Roopa, 20, was brought to my hospital in an unconscious state, breathing heavily, looking pale and weak. "Look doctor what has happened to my wife" said a rather young looking husband of Roopa, "we are married for only about a month, and she was alright."

About 5-6 days back when she started going to toilet a bit too often at night, and looked weak, household medication was given to her thinking that it is indigestion, or MORNING SICKNESS, but today she started vomiting a lot and is gradually becoming Unconscious" The examination revealed that she had blood glucose level of 335mg/dl,

Urine ketones (++++), and features of severe urinary infection, and dehydration. The young girl were in DIABETIC KETOACIDOSIS. "Doctor I want to tell you something in confidence" said Roopa's mother who had reached hospital by then; "Roopa is a Juvenile diabetic since the age of 13 years and has been well controlled on insulin, we had kept this a secret at the time of her marriage, she probably managed once a day or once in 2-3 days insulin shots at her in laws' place".

Roopa gradually developed insulin deficiency but managed somehow, but when urinary infection

came up this lead to steep rise in blood sugars, requiring more insulin but because of fear of opening of her secret about diabetes, she could not tell her husband to get her medical aid. In hospital she was kept on insulin infusion, rapid intravenous fluids, antibiotics and one hourly blood glucose monitoring, she became fully conscious in 4-5 hours, her blood glucose came down to 220 mg/dl, ketones became less and she was well enough to go home in 5 days time BUT not before the whole family was given Counselling about Roopa's disease, its, management and that ROOPA WILL PROBABLY BRING ALL THE HAPPINESS TO THEIR FAMILY PROVIDED SHE GETS THEIR FULL SUPPORT,

This and many such events indicate towards the need for

• More purposeful education of people regarding juvenile diabetes
• Counselling of family with a diabetic child regarding social tolerance
• More openness at the time of marriage of diabetic boy or girl.

* If you are sick and have diabetes.

• Check your blood sugar more often, keep taking your medication, drink plenty of liquids and always mention all the medicines you are taking to your doctor, as some can affect your blood glucose.

* Foot care in diabetics is important.

• Wash feet daily with water and soap, dry thoroughly especially between toes and check for blisters, cuts and sores. Avoid walking barefoot, examine shoes for pebbles, cracks or nails and minimize any risk of injury.

* Are artificial sugar substitutes safe during pregnancy ?

• Sugar substitutes are generally compounds made up of simple forms of proteins. Since it is not a sugar it is used as a sweetener by people with diabetes and is also safe during pregnancy.