SEATTLE â€” Type 1 diabetes can be challenging to live with. The pancreas produces little or no insulin, so the diabeticâ€™s life becomes dependent upon access to insulin injections. In addition, insulin must be balanced with food consumption, so the diabetic also needs to have a blood sugar monitor, blood sugar strips and a lancing device with accompanying lancets. All of these things cost money, which means that life with diabetes at different income levels can be challenging, especially if the diabetic is poor.
According to Gapminder, countries around the world are divided into four income levels, with Level 1 being the poorest and Level 4 being the richest. Level 1 is extreme poverty. Level 2 is lower middle income; people can afford to eat. Level 3 is upper middle income; people have water from taps and some basic appliances. Level 4 is upper income; people can afford decent cars and regular vacations.
In Level 4 income countries, supplies are readily available to those who need them. Many can even make managing diabetes easier by using insulin pumps and continuous glucose monitors (CGMs). Unfortunately, these supplies are only available to people with health insurance because American healthcare is not universal. Other Level 4 countries have universal health care and diabetics receive supplies regardless of their income level.
The author currently uses a CGM, which reads blood sugar every five minutes. Even with this device, she tests her blood sugar thrice daily. Before the CGM, she tested a minimum of seven times daily. She also injects insulin five times a day. With minor variations, this reflects the standard of care in Level 4 countries.
Diabetics in China have ready access to insulin, blood sugar monitors and all related supplies. In fact, the Chinese government provides them for free. CGMs and insulin pumps are not provided and are too expensive for many families to afford.
Proper diabetes education is also an issue in China. Patients are not taught how to count carbohydrates, an essential skill, instead being taught to inject fixed insulin doses at mealtimes. Nurses are often not given enough education to properly teach their diabetic patients. The Internet has somewhat alleviated this by allowing Chinese diabetics to research their conditions and compare notes, but it is still a major problem.
Currently a Level 3 income country, Jordan was a Level 2 country when the authorâ€™s family was living in Amman. This was reflected in the quality of care that the author received upon being diagnosed. She was hospitalized for a week, stabilized, and her parents were taught how to give insulin injections. They were then told to come back to the hospital twice a week to have the authorâ€™s blood sugar tested via a blood draw. However, her parents had to learn everything else about diabetes from the Internet.
The family physician allowed the family to borrow his officeâ€™s monitor, but there were no test strips available in Jordan, so the authorâ€™s blood sugar could not be tested at home. Ultimately, the family returned to the U.S. to get the author better care.
Belize is a country that is currently at Level 2, and its diabetics face similar problems. Currently, organizations in Level 2 countries, such as the Belize Diabetes Association, are given donations of diabetes supplies from Insulin for Life, which are then distributed to families who could not otherwise afford them. However, they do not always have adequate supplies in stock, and Belize is currently experiencing a shortage of lancet tips. While these supplies are available at pharmacies in the country, many people are too poor to afford them, leaving them dependent on donations to manage diabetes.
Just like in Belize, poor diabetics in The Gambia rely almost entirely on donations from Insulin for Life for their supplies. Once a month, they stand in line at the local hospital to receive refills of insulin and other supplies. However, they receive so little that they are considered lucky if they can test their blood sugar once a day and inject insulin twice a day.
Insulin must be kept cold before it is used in order to remain stable. Once it is in use, it must remain at room temperature. In the hot African climate, the former is impossible without refrigeration, which nearly 90 percent of people do not have access to. In order to keep insulin at room temperature, they must wrap it, wet it and bury it in the shade, proving that life with diabetes at different income levels is far from easy.
The World Health Organization has said that 75 percent of diabetes deaths happen in low- and middle-income countries. About 80,000 to 100,000 children wake up not knowing if they will have adequate supplies to properly manage their diabetes that day.
There is one saving grace: It is possible to donate diabetes supplies that are no longer needed. Insulin for Life accepts donated supplies and distributes them to healthcare providers around the world to give to diabetic patients. With such a service in place, life with diabetes at different income levels is more bearable for all concerned.
â€“ Cassie Parvaz