09 March,2022 08:35 AM IST | Mumbai | Vinod Kumar Menon
Komal, 10, was admitted to Shatabdi Hospital in a comatose state. She will be returning home fit and fine over this weekend
How can my child have diabetes at such a tender age?" was the spontaneous reaction of Ashwini Gadekar, 36, mother of 10-year-old Komal, who was rushed to the emergency room of civic-run Shatabdi Hospital, Govandi, last week, in a comatose state. Fortunately, timely medical aid was provided and she regained her senses 48 hours after her admission.
Three-year-old Radhika (name changed), was also admitted during the same period, in a similar comatose state with multi-organ failure. She had to be put on ventilator support at Jaslok Hospital. Brave Radhika, fought all odds and is now on the path of recovery and will be returning home by this weekend.
Both Komal and Radhika were diagnosed with Diabetic Ketoacidosis (DKA) and were in a very critical condition. Both have been tagged for Type 1 diabetes and will be on insulin support for the rest of their lives.
Interestingly, their parents had no clue about them (Komal and Radhika) being diabetic. The paediatricians caution that DKA is a high-risk stage, and earlier detection can prevent the child from suddenly slipping into a comatose state, which gradually leads to multi-organ failure if emergency treatment is not given within the rule of golden hours.
With BMC's initiative to start Diplomate of National Board (DNB) courses in six peripheral hospitals, some of the civic-run peripheral hospitals including Shatabdi, have started performing many supra major surgeries and are also treating high-risk complicated paediatric/medical cases.
Speaking to mid-day, Dr Chetan Shetty, Head of the Department, Paediatrics, hired as a full-time consultant for teaching DNB students said, "Komal was brought to us in a very critical condition, she was breathing heavily and was in a severely dehydrated state. For the past one week, Komal was very sick. Her sugar was 650 (normal values <200) and other blood tests revealed that the acids in her blood had increased to life-threatening levels due to complications of diabetes (diabetic ketoacidosis). She was immediately admitted to the Paediatric Intensive Care Unit (PICU), treated with fluids and insulin infusions. It took over 48 hours for her to regain and come back to normalcy. She was subsequently shifted to the paediatric ward and was finally discharged on Saturday (March 5)."
Komal's mother Ashwini works as a housemaid and is the sole breadwinner earning R6000 monthly, her husband stays away at their native place. Ashwini said, "Komal, never had any health issues. The problem started around two weeks ago when Komal had almost stopped eating food. We took her to a local physician, who diagnosed her with typhoid. The initial few days, she took medicine, but her condition only deteriorated."
Ashwini recalled, "Komal was at home and suddenly she fell unconscious. Luckily, I was home and I rushed her to Shatabdi Hospital, where treating doctors informed that her condition was critical and that they would do their best. I feared for the worst, but as the doctors were very good, they could save my daughter's life. Komal is back home and doctors have advised her to take insulin four times, which they only helped us to get."
Dr Shetty said, "We have given her a short dose of insulin at present so that her sugar levels can be monitored. Gradually we will shift her to a single dose of insulin, which will last for a longer duration. She will have to depend on insulin for the rest of her life, but she can do everything that a child of her age would do."
Dr Shetty said, "The clinical signs of DKA include severe dehydration, deep breathing nausea and/or vomiting, abdominal pain, blurry vision, confusion, drowsiness, progressive decrease in the level of consciousness and eventually, loss of consciousness (coma) etc. The primary risk factors for DKA are especially more in poorer countries due to delayed diagnosis, lower prevalence, poor compliance, and limited access to medical services."
Dr Fazal Nabi, Director Paediatrics at Jaslok Hospital said, "COVID-19 has impacted our lives, making all of us more indoor, which greatly introduces many health problems such as obesity leading to Diabetes Mellitus and Hypertension. Normally the incidence of DKA is one case a year in a private set up, but during during this pandemic period, it has increased to three-four cases a year, showing a two-fold rise in DKA. This is also supported by European data. The DKA symptoms are polyuria, polydipsia, weight loss, abdominal pain, vomiting etc but due to COVID impact, the patients are admitted in emergency rooms with complications such as comatose, confusion, renal failure etc."
Dr Nabi said, "A three-year-old girl (Radhika) was brought to Jaslok Hospital with breathlessness and altered sensorium for two days. With our efforts, we revived the patient. I have at present three paediatric cases who are type 1 diabetic and will require insulin support for the rest of their lives."
He added that parents can easily monitor bedside glucose level urine ketones, which will help in diagnosing DKA. By keeping a check, parents can handle the child from slipping into a complicated situation of DKA.
Dr Mahesh Mohite, senior consulting paediatrician and intensivist at Wadia Children Hospital, Parel, and runs a private clinic in Panvel, said, "Usually, I would earlier get ten cases of type 1 paediatric diabetes in the age group of 5 to 15 years, yearly. And after the second wave of COVID-19, we had almost 12 cases of type 1 paediatric Diabetic Ketoacidosis in span of three months. These children have to spend the rest of their lives taking insulin."
However, Dr Mohite further said, "We do not have any confirmatory reply or scientific data to correlate COVID and sudden spur in type 1 diabetic cases."
Dr Nabi and Dr Shetty agreed and said, "More analytical data would be required for getting clarity on the same."
