A Case From Medical Practice. Real Men Don't Get Diabetes

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A Case From Medical Practice. Real Men Don't Get Diabetes
A Case From Medical Practice. Real Men Don't Get Diabetes
Video: A Case From Medical Practice. Real Men Don't Get Diabetes
Video: Type II Diabetes: Case Study 2023, February
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A case from medical practice. Real men don't get diabetes

A mother with a 16-year-old child consulted for further treatment tactics. About 2 years ago, the boy suffered from cryptogenic meningitis, after which his school performance deteriorated.

A mother with a 16-year-old child consulted for further treatment tactics. About 2 years ago, the boy suffered from cryptogenic meningitis, after which his school performance deteriorated.

The child does not actively present complaints. During a detailed survey, he mentioned episodic ringing and tinnitus, rapid fatigue, insomnia (he sits at the computer for a long time at night).

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According to an objective examination: he answers questions with a delay, avoids direct eye contact. The gaze is lowered, rather defocused. Motor reactions are slightly inhibited. Hypomimic, speech is quiet, emotionally poor. The phrases are logical, meaningful, the sentences are partially broken. Height is above average for sex and age (about 180 cm). Physically, the physique is closer to asthenic, the nutrition is slightly reduced. Skin with a marble tint, slightly noticeable vasomotor hyperemia of the face. The hands and fingers are proportionally elongated and thin.

In the neurological status from the side of the cranial nerves, there is a slight horizontal finely sweeping nystagmus in the extreme leads. Muscle strength and tone are physiological. Tendon, proprioceptive reflexes are lively, symmetrical. There are no sensitive violations. In the Romberg position, he is stable, there is a slight tremor of the eyelids with the eyes closed, he performs coordination tests confidently with subtle intentions on both sides. There were no obvious cognitive impairments. Upon discharge from the hospital, nootropic drugs and vitamin therapy were prescribed in courses, the intake of which had already been completed.

Anamnesis: sick with type I diabetes mellitus from the age of 10. On average, it pricks about 50 units of insulin per day.

The older child, from the first pregnancy in marriage, has a sister and brother. Parents have been divorced for more than 3 years. After the divorce, the mother and children live with their grandmother in a city apartment.

Reference. Type I diabetes is a genetically determined autoimmune disease. In children, it is called "juvenile diabetes". For the emergence, a combination of hereditary predisposition and almost always some external triggering causes is necessary. The first circumstance is a higher level of certain HL histocompatibility antigens (loci B8, B15, Dw3, Dw4, DRw3, DRw4 in the 6th chromosome). The presence, let alone their combination, increases the risk of developing insulin-dependent diabetes tenfold or more. Leukocyte histocompatibility antigens are special antigen-presenting proteins on the cell surface, which are responsible for correct recognition in terms of "friend / foe" and an adequate immune response to a foreign agent. The external trigger for type I diabetes mellitus can be viral infections, incl.h. flu, as well as severe psycho-emotional stress. There is a breakdown in adaptation in the nervous and endocrine systems. The immune system's own immune system begins to destroy the β-cells of the pancreas, depriving them of the ability to produce insulin, a hormone that ensures the absorption of glucose into tissues. The destruction of 70 - 80% of all β-cells of the pancreas leads to an irreversible situation. Glucose is the main energy component of the cell. Its concentration in the blood increases, but it does not enter the cells. There is a total lack of a vital compound with an external excess in the blood. As a result, a hyperglycemic coma, the absence of quick remedial measures is a fatal outcome.The immune system's own immune system begins to destroy the β-cells of the pancreas, depriving them of the ability to produce insulin, a hormone that ensures the absorption of glucose into tissues. The destruction of 70 - 80% of all β-cells of the pancreas leads to an irreversible situation. Glucose is the main energy component of the cell. Its concentration in the blood increases, but it does not enter the cells. There is a total lack of a vital compound with an external excess in the blood. As a result, a hyperglycemic coma, the absence of quick remedial measures is a fatal outcome.The immune system's own immune system begins to destroy the β-cells of the pancreas, depriving them of the ability to produce insulin, a hormone that ensures the absorption of glucose into tissues. The destruction of 70 - 80% of all β-cells of the pancreas leads to an irreversible situation. Glucose is the main energy component of the cell. Its concentration in the blood increases, but it does not enter the cells. There is a total lack of a vital compound with an external excess in the blood. As a result, a hyperglycemic coma, the absence of quick remedial measures is a fatal outcome.but it does not enter the cells. There is a total lack of a vital compound with an external excess in the blood. As a result, a hyperglycemic coma, the absence of quick remedial measures is a fatal outcome.but it does not enter the cells. There is a total lack of a vital compound with an external excess in the blood. As a result, a hyperglycemic coma, the absence of quick remedial measures is a fatal outcome.

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Story

I continue the conversation with the child's mother.

- Tell us how the boy fell ill, how did you manage meningitis, when and under what circumstances did you get diabetes? - Oral details often complement the clinical picture significantly. - What's the name, by the way?

- Ruslan is his name. We moved to live with my husband in the village, when he grew up and started going to school - my mother was ready to tell about everything - you know, there is always a lot of work in the village. The former spouse is a very respected person there, we had a lot of relatives along his line, he wanted a son, he wanted to raise a real man out of him. He himself worked a lot, and in the yard too, and with his brothers. The son was woken up early: it was necessary to give food to the cattle, clean up, cook everything, help the adults. You have to be quick, to keep up with everything. My husband is very demanding, strict, he needs order everywhere, he is very hard-working, everything with his own hands and around the house, and everyone needs everything at work. He always demanded the same from me. But the son did not always keep up with him and did not cope with the tasks that he entrusted him, did not get enough sleep, then he had to go to the Tatar school, and there were 3 classes, and the guys were local,he could not or did not want to study there either. His father tried to educate him, well, of course, maybe he was too strict with him. It was hard for the child, I understand now, but he is not the only one, because his peers live in the villages, help around the house, and nothing. And then, when he had an attack, when he was barely rescued and already in the hospital they told us that it was diabetes, I remembered that my cousin also had some kind of diabetes. Insulin was prescribed, because it is treated in the same way for everyone, but how to live in the village and not work? All the same, his father forced him, sometimes scolded him …when he was barely rescued and already in the hospital they told us that it was diabetes, I remembered that my cousin also had some kind of diabetes. Insulin was prescribed, because it is treated in the same way for everyone, but how to live in the village and not work? All the same, his father forced him, sometimes scolded him …when he was barely rescued and already in the hospital they told us that it was diabetes, I remembered that my cousin also had some kind of diabetes. Insulin was prescribed, because it is treated in the same way for everyone, but how to live in the village and not work? All the same, his father forced him, sometimes scolded him …

- He beat me with a whip in the barn … - the boy said quietly, turning half-turned to his mother, without raising his eyes from the floor.

- When did you beat? - the mother was a little confused and looked at me embarrassedly, expecting his reaction. There was no reaction.

- When, when … I told you when … Always, constantly, if I did something not as he demanded. Only you always waved it off and didn't want to hear, - Ruslan uttered almost without a hint of emotion.

- Well, yes, maybe he did. But after all, they were there, in the courtyard, with the men, all were always together, there was a man's work, I never climbed there, we have our own worries, - as if making excuses, turning to me, mother quickly said, diabetes, we found out who in my family also suffered from diabetes, it's in my line. The husband says that his father raised him with a whip as a child, and his brothers. But all of them have grown up as men, none of them get diabetes from this, on the contrary, how strong they are all in his family, stocky. Everyone respects them in the village.

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- Everything is clear, the picture is almost clear. Your husband probably did an excellent job at school?

- Well, yes … - a little surprised, she immediately agreed, - you just guessed? I didn't seem to tell you …

- A woman should know her place and not interfere in the affairs of men, - probably, somehow he told you so?

- Exactly! - on her face surprise mixed with a smirk of recognition. “He is very proud that everywhere he studied only excellently,” his mother continued, “and he is a very good specialist in their workshops, everyone turns to him. And at home, he always demanded order, the same as in his father's family. For me it was sometimes unbearable, I was not used to that. Even when he courted me before the wedding, he was so attentive, caring and persistent, everything was nothing. It seemed to me that he was so reliable and it would be possible to live with him, but something weighed down, and I didn't want to marry him all the same. My mother tried to persuade then strongly, said that now there are not enough so that I agree, and I listened to her. In the family they have a different way of life, different orders to which I had to obey. We lived hard, the decision to leave was hard. I thought he was going to kill me.But it doesn't matter for me already, I decided to leave completely, when for a second time I didn't lose my son with this meningitis.

- Thanks for the details, on the whole it was predictable. Anyone who is familiar with at least the most basic knowledge of Yuri Burlan's System Vector Psychology training will tell many other details about your ex-husband and your life with him, even without being personally acquainted with him … And this will not be the focus. Let's ask Ruslan, tell us how you got sick? - an attempt was made to hear the details this time firsthand.

Mom took a deep breath, intending to answer, but my gesture stopped her.

After a little pause and as if gathering his thoughts, Ruslan, at first reluctantly, then more vividly, as if he was afraid not to have time to say, began to speak:

- I went to the bathhouse in the evening, after work I was tired, I wanted to wash, they forgot about me, turned off the light and went to bed. I was very cold and, while I got to the house poorly dressed, I stayed in a strong frosty wind for a long time before I got into the house, - looking at the floor in front of him, the boy said, - and then in the morning I felt bad, but my father said work, then it became very bad a day later, the temperature, my head was splitting, and after that I don't remember anything else. No, I remember a little, I told some doctors that I had diabetes and that I felt bad, but they brushed it off and did not believe it, then I don’t remember anything again. Only when I was in the hospital I started to remember something.

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Reference. Cryptogenic meningitis is an inflammation of the meninges caused by a fungal infection (usually cryptococcosis). It develops in patients with weakened immunity, suffering from hemoblastosis, other tumors, diabetes mellitus, in HIV-infected. Diagnosis is difficult due to the underlying disease. The inflammatory process is localized mainly in the basal parts of the brain. Low immunity extremely complicates the course of the disease. An acute onset with pronounced signs of meningoencephalitis makes the prognosis absolutely unfavorable.

- Doctor, I thought he was sleeping at home, and we turned off the light everywhere and in the bathhouse too (the switch in the house) and lay down. It was February, we had very strong frosts, and the wind was blowing, the bathhouse was standing to the side of the house. - Mother confusedly told the details.

- I realized that they forgot about me. I should either spend the night in a cold bath, or try to run home. After sitting a little, I decided to run. It was cold, - added Ruslan.

- After that, I could not stand it any longer to live in this village, I gathered my children and went to my mother. He skipped school, almost a year, with these diseases. Now she's already on disability.

- Are you divorced?

- Yes, he brings us alimony every month and meets with the children.

- Hits children the same way?

- Well, not much, hit the head a couple of times to this, this … But, doctor, it's hard for me myself, the younger ones don't listen to me at all, and when he arrives, they become like silk and clean the apartment and sit down for lessons. He is strictly with them, well, perhaps, with them it is necessary? And how else to educate, I no longer know. The elder sits at the computer at night, I work, I do not have enough strength, I break down, I recently pulled my daughter by the scythe - brought it out, - the woman sincerely wanted to speak out and complain, - the husband calls back, says everything will be different, but I will not return there to him. Do you think anything will change? Will he stop being like that with us?

- No, you should not deceive yourself, think about your younger ones, they will soon go to school, - I answered carefully.

- So I think that it will not change, but you know, he is threatening, he even said somehow, being angry that he would order me, - in her eyes, fright was guessed, - but he never touched me with a finger, beat the children, but I was gone …

- Your husband's behavior in many ways provoked your son's illness. Beating is not upbringing, beating is the one who cannot find an approach and words. They don't respect him, they fear him. And life in constant fear, you understand, has not benefited anyone yet. I strongly discourage you from raising your children in this way. And if you want your children to have a healthy future, you will have to make an effort and try to sort out the details of what happened in recent years that have escaped your attention and understanding in order to live on and minimize the consequences of what has already happened. There are ways to do this. And after all, there are positive aspects: now you live with your mother and children in the city, you have found a job, as far as I understand, there is enough money for the necessary expenses. Ruslan, would you like to play on the computer for the rest of your life or what are you doing there?

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- I want to study, I will not return to the village, - this time the answer was quick.

- Yes, he tells me that he really wants to study at school, and I want it, - my mother nodded.

- So this is great. Send the guy to school, here are the necessary medications for you that Ruslana can take in courses for the purpose of further rehabilitation and rehabilitation treatment. We will try to maintain a margin of safety where we can at least somehow manage it, and regular monitoring of an endocrinologist is mandatory.

- Thank you so much. You said that it would be desirable for me to think about how to live further, you will not believe it, I went to several psychologists and psychotherapists before you. All of them demand that I make some decisions, they say that I am to blame for everything, that I must set myself up for a good future for myself and my children and achieve everything on my own. But for me all these are empty words, I do not understand what my fault is, how to avoid now this relationship with my ex-husband. It seems to me that they do not know him at all and accuse me, in general, I don’t understand how I should be, and even my mother now accuses me, only I didn’t hear any reproaches from you. Did you talk about something that there are some means that will help me? Do you want to assign something to me too?

- Not to appoint, but to advise what has recently become a discovery for me. These are not pills, all that is required of you is your desire, perhaps, to rethink some things in a different way and your willingness to listen carefully to what they tell you for a while. Ruslan, too, may be interested. Perhaps you will allow him to listen to the introductory lectures with you.

System-vector postscript instead of conclusion

The first thing that catches the eye of anyone familiar with systems thinking is the anal father and the skin and sound boy. The anal father's demeanor is heightened and accentuated by the village landscape and rigid mentality. To teach is to beat. He believes that since he was beaten and nothing bad happened to him, but rather, on the contrary, having matured, thanks to this, he also became a respected person and fit into his social niche, then you can do the same with your children.

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In addition, there is a muscular village mentality. We remember who organically fit into the village environment, which is quite difficult and requires daily physical efforts to provide themselves with a piece of bread - these are the gene pool carriers, muscle people. They are completely complementary to the environment, regular work, muscle tension gives them that equivalent of pleasure and enjoyment that fully satisfies them. The threat of physical punishment, even some kind of flogging, is more likely to be perceived by them as an adequate measure of influence and will not be able to cause a catastrophe in the mind, unless there are traces of massive beatings at the level of the physical body. Even some 100-150 years ago, physical punishment, especially among the muscle population, was widespread and quite acceptable. Mentally stuck in the past, his anal vector lives in the father in a far from developed form.

There is reason to believe that the thoughts of Ruslan's anal father would even be somewhat justified if the proverb "An apple falls not far from an apple tree" were one hundred percent correct. In fact, this is far from the case. And as before, and now, bright oranges sometimes appear on apple trees. Unfortunately, parents who are not familiar with systemic knowledge do not know this, and many of them, even verbally declaring the notorious individual approach, in fact continue to tailor their children for themselves, without realizing the slightest account of this.

The first child in the family turned out to be a sound specialist; in the village, the conditions for the development of such a child are far from being the best. His desire to acquire knowledge could hardly be fully satisfied in the conditions of a rural primary school, where there is one teacher for all subjects and there are only a few children in the class. It is difficult for a skin sound engineer to cope with physical labor with the same efficiency as in anal-muscular people.

The traditional, conservative, household style of life, which was adopted in the father's family, did not allow women to delve into the male part of the household. The dominance of an authoritarian father could not be limited by anything. The child made timid attempts to receive at least partial protection and to gain a sense of security from the mother, but, as we see, in vain. The mother is very aware and herself, apparently, was afraid of her husband. The loss of one of the most important feelings of safety and security that a mother gives him from birth has made the situation even worse.

If for someone a regular early morning rise is not so difficult, then for a sound child, even an extra hour of sleep is sometimes vital. The lack of adequate rest has a cumulative effect and, accumulating, also contributes to the disturbance of neurohumoral balance. Against the background of destroyed immunity, and even more so the general state of the body weakened by type I diabetes, the addition of any infection is only a matter of time, and any cold can lead to the most serious complications.

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For an outside observer, this story is a confluence of unfavorable circumstances in which each of the adults seems to find justification for themselves, but for people familiar with systemic knowledge, all the background, all the ulterior motives of behavior and deep lack of participants are visible. Ignorance of the true roots and root causes of many troubles dooms in the end to their repetition.

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