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Consultant Diabetologist, Chennai
Rise of diseases and disorders globally accompanied with various complications took time to eradicate, regulate and treat five decades ago. We see that with rapid advancement and technological disruption in the field of healthcare, we were successfully able to find amazing medical breakthroughs for a large number of NCDs.
Diabetes care and management has really been transformed in the recent times with the help of new innovations and research. Insulin’s discovery was the turning point for big breakthroughs in treating and managing diabetes. I firmly believe that in my past work and papers, I have often highlighted that insulin needs to be made available to anyone who needs it and certainly that has to be ensured by all the major stakeholders in the decision making capacity . This is majorly so , since Frederick Banting and Charles Best, who discovered insulin, backed up by their passion for providing this clinical breakthrough for humanity believed that it was meant “for the world” and sold their patent for only a dollar.
Story of Insulin – A Century
I would like to take you through on how this insulin came into our lives and who were the major brains behind it. Insulin was discovered in the year 1921. Till that time all those who had insulin dependent diabetes (now called as type 1 diabetes), died within a days, weeks or months after the diagnosis of diabetes, because there were no medicines at that time to control the diabetes. By extreme starvation, a few extra weeks or months could be gained, but eventually they died a horrible death, often going into a diabetic coma. With the discovery of insulin in 1921 and after its commercial production began in 1923, the life of those with type 1 diabetes underwent a dramatic change. Initially, they managed to live a decade or two, but gradually with improvements in therapy the lifespan of people with type 1 diabetes is nearing that of non-diabetic people. The oldest person with type 1 diabetes in India is now nearly 90 years old having had diabetes for almost 76 years. We have many other patients who have completed 60 years with type 1 diabetes and they are all doing very well. Last year, the Dr.V. Mohan Gold Medal for Victory Over Diabetes was conferred on eight people with type 1 diabetes in India who had completed 60 years with diabetes and on continuous insulin therapy, and they are still doing well, with no complications. It is therefore obvious that the discovery of insulin is one of the greatest triumphs of modern medicine. Indeed, the Nobel Prize was awarded for the discovery of insulin within a year after its first clinical use. This is unprecedented in the history of Nobel Prizes. This itself shows the dramatic way in which the lives of those with type 1 diabetes was changed with the discovery of insulin.
Dangers of Insulin Rationing
Type 1 diabetes is a condition where there is an absolute lack of insulin in the body. As the body does not produce any insulin at all, it is extremely important for everyone with type 1 diabetes to take their insulin injections in the full doses that are required for them. It is extremely dangerous for them to ration their doses as their sugar levels could shoot up. There is also risk of their developing diabetic ketoacidosis and coma. Hence, insulin should never be rationed.
Role of Insulin
Definitely insulin cost plays an important role. If somebody needs insulin, but cannot afford it, there is a danger that the insulin could be stopped, and thus putting their life in danger. If the insulin is made affordable, then this issue will not arise. However, given that some people may not be able to pay for the insulin, whatever the cost, it is the duty of Society, Governments and Non-Governmental Organisations to ensure that everyone with type 1 diabetes who requires insulin should have adequate insulin supplied to them and cost should not come into the equation at all.
Regular check-ups are vital
It is very important for blood sugars to be tested by the elderly, because of the risk of low sugar reactions (hypoglycemia). While hypoglycemia is bad at any age, in the elderly, this can trigger a heart attack, a stroke, or even lead to coma or sudden death. Hence, it is very important to monitor the sugars and keep the blood sugars slightly above the normal, i.e., in the safe range, so that this risk of hypoglycemia is avoided in the elderly.
Is there is a need for awareness on Insulin Rationing?
Of course, they have to be educated that insulin rationing is not to be done under any circumstances. If a particular amount of insulin is needed, they have to take that particular dose of insulin. Regulation and proper balance of insulin intake guided by diabetologists is a crucial factor for all.
Combating Diabetes
Though we come across alarming statistics on the number of people with diabetes worldwide expected to reach 643 million by 2030 and India set to become the second highest number of people with diabetes (77 million), after China etc. or type 1 diabetes to double up by 2040, I believe that we need to have a concrete healthcare plan in the form a social health revolution to fight and keep Diabetes in control. This has to be backed up by experts in the field of Diabetes and medicine.
Active on-ground and social media campaigns, public awareness rallies etc. coupled with frequent public engagements with people advocating and propagating healthy food, proper diet and an active lifestyle is the need of the hour.
The above discussed suggestions are with regards to managing and controlling diabetes and its rapid spread among our population. Insulin has been the biggest blessing for treating and regulating Diabetes. One should never try experimenting with it at the cost of their health in terms of rationing the dosage either owing to lack of awareness or due to financial reasons etc.
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Views expressed above are the author’s own.
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