Happenings!

Well i know i've been slack with updating my blog, and for that my apologies!

We've recently had a change in Federal Government here in Australia, which poses a few issues. The previous Howard government promised $22million towards increasing access and reducing the outlay prices of insulin pumps (which here, un-covered by insurance, cost around $US10'000) each. The obvious strain on families and/or the person with diabetes is significant, on top of the ongoing costs of insulin and consumables (even though they are funded by PBS and the NDSS respectively).

The ongoing argument remains: does a government pour money into subsidising insulin pumps, which some people say would be a luxury healthcare item? I beg to differ to those arguing the no, which is the case taken up by so many governments over the world.

You see, without an insulin pump, a type-1 diabetic can only go so far without feeling like a pin-cushion. A basic basal/bolus regime using insulin pens (or syringes) will cause the person with diabetes to be injecting up to 8 times a day to have proper, controlled care. Even then, the variations in BGL's can still be extreme, causing a higher overall HBA1c, and putting the person with diabetes at a much higher risk of future complications.

But this point is overseen by governments and private healthcare insurance providers. They fail to realise that a person with diabetes can not have 'perfect' care on insulin pens/syringes alone, despite how effective the insulins may be.

The subsiding of insulin pumps is an investment, quite plainly. Insulin pumps make it easier for people with diabetes to take better care of themselves, reducing the risk of further complications. Now what does this do? This helps reduce the risk that in the future, governments will be paying for the kidney dialysis, the post-op amputation care and rehab, the constant heart monitoring and eye checks, and possible eye/laser surgery.

Unfortunately, governments, cabinets and ministers/secretaries alike fail to realise that spending now prevents larger spending in the future.
This effect is further compounded by the double-whammy effect of having a diabetes pandemic - with more and more people with diabetes, this will lead to more and more people with diabetic complications; causing further strain on Medicare and similar systems.

So the solution remains clear; Invest now to prevent imminent social and financial hardship, not only for people with diabetes and their families, but for healthcare and Medicare-related systems.

Halle Berry - A fairly confused 'advocate' for diabetes..

Halle Berry, diagnosed with Type-2 diabetes in 1989, is possibly one of the most famous persons living with diabetes. However, this fact is coming under scrutiny.

Berry is in a perfect position to be a global advocate and ambassador for people with diabetes. Beautiful, well-known and a person with diabetes herself, there is no limit to the effect she can make with her words. However, that all depends on the words that actually come out. In the past, she has shown diabetes in an accurate light. In an article with the Daily Mail, she explains her usual day living with diabetes.

"I have to test my blood sugar levels at least a couple of times a day," she explains.

"I do a tiny pinprick, usually on my fingertips, and test it with a special kit which tell me how high or low my blood sugar levels are.

"Then using this as a guide I inject myself with the correct dose of insulin to level up my blood sugar. "People always kind of cringe when I say that," she laughs.

However, recently in an interview with Inside the Actor's Studio, Ms. Berry was shown to have absolutely no idea about what her condition is, let alone any complete sense about even which type of diabetes she suffers from. In actual fact, Ms Berry has always been a Type-2 diabetic, and never suffered from Type-1 as she is so confused about in her words:

"I've managed to ween myself off insulin, so now I like to put myself in the Type 2 category."

This complete lack of self-awareness of a condition she suffers from is phenomenal. The shame is that despite global efforts and awareness campaigns, popular culture will mean that people will listen to her and not hear anything else about the disease.

As a respondent to the article mentioned in a comment;

"Yes, please share with our little children how it was managed? My 11 year old would LOVE to know. I wanted to just puke when I read this. Thanks alot, now people are going to be asking my CHILD why she still has Type 1 diabetes."

One other serious complication (pardon the pun) of this article is the fact that Type-2 diabetes i seen as a "drop" from Type-1 diabetes and that you can make the jump whenever you want. Type-2 diabetes at times can be more serious as it goes commonly undiagnosed, creating diabetic complications without any symptoms for a number of years.

Ms Berry, please get your facts straightened out before speaking publicly about diabetes. It is obvious that you have NO idea what is happening with your own diabetes.

"Diabulimia" - lack of psychological care & counselling.

Something that has caught my eye recently has been the sudden media exposure of a situation most common amongst young diabetic women as 'diabulimia' - the practice of lowering or completely omitting insulin as a way of losing weight and staying 'healthy'.

I came across this article, from the ABC from back in June this year which explains the fight to have diabulimia recognised as a phycological and medicla condition. Whilst eating disorders are usually classified as a psychological condition, it's time diabulimia be seen as a medical condition on top of this. The article claims that women with Type-1 diabetes are twice as likely to develop an eating disorder than those without Type-1 diabetes.

The risks of eating disorders coupled with type-1 diabetes are significant. The constant high-level blood sugars will cause ketones, and possibly extended ketoacidosis (acid within the blood stream), resulting in severe damage to kidney tissue. On top of this, the long term complications of diabetes are put at further risk as a result of prolonged, uncontrolled diabetes.

However, do doctors and specialists help or refer patients who they suspect to be 'diabulimic'? Most probably not, as it would probably be a situation where the patient would not see a doctor in the first place. Without support and treatment, the condition poses a very serious risk to the health and lives of those who have the disorder. If the patient does see their specialist/doctor, the situation is then in their hands - and they may not be well enough prepared or trained for this type of issue.

As with most diabetes specialists and GP's, the lack of counselling and psychological support is apparent everywhere. For a person who has diabetes and is subject to 'diabulimia', the situation is dire.

India: Nayana Eye Care & WDF

As part of my role with the International Diabetes Federation (IDF) and Novo Nordisk, I volunteered to go to rural Karnataka (southern India) for 10 days to see the Nayana eyecare clinic in action. The clinic is part of a wide range of care and outreach programs funded by the World Diabetes Foundation (WDF) in India. These include footcare, diabetes camps, eyecare and diagnosis. The WDF also funds many projects in other developing nations around the world.

The clinic runs as part of the Vittala International Institute of Opthalmology (VIIO), and is supported by the WDF. The aim of the clinic is to take care and expertise into rural Karnataka in an effort to diagnose, treat and educate local doctors and patients about diabetic eye care.

The clinic itself is housed in an Ashok Leyland van, carrying vital laser, fundus cameras, ultrasound and plenty more equipment. It is also equipped and prepared to do Fundus Angiograms. The van travels for around 25 days a month, visiting rural towns and villages treating patients.

VIIO recognised that part of the problem in India is that the only care for people with diabetes is located in state capitals such as Bangalore (the centre for VIIO). Travel costs, accomodation costs, lost income from days spent away from work and a general fear of large cities and unknown doctors prevents nearly every patient from following up in the traditional model of care. Originally, when VIIO was stationary in Bangalore, their referred patients from rural Karnataka would have a 100% drop-out after the first consultation. Patients could not simply go back 3 months later for the above reasons. As such, they could not follow up with care, significantly effecting the chances of saving their own vision.

However, with the Nayana mobile eye care clinic, the doctors from VIIO and Prabha Eye Hospital (both based in Bangalore) are able to travel with the clinic and treat patients in their local towns. The VIIO & Prabha doctors act as consultants, and educate the local doctor(s) in eye treatment using lasers and other tools on the van. In tricky situations, the consultants will often do the treatment, with the referring doctor viewing the procedure through modified instruments specially made for the clinic.

The clinic used to visit 8 districts, but has now grown to 13, with plans for further expansion soon. On average, around 30-45 patients would be consulted per day, with around 20 needing treatment - with that treatment being delivered the same day.

Subbakrishna Rao, the project manager for Nayana, explained that "the main success of this program has been around the recruitment of the local doctors. They get a financial benefit from referring the patients to us, and the patients get treated quickly and without any hassles from going to Bangalore." He explains the simple model to us, that when patients pay for treatment, the clinic keeps 30%, and the local referring doctor keeps 70%. Those who cannot pay for care do not have to. The financial benefit has been the main incentive for most of the local doctors. "Without the incentive, why should doctors refer patients to us?" Rao says. The bonus is also for the patients, and with the education the doctors receive while attending the clinic with their patients, they can then convey this on in future to their patients. "There is a big problem, and that is that some patients do not like other doctors or doctors they do not know. At least here they can be treated and cared for by their own doctors".


The success of such a project is hard to guage, as Rao identifies. Whether it be financially sound, socially equitable or about saving vision, Rao does not talk of any of this when talking of a target. He says that the way to show that this project is succeeding is that "by next year, it [Nayana] will be self-sustainable." The bonus of this is obvious; "We can continue our work, keep expanding and most of all offer the care that is so urgently needed".

Alex

WDD November 14 and YOU!

As we gear up for the first ever UN-recognised World Diabetes Day (WDD), there are a number of activities happening around the world that you can be part of. Making as much noise, exposure and awareness of WWD is integral for the success of the Unite for Diabetes campaign.

So what can you do? Write, talk, yell, and now walk for the occasion! If you're short on finding out what's happening in your area, visit the WDD Official events page and get into it! If in the unlikely scenario that there isn't a local event for you, by all means organise a walk, colour something in Unite for Diabetes blue, or form a circle with anything you can and send in photos! It doesn't have to be a huge thing, just something to show that you beleive in uniting for diabetes.

Alternatively, contact the local patient organisation from your country and see if they are doing anything - a whole list can be found on the International Diabetes Federation's website here.

Get into it!

Alex

The Asian Diabetes epidemic...

With my work as a diabetes ambassador for the IDF continuing not only in Australia, but officially throughout the West Pacific, i went searching for information about the Diabetes pandemic and it's stats in Asia. Traditionally, we don't hear much about diabetes in Asia - one of our panellists from China put it simply that "It's not something you share with people in our country [China]". One of the most frightening things is that whilst people remain to the old traditional thought that because Asian people tend to be slimmer and weigh less than most other Western countries, the risk of diabetes is not there. Asian and Middle Eastern news outlet, www.gulfnews.com, ran an article recently about the problem of diabetes in Asia

Published: 09/07/2006 12:00 AM (UAE)
Asia faces obesity and diabetes pandemic
AP
Sydney: The rapid modernisation of China and other Asian countries has produced an alarming spike in the rate of obesity and diabetes, which could undermine the region's economic and social stability, experts warned on Wednesday.

Asia currently has around two-thirds of the world's diabetics, or around 90 million people with the disease, according to Paul Zimmet, the chairman of the International Obesity Task Force. The majority of those are type 2 diabetics.

Four out of five of the world's most diabetic populations are also in Asia India, China, Pakistan and Japan and the number of diabetics in Asia is set to reach 120 million by 2010, said Zimmet, citing World Health Organisation data.

By 2025, the number of Asians with diabetes could hit 198 million, he said.

Meanwhile, the rate of obesity among Asian children is increasing by about 1 per cent each year, roughly the same rate as in Australia, the United States and Britain, according to the task force's Asia-Pacific director, Tim Gill.

"It's a social and economic disaster," said Zimmet.

Rapid economic development and the shift from an active, agricultural lifestyle to a sedentary, urban lifestyle are the main factors to blame for Asia's burgeoning weight problem, both experts agree.

As their economies have grown, many Asian countries that were once agriculturally self-sufficient have begun importing high-fat, high-calorie foods that were never a major part of their traditional diets.

In China, for example, the per capita consumption of vegetable oil has increased from around 1 litre per year to up to 17 litres in the past two decades, Gill said.

Anti-fat bias affects women more
Global obesity pandemic combined with society's anti-fat bias is more damaging to women than to men, an expert warned on Wednesday.

"Being obese and female is as bad as it gets," Berit Heitmann, advisor to the Danish government, told a meeting of world obesity experts in Sydney.

Obese women are socially stigmatised more than their male counterparts, delegates at the 10th International Congress on Obesity heard.

The most disturbing fact i highlighted in yellow. With the diabetes population in the world being estimated to reach 333-369 million by 2025, that means nearly 33% of the worlds' diabetes population will be in Asia alone. It's time that not only diabetes be taken seriously as one of the worst killers in the world (rivalling HIV/AIDS), but also for people to pay real attention to where the help is needed the most.

Alex