Testing the limits - the double burden of diabetes and disaster


How do we measure a diabetes crisis? Living with diabetes, particularly type 1 diabetes, in the developed world often exposes the limitations of life-saving therapies and medications: testing blood glucose five to ten times per day, injecting insulin anywhere from six to ten times daily, wearing medical devices subcutaneously and dealing with hyperglycaemia and the threat of complications against tight blood glucose control and the risk of severe, sometimes fatal, hypoglycaemia. In the best circumstances, diabetes therapies are difficult, but people can survive.

Now imagine a double burden such as the isolation and deprivation in war or natural disaster: these are regions without electricity, clean food and water, medical care and essential diabetes supplies. Consider the ten-year old boy living with type 1 diabetes who, buying time in a refugee camp, is finally administered a blood glucose test by an aid worker. The result of the test is alarming; perhaps well over 40 mmol/L (720 mg/dL), partially because he had his first bowl of food for the first time in a week. How long will he survive without insulin?

Testing the limits of diabetes in a world where early death from the condition is preventable is intolerable and unjust, but still occurs today in many regions worldwide. Thankfully, aid sometimes arrives, saving lives in a climate where international aid operations often dictate ‘diabetes is not in the framework and not an emergency’.

Our special report focuses on three regions and the voices of those closest to diabetes in environmental or political crisis: doctors and aid workers helping people without diabetes supplies survive the aftermath of Typhoon Haiyan in the Philippines; an insulin distribution team and advocacy leader who are taking risks to get insulin to those most in need in Syria; and a team of specialists saving the lives of thousands who live with diabetes in the Republic of Mali.