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:: TAG-VHS Diabetes Research Centre
:: TAG-VHS Diabetes Research Centre
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“Lily… Lily… Wake up…”
She heard the voice for the first time, but the face…? She rubbed her eyes over and over again. The doctor’s smiling face was still hazy. And O dear! She was in a strange bed, in a strange hospital, in a strange country!
Lily was just recovering from the dreaded ‘Diabetic coma’. Juvenile diabetics (children below the age of 15 years) are at risk of this condition. Also known as type 1 diabetes, coma usually occurs, when they miss their daily dose of insulin injections for some reason or the other.
In her befuddled mind her first thoughts were, “am I Alice in Wonderland? Or Snow-white? Or, maybe, Sleeping Beauty?”
A 21-year-old smart and pretty Danish, Lily, could easily have been any of these girls.
“You’re going to be alright, Lily. Don’t worry, you are among friends,” the Doctor at her bedside reassured her.
Her face and body were covered with hundreds of red dots – a result of mosquito bites. She had been very sick. Yes, she remembered the waves of nausea and the intractable vomiting before she passed into a comatose state. These sensations were subsiding, thankfully.
She was feeling very thirsty. She wanted to pass urine and tried to seek help to get up.
The nurse gently laid her back on the bed. “Relax, Lily. The catheter you have on will take care of that. We’re all here to nurse you back to health.”
Lily had been diagnosed as an insulin dependent diabetic when she was barely four. Her parents had been devastated; Lily was too young to understand the consequences. But since then, the insulin shots and finger pricks to test her sugar levels had become a daily chore. Basal insulin shots, before food, morning and night, plus a bed time top-up dose had become a part of Lily’s life.
The Diabetes Educator back home had cautioned the family about the Diabetic-Coma. Supportive parents, and a Welfare-State, where all health care services were absolutely free, ensured that she was soon on the road to good health. She excelled in her studies and sports. A very good looking teenager, Lily, took part in all the activities of her peer group including dating boys, which was common in her country.
As soon as Lily and her boy-friend had finished high school, they set off on their much awaited tour of India on a shoe- string budget. Having heard about India’s great heritage and cultural plurality, they had been planning this tour for ages. They decided to start from the South of India.
They had been fore-warned about malaria and other infectious diseases like jaundice and typhoid. However, they threw caution to the winds with the exuberance of youth and eternal enthusiasm. Having been an Insulin-dependent diabetic for nearly 17 years now, she felt confident about travelling to a strange country with vastly different food habits. To her, the tour was just an adventure, and not the daredevil act that her parents portrayed it as, more so because she was being escorted by a fairly supportive companion who understood her challenges and was ready to help!
To assuage her parents’ apprehensions, Lily had gone to the diabetic clinic in the hospital where she was registered for regular care. There she learnt how she could self-manage her insulin dose, and how to check her blood sugar, using the old type of B.M.Meter. She was also taught how she could tide over minor emergencies like vomiting, diarrhoea etc.
The moment the young duo landed in Madras (as Chennai was called then) they rushed off to Mahabalipuram by the seaside. There they befriended a very nice fisherman – Velan – and his family. Velan had promised to treat them to a ride in his catamaran. They left with him at 4am and got back with the catch by 7am. Lily and Julian were so thrilled with the fishing expedition that they requested Velan to host them for a few more nights in his hut, close to the seashore, so as to repeat the experience. He agreed.
That night Lily started vomiting. She took some pills which she had brought with her. As she could not eat a morsel, she skipped her Insulin injection. The nausea and vomiting aggravated overnight and by morning she was feeling quite sick and weak. Julian took her to the local doctor who prescribed some medicines and injections to control, what he thought was, food poisoning.
That night Lily’s condition worsened. She continued to throw up everything she took orally and gradually became very drowsy and was fast losing consciousness. Her breathing was rapid and shallow and her body was cold and clammy. A fruity odour was emanating from her breath.
The local doctor recognized the symptoms of diabetic ketoacidosis going on to coma and arranged for her to be transferred to the Voluntary Health Services Hospital in Adyar – 40 kms away.
By the time Lily reached the VHS, she was in deep coma, severely dehydrated with fast, thready-pulse, low BP, shallow acidotic breathing with fruity odour and her blood sugar was well over 700 mgm/dl (normal - below 140 mgm/dl) with urine loaded with sugar and Acetone (Ketone bodies) and severe electrolyte imbalance in the blood.
Doctors at the VHS Diabetes Department pumped her with several litres of normal Saline. Short acting insulin was given in small and frequent doses with supportive measures.
It was touch and go! Julian stood by her side all through her crisis. He was ever-willing to rush out and get any special medicines that might be required! By divine grace Lily started showing signs of recovery within 24 hours.
Having regained consciousness, she started taking oral feeds. But she did not like the food that was being served in the hospital. The kindly Resident Medical Officer who had her quarters within the hospital prepared special nourishing soups and bread and other dishes that Lily relished.
Her condition had improved and she no longer needed care in the ward. She could come down to the diabetic clinic-OP. The doctors could then get a complete picture of the case by putting all the pieces together.
A few days before the sickness, Lily had experienced hypoglycaemia (low blood sugar). She had reduced the dose of her usual insulin, based on her meter reading; little realizing that the B.Meter sticks were date-expired. To make matters worse, the mono component Insulin (the latest at that time) had curdled and had been rendered ineffective due to the poor storage conditions in the tropical heat during her stay at the fishing hamlet! Stopping the insulin doses due to vomiting and starvation proved to be the last straw – all aggravating factors – in pushing the blood sugars to very high levels, breaking down the body fat to supply energy. In the bargain, the deadly ketone bodies had been produced in the blood and urine. This in turn, worsened the vomiting (incious cycle) and resulted in making the blood highly acidic due to severe electrolyte disorder and creating the metabolic crisis called diabetic coma. But for the timely correction it could have led to an irreversible condition and resulted in multiorgan failure and death!
Lily had been indeed lucky, to have had Julian to help her; a set of committed doctors, Nurses and para medical support staff at a full-fledged hospital in VHS, that too, offering a unique Free Comprehensive Lifetime Medicare for all Juvenile diabetics, including the co-morbid conditions, through the Juvenile Diabetes-Care Programme.
The VHS in the NGO Sector, was founded by the visionary Prof. K.S.Sanjeevi, way back in 1955. There are 650 registered cases of Juvenile Insulin Dependent Diabetes Mellitus (JIDDM) to date and over 400 of them are availing Free Comprehensive Life time Medicare! The VHS Diabetes Department is indebted to all the Donors and Friends, who have, over the past 44 years, unfailingly helped sustain the efforts to serve this small, but severely challenged, children’s-community, for a lifetime.
Needless to say, the Department and its dedicated staff were delighted at the happy outcome of Lily’s case. At a time when facilities for treating such cases were least sophisticated and technologically low in our country, the success was a result of team work, commitment and passion for excellence in work ethics and understanding of human physiology… and of course, divine grace!
“Lily, you are now fit to travel back home. We can even make all arrangements for your safe return…,” he offered.
Lily was adamant. “Doctor, it’s very kind of you. But I’d rather continue with our tour of your wonderful country. I must visit Pondicherry and I’d like to go back home only after a month, as planned.”
After a pause, she began hesitantly. “Doctor you have done so much for me, please do me one more favour… Could you please get me enough Insulin – the Mono-component variety that I have been using – to carry with me?”
The Doctor obliged even though at that point of time this purified form of insulin was not available in India. Luckily for him, when he requested the company (Novo-Denmark), who were marketing this insulin, they supplied enough stock, that too free of cost to Lily. The Doctor handed over the same to Lily and gave her extensive in-depth advice as to how to manage her diabetes under such adverse conditions. He also gave a detailed note to her doctors in Denmark.
Julian and Lily bid adieu to the Doctor, gratitude writ large on their faces, and left for Pondicherry. The Doctor wished them Bon Voyage and silently prayed for Lily’s good health.
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