Taking fluids in Kenya

Dehydration is a major threat during hot periods for people with T1, and can result in prolonged high blood sugar and possible DKA!

It’s gotten very hot here in Kenya- January through March is the dry seasons, and the hot sun makes the temperatures sore! If not taking enough fluids, the intense heat can cause dehydration.

A couple weeks ago, I fell into this pit- my blood sugars were high for several days, my insulin didn’t seem like it was working, I was feeling sick. Luckily, in Kenya, you can go to a pharmacy and buy bags of saline, tubes and IV insertion sets. My clinical-officer friend gave me the IV, hooked me up with a liter of intravenous fluid, and within the hour my blood sugars started to come down!

Lesson of the week: water is essential (it makes up the majority of our cells), and we have to remember to respect the fluid balance!

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“It is better to have HIV, than to have cancer”.

This statement was made by Akinyi, the mother who lives with her 7-year-old son on the compound with me and looks after the area. We were sitting in the kitchen, her in front of the wood-burning cooking stove stirring milk tea, me sitting on the floor that had been smeared with cow dung and clay a few days prior. We sit most days and talk, becoming more frank as our comfort with each other increases. This statement, however, took me by surprise. She explained her reasoning for saying this: in Kenya, ARVs are relatively easy to get, as NGOs and rich Western countries have flooded clinics and hospitals with either free, or very inexpensive forms. But as HIV becomes less of a death threat, and more of a chronic illness, other diseases are starting to be identified as life-threatening… cancer is among them. I saw an article a few weeks back in one of the Kenyan national newspapers about breast cancer’s large impact in Kenya. But I didn’t think much of it, as cancer is a problem most everywhere. But as Akinyi continued to tell me, there isn’t much equipment or drug supply to treat cancer, making it inaccessible to the vast majority of Kenyans, rich or poor. In Kenya, if you have cancer, you go back to your house and lay and rest until you pass… cancer literally means death. I think back over the weeks I’ve been here, and realize I’ve been seeing it, assuming people were getting treatment… most recently, a man with a hugely distended, perfectly spherical stomach, coming out of the general hospital. The longer I live here, and the more I see, I believe more strongly that health care isn’t simply a universal human right, it is a privilege, and one that many don’t have. Universally, human bodies falter, fail and are in need of repair to continue life… and this care isn’t available. How do we lower the cost of health care universally? I read an article recently in the New England Journal of Medicine discussing the cost versus need of HPV vaccination in developing countries… in the US, this cost is around $360, far above what most families in rural Kenya earn in 3 months. And yet, cervical cancer is the second most deadly cancer for women, regardless of country or region.

There are far more health issues in Kenya than cancer and HIV, and it seems that despite the effort put in so far, there is so much still that is totally wrong… structurally, we are flawed. And I feel incredible guilt in having the ability of having access to such a higher level of health care in a mere 26 hours of flying time. It is very different growing up hearing that life isn’t fair, and actually seeing how unfair it is… perhaps this is naivety why should one life have that much more opportunity than another?

Knowing that You’re Plugged In…

Last night, beneath my blanket, under a mosquito net, I tried to sleep… and although it was like every other night since I got my pump in 2002, I was particularly aware that I was connected to it last night… every turn and shift made me alert to the fact that next to me lay a small mechanical box keeping me alive!!

 

Sitting at the table this morning drinking milk tea (a Kenyan staple), I wonder what caused my hypersensitivity… my pump site wasn’t causing any discomfort, and while I got tangled a little bit, that’s kind of normal when turning over in sleep… and yet, the entire 7 hours of semi-sleep, I consciously knew I was attached. Hmmm, metaphorically, maybe this means I’m having an issue with always having to be attached via cord to a lifeline… and maybe these musings are better for later in the day, once I’ve gotten more caffeine… anyone with a psychoanalysis of this predicament, I am open to your interpretation.

October Post… FROM KAKAMEGA KENYA!!!

Wow, I can’t believe how remiss I have been about posting since getting to Kenya!! The entire concept of “Kenyan time” is clearly affecting me, seeing as it doesn’t feel possible that it has already been 4 weeks since I arrived in Nairobi. I am now in rural northwestern Kenya, near a town called Kakamega. This experience so far has been amazing—my eyes are open to so many brand new things, I feel that I am learning a lot and my views are changing.

But… as this is a blog on health and diabetes, I probably should not get on my soapbox about all things social and public health… or at least not until I get my update on diabetes done!

So, here we go. Things with my blood sugars have been pretty good considering all the changes- it is much hotter here than I am used to, meaning that I sweat more, so I have to keep focused on rehydrating! I have used Gatorade powder that I brought from the States, and on the couple of days that I have felt very under hydrated, they have helped restore water content and salt (both of which is lost through sweat). The food is also very different here, I eat a lot of maize (similar to corn) and grains, some vegetables, and occasionally fruit. This is a shift from my diet that has a lot of fruit in the US… but I’ve found that even though I am eating more grain here, my blood sugars seem more stable. I attribute this to the lack of processing—most things here are pretty fresh! And in general, I need less insulin for things like bread… the only thing I’m finding that causes me consistent challenges is corn flakes! A surprise to me! Lunch time is usually getheryi, a mixture of maize and beans, with some vegetable (recently, it has been kales!), which ends up being a pretty big bolus for me during the day (around 6-8 units, depending on amount and the day’s activity).

Another surprise was that I had a lot of middle-of-the-night low blood sugars, causing me to change my basal rate (which I haven’t made any significant changes to for about 2 years)… this fixed the problem, and I usually wake up around 100 if my blood sugar is doing well the night before.

Like Eugenie said in her interview, it has been pretty easy to find local snacks to treat low blood sugar, from juice boxes to local candies… so this hasn’t been an issue. Additionally, I was pleasantly surprised to find that certain chemists (pharmacies) in Nairobi carried Humalog in addition to several other types of insulin (several that I had never heard about), so I have a pretty local backup plan in case of any insulin emergency. But for now, the 20 bottles are keeping chilled in my FRIO packs, a product that I will happily recommend to anyone doing any traveling or needing a way to keep insulin cold when on the move!

I think that is all for now, beyond the general encouragement I would like to offer to any yearning travelers… don’t be afraid, having an amazing adventure despite T1 is totally possible with the right preparation. So go, be brave, have adventure, and look forward to learning about the world around you and yourself!

KENYA!

It is my 5th day in Kenya, and my final day in Nairobi—tomorrow, I will head northwest to the town of Kakamega. Spending my first few days in Nairobi with the director’s family has been very helpful in acclimating me to a very new environment and culture. Likewise, being in the capitol city for the first few days in a new country has given me some peace of mind, as it is in Nairobi that I will have the greatest access to extra insulin supplies should I have any issues with what I packed.

From my last post, you know that I was nervous about Kenyan customs having a problem with the amount of needles and other “drug” supplies I was bringing into the country… upon arrival, I was relieved to see that my checked bags looked to be about the same size as they were in the US, and taking the advice of an older friend who has traveled in and out of Kenya many times, I made it through customs just fine by smiling and making light small talk! In fact, the only thing they asked me about was the rectangular shape in one of my checked bags, which was the board game Sorry! After asking me a few questions about this (what is this? – a child’s board game… how much is it worth?—probably 5 American dollars, it is used… used?—yes sir, I used it as I grew up), the security guard nodded, and let me on my way.

Upon arriving at the home I am staying at for my time in Nairobi, I took a minute to myself to check the bags for my supplies, and confirmed that nothing appeared to me missing! Huzzah! Storing my extra supplies of insulin in the fridge, I proceeded to enjoy my time getting to know the director and her family, going around Nairobi, and visiting the Giraffe Home and getting a giraffe kiss!! Wonderful!

Reflections from Istanbul (9.28.13)

Sitting in the Istanbul airport awaiting my third and final flight to Nairobi, I have a spare moment to reflect. The last few weeks have been spent pulling together all the little final threads to prepare for Kenya—malaria pills; new labels for the malaria pills as my name was spelled incorrectly; a yellow fever vaccination; a last refill of insulin, test strips and needles; ordering extra clothing- reordering, when some items didn’t fit as I wanted them to; finally receiving the backpack I had been waiting on, reminding my dad to bring home a green canvas sailing bag I planned to pack into that was on his jobsite; the constant organization and reorganization of a growing pile of items to take; buying Frisbees for the girls I will work with; sorting through board games from my youth to donate to the girls’ home; catching a coffee break, breakfast, lunch, dinner or walk with loved ones; finishing up my final summer job; washing the costume I wore at that job (a dirndl) and returning it to the restaurant… it was busy, to say the least.

 

But, here I am, sitting in a new country (alright, I won’t count it as “visited” yet as I don’t have the time to leave the airport, but it’s now on the “to-visit” list!), awaiting the final flight that will bring me to my home for the next 9 months. Getting through security with a lot of insulin and test strip supplies so far has been a breeze—I think my previous experience with travel helps this fluidity of taking out the laptop and insulin, shoes off, showing my pump before walking into the body scanner, being scanned, being pulled aside, then showing my pump, touching it with both hands, and my hands being wiped with a cloth that is then analyzed for any explosive materials. I will say I am worried about getting through Kenyan customs, and hoping that nothing gets taken out of my bags while out of my sight. I am sure it will make for an interesting post!! Some precautionary actions against things being taken out include placing copies of my doctors travel letter and prescriptions in each bag. Based on sheer quantity, I had to put the majority of my pump supplies, needles and extra meters in my checked luggage. I am carrying with me all my insulin and strips, my malaria pills, my thyroid medicine, and a meter—it makes for a somewhat bulky and hefty carryon! But, as I repackaged all my strips and pump supplies into gallon sized ziplock bags, my carryon is still within the limit! Ahhh, my flight is being called, so off I must go! Onward with this adventure!

What the Gluten?!

The interview with Eugenie was really awesome to share with everyone—I was particularly excited because it gave me some insight into what it is to travel in another country with diabetes supplies, considerations to think about, and it supported some things I’ve already done to prepare, validating the amount of effort I’ve spent (which feels great!). There was an additional point of interest that I had not expected: Eugenie’s comments on trying a diet that avoided gluten. I was intrigued, and reached out to some of my gluten free (GF) friends, to hear about their experiences and insights! And here is what I found!

The people:

Sara: 18, started GF in 2004 after being diagnosed with T1 and Celiac

Lydia: 22, started GF August of 2012 after suffering from small, but not insignificant, health problems (tiredness, frequent stomachaches, bloating, mysterious aches and pains)

Jen: 20, started GF fall of 2007 after being diagnose with Celiac disease

Summer: 19, started GF summer of 2012 after being diagnosed with Crohn’s disease (GF diets help reduce symptoms)

Question 1: Tell me about your overall experience with a GF diet?

Sara: When I first started a GF diet (9 years ago), it was very difficult, as the GF industry had not become popular, so we had to order food from Canada that tasted like Styrofoam. I was forced to mainly eat vegetables.

Jen: Within the past 3 years, the GF industry has exploded. Now many restaurants are aware and even popular brands like General Mills and Betty Crocker provide options for GF.

Lydia: Now, it’s actually not that hard. I’m a GF vegetarian, so you’d think my options would be limited… but, I can substitute GF pasta and bread products when I want them. I’ve gotten into baking and even made my own GF pasta and gnocchi!

Question 2: What physical effects do you experience with a GF diet?

Sara: At first, I had a really hard time staying completely away from gluten… sometimes it was a matter of not being able to resist Oreos, and sometimes I wasn’t aware there was gluten in so many things, like red food coloring. At first, I would barely notice the difference, so I ended up eating a lot of gluten. After about a month of eating gluten, I ended up in the hospital with some serious side effects of not being on a GF diet. The result has been that I am now much more sensitive, so I have to be very strict—any contamination can send me into a puking fit and eventually to the hospital with DKA (diabetes ketoacidosis).

Jen: Similarly, removing gluten from my body didn’t change much beyond not getting sick anymore.

Lydia: When I started, I didn’t know what would happen to my body on a GF diet, but I have found that I feel much more rested, and my energy is way up.

Summer: I believe GF diet is a main factor in what keeps most of my Crohn’s symptoms away. Some added benefits of a GF diet include: stopping having skin breakouts, the puffiness under my eyes is greatly reduced, I have more energy, and I feel “light”… not like a weight thing, but more of a feeling.

Question 3: What do you classify as gluten—what do you avoid?

Summer: All grains in general, so soy, wheat, rice, corn, and oats.

Lydia: Wheat, barely, rye, malt. Although barley malt hasn’t made me sick… I wonder if I’m only allergic to wheat and not barley and rye.

Sara: I stay away from anything risky because my sensitivity to gluten is so high. I absolutely cannot eat wheat, rye, barley or oats. What makes it difficult is that gluten can be in so many things: red food coloring, a lot of preservatives in drinks and candies. I also avoid anything I cannot pronounce on the first try. Also, I recommend to avoid dairy if you are going to slip up a bit and eat gluten—dairy makes the reaction way worse.

Jen: I classify gluten as wheat, rye, barley and malt. I also always avoid all types and never make exceptions. I also consider oats as gluten, as they are often farmed in the same field as wheat. But, I will eat specially grown gluten-free oats.

Question 4: What is your perception of GF diets for the masses (like the Atkins diet)?

Sara: I love that people are so interested in GF! The more people who are interested, the more opportunities I get to eat (as more companies produce better and a wider range of products)!! It’s a really healthy diet and I have heard from a large number of people that they just feel better after not eating gluten anymore, regardless if they didn’t feel like anything was wrong in the first place.

Jen: I have never been a fan of fad diets, so I don’t believe there is one type of food or one solution to a healthy diet. As in anything, I believe that gluten is appropriate in moderation, and whole grain wheat provides important diversity in nutrition.

Lydia: Do a GF diet it if you feel better! If you don’t have health problems related to gluten, you are just restricting yourself pointlessly. Avoiding gluten isn’t necessarily healthier. You have to see what personally benefits you. No harm done in trial and error!

Summer: I think everyone has his or her degree of tolerance for gluten. So if a person is even a little bit intolerant, they might benefit, but if they are perfectly tolerant, there is no reason to spend the extra effort and money to go GF.

Question 5: Any other insights on certain foods/food categories and health?

Sara: There are a lot of great bakeries that make GF options, and there simply isn’t anything better than being able to walk into a place expecting temptation and tourture and walking out with a cupcake that won’t make you sick.

Lydia: The best gluten free breads are Schar, Udi’s and Kinnickinick.

Jen: One time I went two weeks trying a pseudo-raw diet without eating processed or packaged food. I really felt a lot better, but it was too challenging. Since I don’t leave much time for cooking from scratch, I only was eating vegetables and rice and missed things like pasta, granola and yogurt in my diet.

A few weeks ago, the FDA released an announcement that it has (finally) created a gluten free label that will be regulated and enforced: products sporting this label must have no more than 20 parts per million of gluten in the product. (http://www.npr.org/templates/story/story.php?storyId=209265283) What’s your take on this ruling?

Summer: I’m for the new regulations on the labels. 20 parts per million is a very small amount… it would be like adding an 8th a teaspoon of flour to a loaf of gluten-free bread. I don’t think its likely gluten free manufactures would bother to do that, so I think the FDA has set a pretty high standard. Even if they were to add it, the gluten would be so saturated within the gluten free product itself it likely wouldn’t cause much harm. I would use the analogy that this is similar to the 99.9% of bacteria that anti-bacterial soap eliminates…that other .1% probably won’t get you sick.

Lydia: 20 parts per million is small enough for me. I am able to get away with eating non-GF labeled products that “may contain wheat”; they usually don’t make me ill. So, yes, I will eat things with a GF label!

Jen: I would ideally like to see it down to 10 or 5, but I understand testing for those amounts can be much more expensive.  As a celiac, every molecule of gluten I digest contributes to colon damage. I generally will eat products with the 20ppm labeling without any physical response, but to me it is not 100% “safe”.

A big thanks to you ladies for sharing your experiences and insight!