P-266: Herbal medicine exposure unmasking type 1 diabetes or triggering disease? a diagnostic dilemma in new-onset childhood diabetes with delayed insulin initiation
F M AdinewAbstract
Introduction
Delayed initiation of insulin therapy after diagnosis of childhood diabetes remains a major contributor to severe diabetic ketoacidosis in resource-limited settings. Traditional herbal preparations with undisclosed composition are commonly used and may influence symptom recognition and caregiver treatment decisions.
Objectives
To describe progression from untreated mild to severe diabetic ketoacidosis in a child with new-onset diabetes following herbal exposure and caregiver refusal of insulin therapy.
Methods
A previously healthy 6-year-old developed polyuria, polydipsia, and increased appetite within 24 hours after receiving a green liquid herbal preparation from a traditional healer. No weight loss or fatigue was reported. Initial testing showed a random blood glucose of 350 mg/dL with glucosuria. Insulin therapy was recommended but declined by caregivers due to concerns based on prior experiences with a paternal cousin who has type 1 diabetes and recurrent hospital admissions after starting insulin. Three months later, the child presented with dehydration, HbA1c 11%, random blood glucose 440 mg/dL, and urine ketones +4, consistent with mild diabetic ketoacidosis. Insulin therapy was again refused, and the child was lost to follow-up. Six weeks later, the child returned with abdominal pain, vomiting, and drowsiness. Random blood glucose was 280 mg/dL with urine ketones +4, consistent with severe diabetic ketoacidosis requiring emergency treatment.
Results
Survival between episodes without insulin was likely due to residual endogenous insulin secretion during early autoimmune beta-cell destruction prior to progression to severe insulin deficiency.
Conclusions
This case highlights a diagnostic dilemma between environmental triggering and unmasking of evolving autoimmune diabetes, and underscores the importance of addressing caregiver perceptions to prevent severe diabetic ketoacidosis in resource-limited settings.