-Diabetes Letters from the Developing World
I got this letter the other day from Jon, who is in a small village in the Dominican Republic.
“Yesterday we had a Skype nconsultation with a 20 year old girl here in (name of town) who has been diabetic since age 3. Poor management, eye, kidney and blood presure problems. She goes to a diabetes clinic in (neighboring town) where the doctor pushes semi-tight control. She’s currently taking 30 iu nph + 5 iu rapid in the morning, 20 iu nph before dinner. (An advising doctor) wants to add rapid before each meal, go from 2 to 4 shots. The biggest problem (aside from trying to get additional subsidized insulin) is test strips. She has a glucometer, but they ran out of donated strips (and money to buy more at market prices) a month ago. Another problem is diet… mostly white rice beans, white bread, some chemically laden tomatoes in season. Teenage Frito-Lay junkfood, juice with sugar added.”
The world needs real locally produced solutions for low cost BG testing.
Transferring to more shots, might also increase the number of hypoglycemic episodes, which given her situation could perhaps be worse.
Now as to management, I am really curious whether an app would assist her in self-management, and if so which.
Lots of challenges and the need for locally tailored solutions. (Spanish speaking, perhaps low education level, perhaps poor adherence, motivation, perhaps poor understanding of diabetes, limited diet options, etc.)
Anyone with suggestions, please write in.