulin for life. They were not convinced and decided to come to Kathmandu. She came to us.
The diagnosis was quite clear to us. She had type 1 diabetes (T1DM) and the second doctor in Tamghas had made a correct diagnosis and placed on the correct treatment. T1DM is a life-altering diagnosis. The patients with T1DM do not produce insulin at all. And if insulin is not given from outside, over time, patients emaciate and die. Even missing a single dose of insulin can precipitate a catastrophic complication.
We explained to her what her disease was and decided on a dose of insulin. Our diabetes educator took her a class where she explained about her disease, about things she will need to consider about diet and lifestyle, taught her how to check blood sugars at home and inject insulin, talked about the symptoms of low blood sugars and how to treat it, discussed about what kind of monitoring she will need to do in the future and gave her our contact information asking her to send us blood sugar results.
She used to call our diabetes educator, who is an excellent communicator and a wonderful and caring human being. After discussing her results with us she used to call Kranti with new doses of insulin and specific instructions.
Kranti came with her father after nearly 4 months from her first visit for follow-up. I knew that things were going well for her based on the phone communications she had with our system. But I did not know that it was going extraordinarily well. She handed me a notebook where she had maintained the log of blood glucoses that she had checked at home. We aim for having fasting blood glucoses between 70-140 and blood glucoses after 2 hours of meals between 70-180. At the beginning, her blood glucoses were off target. But lately, they have been wonderfully on target. Her HbA1c, which gives an idea of a long-term glucose control, was 6.2% (It was over 12% when we started her on treatment; and we generally aim to have it at <7%). Furthermore, she was not having much low blood sugars which can happen with such tight blood sugar control, actually just one episode over the past month.
Her overall outcomes are as good as it gets for patients with T1DM, even with most advanced technologies and therapy existent in advanced economies. But she was achieving that with the cheapest type of insulin, living in Gulmi. How did it happen? I think, the larger part of the answer lies in the other pages of her notebook.
She had written down everything our diabetes educator had taught her; several pages of them. It was clear she owned the disease and was determined to do her best. And she had indeed achieved the desired outcome.
This is success. And it also tells of the ingredients needed for the success. A confluence of determined patient and responsive healthcare institution that she trusted was the key here. Not all patients have Kranti's determination but they do fall prey to the viciousness of diseases. In those situations, the role of healthcare institutions is furthermore important. We were fortunate enough to have opportunity to respond to Kranti's determination. But the challenge for us is to also work hard for those with lesser determination.
The diagnosis was quite clear to us. She had type 1 diabetes (T1DM) and the second doctor in Tamghas had made a correct diagnosis and placed on the correct treatment. T1DM is a life-altering diagnosis. The patients with T1DM do not produce insulin at all. And if insulin is not given from outside, over time, patients emaciate and die. Even missing a single dose of insulin can precipitate a catastrophic complication.
We explained to her what her disease was and decided on a dose of insulin. Our diabetes educator took her a class where she explained about her disease, about things she will need to consider about diet and lifestyle, taught her how to check blood sugars at home and inject insulin, talked about the symptoms of low blood sugars and how to treat it, discussed about what kind of monitoring she will need to do in the future and gave her our contact information asking her to send us blood sugar results.
She used to call our diabetes educator, who is an excellent communicator and a wonderful and caring human being. After discussing her results with us she used to call Kranti with new doses of insulin and specific instructions.
Kranti came with her father after nearly 4 months from her first visit for follow-up. I knew that things were going well for her based on the phone communications she had with our system. But I did not know that it was going extraordinarily well. She handed me a notebook where she had maintained the log of blood glucoses that she had checked at home. We aim for having fasting blood glucoses between 70-140 and blood glucoses after 2 hours of meals between 70-180. At the beginning, her blood glucoses were off target. But lately, they have been wonderfully on target. Her HbA1c, which gives an idea of a long-term glucose control, was 6.2% (It was over 12% when we started her on treatment; and we generally aim to have it at <7%). Furthermore, she was not having much low blood sugars which can happen with such tight blood sugar control, actually just one episode over the past month.
Her overall outcomes are as good as it gets for patients with T1DM, even with most advanced technologies and therapy existent in advanced economies. But she was achieving that with the cheapest type of insulin, living in Gulmi. How did it happen? I think, the larger part of the answer lies in the other pages of her notebook.
This is success. And it also tells of the ingredients needed for the success. A confluence of determined patient and responsive healthcare institution that she trusted was the key here. Not all patients have Kranti's determination but they do fall prey to the viciousness of diseases. In those situations, the role of healthcare institutions is furthermore important. We were fortunate enough to have opportunity to respond to Kranti's determination. But the challenge for us is to also work hard for those with lesser determination.
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