Management of diabetes in a refugee child- the challenges

Madhavi Madhusudhana; Emma Randle; Mark Denial; Neil Wright

doi:10.1530/endoabs.45.P39

Background: Type 1 diabetes is a chronic condition with significant implications on the child, the family and the health services. Management of this condition in a refugee child is fraught with further challenges.

Methods: In this observational case report, we discuss the challenges in the management of a 10-year-old Somalian boy, with type 1 diabetes for the past few years, who presented with Diabetic ketoacidosis.

Table 1 illustrates the challenges faced by the diabetic team during 2-weeks of hospitalisation.

Further management issues

Regular input from the team initially twice a week, then weekly with interpreter.

Telephonic advice not possible, advised to attend hospital if worried.

Dietary assessment at home with interpreter- looked at menu/weighed the portion sizes/calculated carb content/took pictures/made laminated charts along with insulin doses.

Better daily routine with the child starting school now.

Communication still difficult.

Control better than before, blood sugars still erratic- Chaotic lifestyle, lack of routines, multiple hospital appointments, communication difficulties.

School constantly in touch with the team regarding management at school as unable to communicate with mum.


Issue	Implications	Remedial measures
Language barrier	Difficult to communicate, check understanding	Used interpretor every single day during admission.
Innumerate	Interpreting blood glucose readings, understanding decimal points understanding highs/lows, dialling insulin doses	Education sessions on the ward -number charts, visual aids.
		Blocked the decimal points on the meter to avoid confusion.
Care of other siblings during education	Difficulty in getting mum’s attention	Ward staff/play therapist input used.
Meal refusal on the ward	Insulin requirement assessment	Home cooked food brought by mum (difficult as she had no transport and child care)

Conclusion: Management of diabetes in a refugee opens new challenges to the diabetic team. Along with social and cultural barriers, there are barriers to effective communication leading to difficulties in educating the child and the family. The challenges could be overcome with team work and innovative strategies, but with an increased demand on resources.

Endocrine Abstracts

P39