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Knowing Diabetes

Diabetes is a condition where the body fails to utilize the ingested glucose properly. The term “diabetes” refers to a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both.

The causes of diabetes can be various from genetic conditions, family history as well as other health and environmental factors. Patients with high blood sugar will typically experience various symptoms. The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet. Diabetes can damage the many organs including tissue of kidneys, eyes, peripheral nerves, vascular tree, and eyes (causing blindness) and be the cause of loss of limbs in the lower extremities due to poor circulation.

There are three main types of diabetes mellitus: 

• Type 1: Diabetes resulting from the pancreas's failure to produce enough insulin;
• Type 2: Diabetes beginning with insulin resistance - a condition in which cells fail to respond to insulin properly;
• Type 3: Gestational diabetes - occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels.

Disease Burden of Diabetes

Currently it is estimated that there are over 260 million people with diabetes worldwide. There were 526,000 cases of diabetes in Nepal in 2015. Prevalence of diabetes in adults in Nepal (20-79 years) was 3.3% in 2015. Number of deaths in adults due to diabetes was 11,700 in Nepal. Nepal is facing increasing burden of non-communicable diseases (NCDs) and injuries. NCDs account for more than 44% of deaths and 80% of outpatient contacts. Cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, oral diseases, and mental disorders are the most commonly reported NCDs in Nepal.

With the increasing population and changing lifestyle, the burden of NCDs is very high especially in the urban areas. The basic treatment services for diabetes is now available in many places across the country but for major treatment, the patients have to come to the cities. The flow of the patients is also high at the central hospital. The treatment of these diseases require prolonged treatment and extra financial burden for families with low economic condition. The government has prioritized NCDs in the National Health Policy 2015 as well as National Health Sector Strategy 2015-2020, which also includes diabetes. 

A Visit to Bir Hospital

Bir Hospital, the oldest hospital of the country is preferred by many people living in and outside the valley. As this government health facility provides service in minimum amount many people with low economic condition visit the hospital for treatment.

Lack of Awareness and Facilities

When we visited the hospital, various types of patients are seen outside the ward waiting in the queue. Most of the patients didn’t have any idea about the disease while some seemed to know a little. They were aware about the disease but not to a great extent. Most of the patients were friendly and were seen asking many questions to patients who were living with the disease for a long time.

HERD team talked to some of the patients in the hospital. A sixty year old Female Community Health Volunteer (FCHV) was waiting for her turn. She had come to the hospital for checkup as she suffered from thyroid but her blood test showed diabetes as well. She said, “I have been working as an FCHV for the last 22 years. Throughout this time, I learnt about few diseases but diabetes wasn’t one of them. I inquired the disease only when the doctor said I had it”.   

She was not only the one; many patients were unaware about the disease. Another patient aged 55 from Dhangadhi also shared that she learnt about the disease only after the doctor informed her. Unlike them, a literate man aged 50 from Bhaktapur who also suffered from diabetes seemed very positive about the disease and its treatment. He was aware about the disease and believed it is not the doctor but the patient who can control the disease. “Diabetes can be controlled. It all depends upon the will of the patients to control his/her diet and exercise on a regular basis”, he said.

Most of the patients come to Kathmandu due to the lack of proper health facilities. One of the patients shared that although she had her checkup with the doctor in her hometown Palwanpur of Dhangadhi, she was not satisfied with the treatment she received. Even the prescribed medicines were not available in Dhangadhi so her son had to send her the medicines from Kathmandu.

Changing Lifestyle and Subsequent Effects

Lifestyle of almost all the patients has changed after they suffered from diabetes. They shared that the body doesn’t remain as active as before. A 42 year old patient from Chitwan shared that she cannot work like before and the color of her skin has changed too. She shared, “I go for a walk everyday but I lack the energy like I had before. I have also changed my food habits, I avoid sweet items completely”.

Changing food habits is not as easy as it seems. A 55 year old patient shared, “spending long time in the kitchen is difficult so I try to make food which is good for me as well as the family”.

Conclusion

Diabetes is a chronic as well as painstaking disease which requires frequent care and long term treatment. Even after many attempts the patients were upset that the disease is never cured. The patients also stressed on the need of conducting tests time and again. Mostly in the rural areas, the symptoms remain unnoticed. They are informed about the disease very late. The economic condition of many people is weak and coming to the city for checkup has been challenging for many of them as out-of-pocket expenditure would be very high. Diabetes doesn’t just affect the body, it affects the life of the patients and their families.

Non-communicable diseases are gradually emerging as new threats in public health. It is imperative that more awareness is spread about the dreadfulness of diabetes and the impact it can cause to the patients and their families. On the other hand, it is also equally important to have a well-functioning health systems that can ensure affordability, accessibility and better quality of health services catering the needs of patients suffering from non-communicable diseases such as diabetes.

References

http://www.diabetes-info.co.uk/what-is-diabetes/facts-and-figures-about-diabetes.html

http://www.idf.org/membership/sea/nepal