1. DR LUCY MUNGAI, LECTURER DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, UNIVERSITY OF NAIROBI. CHALLENGES IN THE MANAGEMENT OF CHILDHOOD DIABETES IN KENYA

2. DEFINATION Type 1 diabetes is caused by an auto-immune reaction where the body’s defense system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults

3. PREVALENCE Worldwide; 347million patients with diabetes 10% that is 34.7millions have type 1. of these 31.23.14millions are children with type 1 diabetes. In Kenya 3.5millions with diabetes. 350,000pts with type 1 DM. ?315,000 children with type 1 diabetes mellitus

4. 1922

10. Regular insulin -onset 30 to 60 minutes, peak 2 to 3 hours, effective 6 to 8 hours onset –NPH insulin 2 to 4 hours, peak 6 to 10 hrs, effective 10 to 16 hrs = Mixtard insulin Natural Artificial

12. Phases - 1900 – 1920 Urinalysis (Avicenna's Al- Qanun) physician examining a sample of urine. Noted sweet taste of urine in patient with recurrent infection, wasting of body and foot gangrene. Invented in 1907 by the US physician Stanley Rossiter Benedict. Allows estimation of glucose in the urine. Solution is added, heated then cooled. Colour compared to a colour chart for amount of glucose

13. ESTABLISH A PAEDIATRIC DIABETES CENTRE FOOD INSULIN NEEDLES SYRINGES GLUCOMETERS GLUCOSTRIPS LANCETS TRAIN NURSES, CLINICAL OFFICERS AND DRS

14. Diabetes – Modern Testing Blood glucose monitoring using a meter a big step forward in self- monitoring of blood glucose control more accurate and immediate feedback than the urine test - Prototype invented by Anton H. Clemens in 1970s

15. Modern Testing GlucoWatch

16. INSULIN PENS

17. Trying to be as natural as possible

19. Tim Hargrave 23 yrs Diagnosed: 6 years Current A1C: At goal Years On A Pump: Less than one year Insulin Requirements When Training: 40 units per day Insulin Requirements When Not Training: 55 units per day

20. Phil Southerland 27yrs Diabetes Details Age Diagnosed: 7 months Current A1C: At goal Years On A Pump: 5.5-6.0 Insulin Requirements When Training: Basal: 18-25 units per day Insulin Requirements When Not Training: 33-38 units per day

23. Treated for constipation

24. Treated for typhoid

25. Treated for Pneumonia

26. Florid candidiasis

28. Fluctuating insulin needs ( ii)Unpredictable lifestyles, (iii)Irregular eating patterns, (iv)Illness, and the (v)Psychological and social aspects related to age, puberty, and weight gain

29. Insulin Insulin 0.5-1unit/kg prepubertal Adolescents 1-1.4 unit/kg Sports Bs 7mmol/l Lack of appetite mother to adjust the timing and dose of insulin Below 5 years all blood sugars above 5mmol/l and <13mmol/l Adolescents Bs between 5 and 9mmol/l

30. OUR DREAMS FOR THE FUTURE

33. Bio Artificial Pancreas Islets Sheet Artificial Pancreas

34. ”Negative vaccination” Injection of GAD may Induce tolerance by educating the educator cell Educator cell presents GAD as own antigen after vaccination Cytotoxic cells directed at GAD are inactivated by the Educator GAD vaccinated non vaccinated

36. CENTRE OF EXCELLENCE DONORS DEPT OF PAED&C H UON NAKURUNAKURU

37. 1 ST INSULIN PUMP LATEST PUMP

38. AT DIAGNOSIS 3 MONTHS LATER THERE IS HOPE