Tuesday, June 19, 2012

The Presence of Diabetes

June 19, 2012
Typical Maya hairdo.

In the US 8.3% of our population has diabetes, this is over 25 million people and it is believed that 3 x that many have pre-diabetes, which means 79 million people are on their way to getting diabetes.  Our western sugar-laden and processed food has worked its way into the Maya diet and all our venous and foot ulcer patients are diabetic. As much as I talk about how good and healthy the food is here, people by nature, enjoy sweets. It is not easy to find something as sweet a Coca-Cola growing from a tree or grown from la tierra and its much easier to buy. Kids naturally get hooked on the sugared candies and it becomes a hard habit to break… just like cigarettes. It is believed Mexico's diabetes rate is 11% — more than the US and their soda pop consumption per persion is 160 liters.
A short and long term accident waiting to happen, burn and diabetes, respectively. Family deep fries tortillas and sprinkles with sugar to sell, this may be the only way they know how to make a living.
Our ulcer patients are usually 40 years old and up and all with ulcers have type 2 diabetes. What is interesting is they are all thin, or at least not overweight or obese, unlike in the US where most type 2 diabetic patients are larger (girth-wise) in size. When I ask if they have diabetes many say yes, some say no; I check their sugar levels and prove to them they do have it and for almost all of them it is uncontrolled. Most have been given one medicine but I'm never sure if they take it consistently. Sergio and I spend quite a bit of time educating them on the importance of compliance. I also check their eyes but I can't get past their cataracts to see the vessels which is not surprising. Their cataracts most likely are caused by their life-time of sun exposure of working in the fields and the uncontrolled diabetes does not help.

The way we should all eat: beet soup, fresh leafy green salad and the agua del dia is watermelon. This is one of my favorite Chiapanecan dishes!
The solution here, as in the US, is education. We MUST educate the masses on diabetes, young and old. Whatever happened to public service messages? Health education in the schools? Diet in the schools? When people are diagnosed with diabetes or they have it poorly controlled, I've resorted to, "Well, if you don't control your diabetes you can lose your eyesight, have nerve pain in your feet, develop ulcers and if these don't heal may lead to amputation, your kidneys may stop working and you'll end up on dialysis" and for the men I add impotence.  One physician told me he tells patients, "You'll die slowly, piece by piece".
Blue corn atole is a breakfast soup that is soothing to the stomach.
A couple of years ago Sergio had a of a 44-year old woman with insulin dependent adult onset diabetes patient with a 5 x 5 inch full thickness ulcer on the back of her neck (started as a ruptured cyst). She would not take her insulin as she was given an antibiotic and did not want the meds to interfere with each other. I told her the wound would have a better chance of healing if she took her insulin as directed. Although, the wound was so large, infected and really needed a full-thickness graft I was doubtful it would heal. She took her insulin and antibiotic, Sergio continued to clean and dress her wound and it healed. The photos before and after are REMARKABLE which I'll spare the reader.

The large blue-green stalk in the background is a brussel sprout tree.

When patients have infections their blood sugar goes up, when their blood sugar is high, their wounds don't heal; a vicious cycle has started. This is what we are up against with wound care, what we need is a combination wound care clinic with a full-time endocrinologist and promotorasquisiéramos!  Don Sergio seems to almost always be successful with diabetic wound care although it can take months as opposed to weeks if all the right resources were in place.
We usually have fewer patients when it rains but this evening we were quite busy.

At the end of the evening a few ladies come to just sit and chat with Don Sergio, he welcomes them all.
For those interested in checking out the facts on diabetes please go to the National Diabetes Fact Sheet 2011… the numbers are astounding.

Posted by Patricia Ferrer, PA-C

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