Insulin

The latest statistics suggest that in the future the majority of people with diabetes will live in developing countries. There are an estimated 35 million people living with diabetes in India, for example, and it is estimated that this number will rise to more than 73 million by 2025. Sadly, it follows that the majority of people with diabetes complications will come from countries whose health systems are not able to deliver quality diabetes care.

The first practical use of insulin by Banting and Best in 1921 heralded a medical revolution. Overnight, type 1 diabetes went from being a uniformly fatal disease to a manageable disorder. Thousands of people around the world have received awards for surviving 50 years on insulin – some reaching 80 years. Insulin is classified by WHO as an essential drug. Yet, 85 years after its discovery, untold thousands of people with type 1 diabetes and type 2 diabetes in developing countries die each year because they can neither readily access nor afford insulin.

DREAM Trust is a non-government organization and registered charity in Nagpur, central India. In this region and indeed throughout the Indian sub-continent and the developing world, covering the medication needs of a child with diabetes requires many families to commit a quarter of their monthly income. The principal objective of DREAM Trust is to respond to these needs by providing insulin, accessories and healthcare free of charge to poor children with type 1 diabetes.

At 7.59 am local time on 26 December 2004, a mighty earthquake rocked the floor of the Indian Ocean just northwest of Sumatra, triggering a series of large and powerful tsunamis that killed nearly a quarter of a million people – 168 000 in Indonesia alone. The tsunami decimated towns and cities from Indonesia, Thailand and the north-western coast of Malaysia to Bangladesh, India, Sri Lanka and the Maldives, thousands of kilometres away, and as far as Somalia, Kenya and Tanzania in East Africa.

I am a forty-seven year old white male living in Ypsilanti, Michigan, USA. For most of my life, I have lived in either southeast Michigan or northwest Ohio. I hold a Masters Degree and Bachelors Degree in Geology. For the last 17 years I have been employed in some form or another in the environmental resources divisions of major US car manufacturers. But neither my studies nor my employment record prepared me for the difficulties I have faced and the adversity I continue to endure in attempting to manage my diabetes.

Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction. Adolescence refers as much to the psychosocial characteristics of development during puberty as to the physical changes. Adolescents with diabetes, who need to adhere to a complex medical regimen based around self-care throughout this period of development, face a series of particular and considerable challenges.

When IDF brings together the global diabetes community at a World Diabetes Congress, it does so with a number of key objectives, which include raising overall diabetes awareness, sharing innovative ideas and best practices, and helping to build and consolidate networks – in line with the Federation’s mission to promote care, prevention and a cure for diabetes worldwide.

The move towards non-medical prescribing is a process that has evolved over the past 20 years. But some diabetes healthcare professionals continue to question its benefits. In this article, June James looks at the challenges surrounding non-medical prescribing and describes the training required for effective prescribing. The author focuses mainly on work undertaken in the UK but also explores non-medical prescribing in other countries, and the potential impact this might have on diabetes care worldwide.