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Question:

From Borneo, Indonesia:

I am looking for information on the care of a diabetic patient. My location is in Kalimantam, Borneo, Indonesia. Medical assistance is very basic and I'm not so sure up to date.

The patient is 60 years old and requires constant attention following paralysing stroke. Hospital not very clear as to dosage of insulin etc. The patient returned home after one month's hospitalisation and has a nurse in constant attention.

I need details of equipment for administering medication by non-qualified personnel. Details here are sketchy to say the least.

Answer:

You have a difficult problem; but my reading of your message is that you are trying to cope with a hemiplegic or diplegic 60 year old with insulin-treated diabetes. I also assume that in the hospital it has been established that his blood sugars are indeed high enough to warrant treatment with insulin. I am also assuming that you have the means to obtain an occasional blood and urine sugar to be analysed in the hospital.

The task then is one of conventional nursing of an elderly handicapped patient added to which he is going to need some insulin, some management of diet and some assessment of the degree of diabetic control. On the insulin aspect I would opt for just one shot a day of any long-acting insulin that you can get ahold of: NPH, Lente or even Ultralente. The first two might be given before breakfast and the second in the evening. Don't worry about using short-acting Regular insulin unless that is all you can get in which case you should give three times the dose in the morning that you give in the evening. As an additional economy there is some reliable work to show that beyond reasonable soap and water cleaning, it is not necessary to use alcohol swabs to clean the skin before giving the injections and if the house has some form of icebox a plastic syringe can be made to last at least a week. A glass syringe and needle could be kept in any household disinfectant and boiled once a week.

I don't know what the main carbohydrate staple is in your part of the world, but you should allow the normal food intake for a 60 year old but restricting the carbohydrate component to perhaps half of the usual amount. If however he has had a long history of malnutrition you have to remember that this can induce a form of diabetes especially in Tapioca eaters.

Exercise can obviously play no role under the present circumstances, but passive movement is still important.

The last issue is monitoring blood sugars. In general, you would like to keep fasting levels below 250 mg/dl or about 14 mmol/L and urine testing is not going to help much. A test once a week should be enough if there is no superimposed infection. It is important to avoid severe hypoglycemia from too much insulin, so that you should have some form of sugar available if he shows any neurologic signs more than he already has.

DOB

Additional comments from Dr. Quick:

What Dr. O'Brien proposes is clearly a lot different than what might be proposed for a healthy youngster who lives in a situation of relative affluence, unlimited financial resources, and close-by highly-qualified experts. His advice is entirely appropriate for the circumstances as described where, as the writer described, medical assistance is very basic.

WWQ

Original posting 2 Jan 1999
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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