Malnutrition and diabetes mellitus: a case study

ABSTRACT

A ten-year-old girl was admitted with marasmic kwashiokor, mucocutaneous candidiasis. Necator americanus and Trichuris trichiura infestation, small bowel overgrowth and faecal impaction due to acquired megacolon. During early recovery, she had an acute overt hyperglycaemic episode without ketosis. This responded rapidly to intravenous fluids and soluble insulin. She then gained 1 kg per week for 8 weeks on a recovery formula. During this, her blood glucose level fluctuated between 1.3 and 25.5 mmol/l. Abdominal X-rays and ultrasonography demonstrated diffuse pancreatic calcification. After 3 months, she was changed to a mixed diet and, later, a single daily dose of lente insulin. She ceased weight gain and began height gain. Six months after admission, she was discharged to a very poor home environment. However, she continued to gain weight and height though her blood glucose level remained poorly controlled. Her mental age increased from 50 to 56 months, over 10 months. Her mother also had diabetes mellitus but without pancreatic calcification. It seems that her primary problem was malnutrition. The cause of pancreatic calcification which presumably led to her brittle diabetes mellitus remains unclear. Gut stasis with ensuing pancreatic duct infection may have been largely responsible. Her monotonous diet, in particular, its relatively high carbohydrate content and the inclusion of `coldbush' tea, may also have contributed. In view of her continuing insulin dependence and her poor home situation, the prognosis remains guarded (AU)