The World Health Organization (WHO) estimates 346 million people worldwide have diabetes. 5-10% of these are expected to be juvenile (or Type 1) diabetics. In 2004, an estimated 3.4 million people died from consequences of high blood sugar and 80% of the deaths came from low- and middle-income countries. India, with a sixth of the world's population at relatively lower income levels has a horrifying share of the numbers above.
While juvenile diabetes has many shared challenges across nations -- patients need to mathematically coordinate exercise, insulin, and diet -- there are a few behaviors that make advising patients with juvenile diabetes in India more challenging:
(1) Hoping against hope with alternative treatments.
Newly diagnosed patients lacking knowledge of the science underlying juvenile diabetes sometimes turn to practices such as Ayurveda and Homeopathy holding out hope for a magical cure. Patients should accept that insulin therapy is the only proven methodology for management of juvenile diabetes.
(2) Inability to account for unlabeled / unpackaged food.
In the West, restaurants and fast-food joints have nutritional labels. In addition, food cooked at home uses ingredients that come in labeled packets. This is not the case in India. Home-cooking uses ingredients that are sold unpacked and unlabeled. Similarly, restaurants and fast-food joints often vary in recipes and portion sizes making it hard to adjust insulin according to carbohydrate intake. Juvenile diabetics in India need to overcome this by measuring portions, understanding food recipes, and using raw data sources to deduce the carb-content of the food they consume.
(3) Unsophisticated consumption of insulin.
There are several types of insulin (rapid-, short-, intermediate-, and long-acting) and regimes (basal/bolus through pump or multiple injections) appropriate for different patients in different circumstances. Patients in India often think of insulin as just any other routine medication (like a course of antibiotics!). This is grossly sub-optimal. They need to be educated in some of the science behind different insulin therapy options in order to effectively use these.
(4) Insufficient development of chronic disease management systems and attitudes.
The attitude towards a chronic disease should be fundamentally different from that towards an acute ailment. Patients often are delinquent in regular check-ups, HbA1c tests, blood-sugar monitoring and record-keeping. Doctors and medical practices have not created a system of nurse practitioners and additional medical advisors to address smaller, day-to-day needs of juvenile diabetics. Juvenile diabetics in India will benefit greatly from an all-round chronic disease management attitudinal face-lift.
(5) Lack of reading helpful books, blogs, and publications from credible sources.
There are many manuals, books, blogs, and magazines available for juvenile diabetics around the world that patients in India are not using. Here are some recommendations: Think Like a Pancreas, Joslin Guide to Diabetes, Mayo Clinic on Management of Diabetes, Smart Pumping, The Ultimate Guide to Accurate Carb Counting, Diabetes Forecast, Diabetes Self -Management (Most of these and others are available on Flipkart.com, the Indian online bookstore).
The barriers that inhibited world-class juvenile diabetes care in India are disappearing. Doctors and patients alike have access to much more information through the internet and books, more patients are able to afford insulin pumps and regular insulin therapy, and newer technologies are available in India due to the presence of multinationals. Now it is up to the medical community and the diabetic community to use resources at their disposal for better medical outcomes.
Co-authored by Dinkar Jain and Dr. Abha Jain.
Dr. Abha Jain has been practicing medicine in New Delhi since 1983. She was a physician for the Government of India's Health Scheme. She currently does charitable medical counseling to patients of juvenile diabetes in North India.
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