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Abstract

A quick diagnosis of type 1 diabetes (T1D) and the start of a prompt therapy with insulin are necessary for preventing a dangerous ketoacidosis (DKA). Nevertheless, the unmotivated confidence in alternative therapies has led to serious consequences, as we show in the following case. A 15 years old girl at the onset of T1D presented with DKA and leg skin necrotic ulcers due to sustained hyperglycemia. She has been treated with insulin infusion and after 24 hours of IV therapies, a basal bolus therapy (Lyspro and Glargine) had been started. During the inpatient hospital care educational therapy has been performed by Diabetology Unit Staff. During the follow up she mantained a good metabolic control with a HBa1c lower than 49 mmol/mol. Nine months after diabetes onset she has been evaluated by an enchantress, who denied T1D diagnosis and recommended to stop the insulin therapy in order to stimulate the insulin secretion. She recommended to take galenic formulations containing vitamins and mineral salts, taken both orally and through poultice. Parents reported that three days after discontinuing insulin, the daughter presented with abdominal pain, weakness, drowsiness. General conditions worsened in a week and she started presenting pale skin, dehydration, Kussmaul breathing and coma. After ten days she presented with a respiratory arrest and parents called the Emergency Medical Service. When she arrived at the hospital she was unconscious, intubated and mechanically ventilated because of the cardiorespiratory arrest; glycemia was 47.22 mmol/L and blood parameters showed a severe DKA (pH 6,5) and hypovolemic shock. Although the clinical condition were severe, the parents asked to continue the treatment with their galenic formulation. Despite the IV administration of liquids, insulin, bicarbonate, dopamine, the day after she died. During the same year, other two children died for neglected diabetes worldwide.