Zimpapers Logo

Gloria Ganyani Correspondent
Yesterday, November 14, was World Diabetes Day. This is a day set aside to raise awareness on issues affecting people living with diabetes.
The theme for this year’s campaign is “Family and Diabetes.”

The family plays a crucial role in giving support to people with diabetes and it helps in the management, care and prevention of the condition.

Diabetes is a condition in which insulin is too little or unable to push the sugar we eat into the cells, leading to high sugar levels.
Insulin is a hormone produced by our body to help push sugar from the blood stream into the cells. Insulin facilitates the entry of glucose into the cells so that it generates energy.

Type 2 diabetes (T2D) occurs when the body is not able to use insulin well and it is commonly diagnosed in adults, while Type 1 diabetes (T1D) is when the body cannot make insulin.

T1D is mainly diagnosed in children and adolescents, and without insulin, these children will quickly die.
Management of T1D requires multiple insulin injections every day with careful monitoring of sugar levels.
Most T2D patients can manage their diabetes through a combination of diet, exercise and oral medications. For a few (10-15 percent), insulin injections will also be needed.

Due to economic hardships, many patients cannot afford to buy insulin and syringes to be able to inject themselves.
Some patients are forced by circumstances to ration the insulin so that they have at least some insulin for each day, although the dosage will be wrong, with potential serious consequences.

Some patients also use one syringe and needle numerous times, often until it is blunt, instead of once.
Implications of not taking insulin

The implication of rationing and not following prescriptions are serious.
In T1D, such rationing can very quickly be life-threatening, access to insulin quite literally is an emergency for them.
Patients also risk developing complications such as kidney impairment, diabetic ulcers, strokes and heart attacks.

Some of the complications that develop, such as kidney impairment may be irreversible, and diabetic foot ulcers can often result in amputations. The goal of managing this chronic disease is to reduce these complications that can massively reduce quality of life of people living with this disease.

Patient literacy is also very important because it enables patients to know about the condition, like the importance of checking the feet to avoid ulcers or the common side effects like low blood sugar.

Why we need to monitor blood sugar
If there is an imbalance between insulin need and the diet that patients are taking, they risk having abnormally high or low blood sugar, a condition known as hypoglycemia. Hypoglycemia may result in a variety of symptoms, including clumsiness, weakness, sweating, trouble talking, and confusion, loss of consciousness, seizures or death.

Testing of blood sugar is important because it helps to determine whether the patient has high or low sugars and if they are responding well to medication or not.

For the management of T1D, there is also need for constant monitoring of blood glucose for patients that inject themselves with insulin.

T1D patients are supposed to monitor their blood glucose at least four to seven times a day. In Zimbabwe, most diabetics struggle to do this even once a day.

Glucometers are used to test and monitor blood sugar levels. Many diabetic patients cannot afford to buy the glucometer and if they can afford the glucometer, purchasing the strips needed to test the blood sugar levels is an ongoing financial burden.

Assessments done in areas like Manicaland, where Medecins Sans Frontieres (MSF) is supporting the Ministry of Health and Child Care (MoHCC) to provide treatment to patients with diabetes and hypertension, show that there is a shortage of monitoring tools like glucometers, glucometer strips and reagents for laboratories.

Some parents who do not have glucometers have learnt how to pick up the signs and symptoms of high and low blood glucose through monitoring the behaviour of their children. When the blood sugar is low, some children hallucinate and sweat a lot. When the blood sugar is high, some children crave for food. But why should the children suffer like this?

Storage
Insulin is supposed to be stored in a refrigerator at about two to eight degrees Celcius, but for those who do not have refrigerators, they can use clay pots to store their insulin. They put water in the pot, put the vial inside and store in a cool place where there is no sunlight.

The insulin vial has to be packaged in a watertight plastic wrap before being immersed into the water-filled pot. The lack of a refrigerator should not prevent people being able to store and use their insulin at home.

As the nation commemorates World Diabetes Day, let us spare a thought for people with diabetes, particularly those with T1D, who are required to inject and monitor themselves for life, but in reality are rationing their insulin and guessing their blood sugar level for lack of the essential medicines and tools they need.

Let us spare a thought to the families supporting their relatives living with diabetes, they need our encouragement.
We call upon the Government and the donor community to provide funding for the package of tools needed to treat diabetes.
We encourage drug manufacturers to reduce the price of insulin to reflect the cost of production which we know is significantly lower than what is charged.

Access for insulin for T1D is an emergency we need to act on.
MSF has been providing treatment, care and support for patients with non-communicable diseases such as diabetes and hypertension in Manicaland Province, mainly in Chipinge and Mutare, using a nurse-led model, introducing differentiated service delivery (DSD) models since 2016.

Gloria Ganyani is MSF communications officer
Feedback: Email — [email protected]