Diabetes is a devastating disease wherever you go. But in the U.S. and other developed countries, patients often live normal lives. That's because it's standard medical practice to monitor patients very closely to minimize any harmful fluctuations in their blood sugar.
At the University of Minnesota, 13-year-old Aaron Evans slides onto the edge of an exam table. His doctor, Brandon Nathan, checks his vital signs, which seem fine.
"Aaron, since I saw you last, you've been feeling fairly well?," asks Nathan.
Aaron replies that he feels fine. Dr. Nathan then glances at a chart of Aaron's blood sugar readings from the past month and shows them to Dr. Grace Buwule, who's been quietly observing Aaron's visit.
"So he's got three numbers here that were, he was really high on these two days," says Nathan.
Dr. Buwule asks Nathan if he thinks Aaron didn't get enough insulin on those days. Nathan nods in agreement.
A chart like this would be rare to non-existent in Dr. Buwule's clinic in Uganda. Most diabetic patients in Uganda don't have enough test kits to monitor their blood sugar frequently. It's nearly impossible to track them, Dr. Buwule says.
"Now we see like this young boy he has had about at least four testings in a day. In Uganda it's once a month. And you can't control a patient by testing their blood sugar only once a month," says Buwule. But even if she had enough test strips, Buwule acknowledges it would still be difficult to adequately treat her patients. The Ugandan government only gives her enough insulin to consistently treat about 3% of her 70 patients. She says the rest go without insulin and eventually, many of them die.
University of Minnesota diabetes doctor Toni Moran knows first hand the challenges Buwule faces. Moran spent a couple weeks at Buwule's clinic this summer.
"The situation was so desperate that I couldn't help thinking of all the ways that just little, little things could help make a difference," says Moran.
The extent of diabetes in Uganda is hard to measure because there are no diabetes screening programs. But most of the cases are thought to be Type 1 diabetes, a form of the disease which usually develops in childhood and is not caused by an unhealthy diet. Moran says Uganda's medical system is not set up to handle chronic conditions like diabetes. Instead Uganda is much more concerned with acute crises like malaria and the spread of other infectious diseases.
Moran suspects most diabetic kids in the country die without anyone really knowing why they were sick.
"If anyone presents with dehydration and shock and maybe some mental confusion, they're diagnosed without any tests, they're just given an empiric diagnosis of cerebral malaria or maybe something infectious, shock from infection," says Moran. "So for the most part, these kids aren't even probably being picked up."
But Dr. Moran and Dr. Buwule are not pessimistic about the diabetes situation in Uganda. Moran is trying to get a grant from the World Diabetes Foundation to buy more insulin and test strips for the Uganda clinic. In the meantime, Dr. Buwule says there are several changes she will make in how she deals with patients.
First, she plans to spend more time with her patients, after observing clinic visits at the University of Minnesota.
"They take one hour to attend to one child," says Buwule. "But in Uganda we're spending about 15 minutes because we have so many children. So we're not giving them all the time that we should."
Until now, Buwule has done all of the diabetes care in her clinic herself. But she says it's too much work for one person to do well. So she plans to assemble a diabetes team to help her that includes a nurse, a nutritionist and pharmacist.
If she has any spare time after that, Buwule says she will train other physicians in her hospital to recognize the signs of diabetes, so more Ugandan kids at least have a chance of living longer, healthier lives.