When it doesn’t hurt, the disease is forgotten or ignored. “I feel really good, Doctor,” patients often tell her.
Dr. Mihaela Vladu is an associate professor, doctor, primary doctor of Diabetes and Nutrition Diseases, and for several weeks she has been the head of the Diabetes Department at the County Emergency Clinical Hospital in Craiova. He saw many patients who ruined their lives because they did not pay due attention to the disease and ignored medical recommendations. But following the pandemic, cases have multiplied. And in recent years, he sees more and more children with diabetes, high blood sugar and hypertension. “During my studies, we learned that in children we talk about type I diabetes, insulin-dependent. A case of diabetes was an exception. Today things have changed a lot. “
The boy for whom happiness tasted like sweets
Often, imbalances among children occur against a background of a supportive family environment. This is also the case of a 12-year-old child, whom we will call Vlad.
The boy arrived at the SCJU Craiova emergency room with blood glucose 400 and glycated hemoglobin with double values compared to the maximum. Glycated hemoglobin indicates an average of blood glucose over the last three months and is an important indicator for diabetologists. Normally, the limit is 7. Vlad was 14.
At the age of 12, the boy weighed about 90 kilograms.
“I hospitalized him, I also discovered a urinary tract infection. Gradually, he reached very good blood sugar levels. With Siofor, an insulin-sensitizing drug, blood sugar levels have dropped dramatically. Initially, we imagined it could be type II diabetes and left a small dose of insulin. I continued with the additional investigations for type I diabetes. I realized that this was not really the case. The child had sufficient insulin reserves. What happened next? He lost 10 kilograms in a month, he came with very good tests, I reduced my medication. The insulin is completely gone. At the moment, she has 30 kilograms lost and her blood sugar is within normal limits, only through lifestyle ”, says Dr. Vladu.
The family environment is extremely important here, the doctor tells us.
Vlad’s parents are separated, the father has gone abroad, and the child is raised by his paternal grandmother. Out of too much love, the grandmother tried to make up for the absence of her mother and father through sweets. Vlad’s happiness was measured in sweets.
“In the end, my grandmother understood that this good was, in fact, a bad thing. I explained the regime, I explained that this child needs to exercise, to ride a bike “, continues Dr. Mihaela Vladu.
The child was not even allowed to leave the yard so as not to go to his mother, who was in the same village and was not allowed to see him.
The doctor from SCJU Craiova became not only the child’s diabetologist or nutritionist, but also the family psychologist. He discussed with his grandmother how important it is for the boy to have an emotional balance and finally agreed with his grandmother to let the child ride a bike from home to his mother, who lives in the same village.
Vlad arrived at the hospital after his grandmother noticed that he often went to the bathroom at night to urinate. He went with his nephew to the village doctor. After he took his blood sugar, he immediately sent it to a specialist.
“Why end your life at 51 because you didn’t want an insulin shot?”
Most patients with diabetes are at opposite poles. In blood sugar levels that do not exceed the limit, some of them are very scared and very attentive to treatment. At the same time, doctors meet many patients with very high blood sugar who are very calm because “it does not hurt or bother them.” Why is this happening?
“Because these blood sugar levels have increased over time, gradually. If your blood sugar rises suddenly, if you suddenly go to the bathroom every hour, something seems wrong and you go to see what’s wrong with you. But if you go to the bathroom once a night now, in a few more months twice a night, and so on, you don’t find anything strange. Although, normally, it is not normal to urinate at night. But because the symptoms increase progressively in intensity, the patient no longer perceives them as something abnormal “, explains the head of the Diabetes and Nutrition Diseases Department at the Craiova County Hospital.
Dr. Vladu says that many of the latter refuse medication and end up with severe complications. An example is even a former colleague of the doctor.
“He was with blood sugar levels of 300… I did some titanic clarification work. An extremely beautiful, chic, successful woman. He refused insulin treatment because “she is feeling very well.” Imagine that at the age of 51, this beautiful, successful woman had a stroke and went to bed immobilized… Practically the whole balance of that family was destroyed, her husband took care of her for 10-15 years and then she died. This woman could have led a normal life if she had accepted the therapy. In addition, everyone in the family stayed to take care of her. Why close your life like this at the age of 51? ”, The specialist asks.
“I always tell my patients that if they don’t think about them, at least they should think about those around them. Otherwise they are selfish. Because these complications do not only affect you, they also affect your loved ones “, adds the doctor.
A pandemic of complications
The pandemic has aggravated the disease of many patients with diabetes, who were diagnosed late or did not come to the doctor for treatment. The low accessibility, against the background of the restrictions, but also of the generalized fear of contracting the infection with Covid, especially in the hospital, kept people at home.
“We had ulcer patients who did not come to the doctor and died at home with toxic-septic shock, we had many amputations. We now have a recently diagnosed patient hospitalized. And he was diagnosed directly in the stage of major chronic complications, with proliferative retinopathy, severe neuropathy, arteriopathy and forefoot amputation at this time… “, says Dr. Mihaela Vladu.
“We also have a patient with Charcot’s foot – a severe and quite rare complication that involves some important deformities in the bone and joint. Basically, the plantar arch has disappeared, the foot is flat, and the pressure areas become a risk factor for ulcers. If the patient has a neuropathy – that is, he does not feel much – he walks and does not feel the pain and then he can wake up with injuries without realizing it. He can walk with his feet up and not feel. The patient knew she had diabetes, but she was not very aware of the pathology and the complications it entails “, adds the doctor.
Complications of complications: From blindness to dialysis, stroke or heart attack
Complications in diabetes take many forms. They can appear on small blood vessels or large vessels. Retinopathy can progress to blindness, and nephropathy can lead to chronic kidney disease.
“The majority of patients who need dialysis are, in fact, diabetic patients, 50%. Another 30% are those with hypertension, 10% are those with other diseases and only 10% are, practically, their own kidney diseases “, states the diabetologist.
Other important complications are diabetic neuropathy, which can lead to amputations and cardiovascular complications, up to stroke and myocardial infarction.
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