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Remove import duties in insulin, save diabetic children – Experts

By Franka Osakwe
05 November 2017   |   4:27 am
Seven-year-old Rachel Oni, a type 1 diabetic sufferer developed complications because her mother could not afford her daily insulin intake.

Diabetes Test

• Burden Of Diabetic Assuming Epidemic Proportion-Mbanya
• Stigmatisation Of People Living With Diabetes Leads To Concealment
• Ignorance, Inadequate Infrastructure, Lack Of Policy Worsens Disease Burden -DAN

Seven-year-old Rachel Oni, a type 1 diabetic sufferer developed complications because her mother could not afford her daily insulin intake.

Kids that suffer type 1 diabetes require insulin injection everyday in order to remain alive, and healthy and Rachel’s mom, a widow catering for three kids, needs about N15, 000 monthly to stock insulin and other drugs that would guarantee her daughter’s wellbeing, every month.

Because Rachel’s mum was financially weak, her daughter serially defaulted in receiving insulin, and was soon admitted into the Pediatric Ward of the Lagos University Teaching Hospital (LUTH) completely unconscious.

Several tests revealed that she had developed diabetes ketoacidosis (DKA),  a potentially life-threatening complication in people with diabetes, predominantly in those with type 1 diabetes. DKA results from a shortage of insulin; in response to which the body switches to burning fatty acids, producing acidic ketone bodies and causing complications.

This medical condition (DKA) made Rachel to developed cerebral odema (swelling of the brain tissue), and kidney failure. Due to the severity of case, she passed on despite all efforts by the doctors.

Like Racheal, there are so many other children with type 1 diabetes, who are dying after serially defaulting in treatment owing to insulin scarcity and cost.

According to a Consultant Paediatric Endocrinologist at the College of Medicine, University of Lagos/Lagos University Teaching Hospital (LUTH), Prof. Abiola Oduwole, insulin is very essential in managing type 1 diabetes, but many Nigerian parents cannot afford it consistently for their children because of the cost. Sometimes, even when the money is there, there is stock out of brands.

Prof. Oduwole, who spoke recently, at the maiden edition of Sanofi Diabetes Summit in Lagos, expressed worry over insulin stock out, which is one of the reasons why the price is usually high.

“Because nobody is manufacturing it here, and the exchange rate is so erratic, it has become extremely difficult to bring insulin here. Hence the period between requesting for it and bringing it in, there’s always stock out.

“Once this happens, it is only those who have it in stock that would sell, and at very exorbitant price. Because of this, it has become difficult for parents of children with diabetes to buy insulin,” Oduwole said, adding, “Some times the stock out will last for two months, and for those two months, parents won’t have insulin to give their children, and when these parents come to the hospital, they spend more money than they should have because they would have to pay for admission, insulin, drugs and tests.

She further explained that because of the scarcity, some parents cut corners by simply adjusting the dosage without informing the doctor. Such parents could decide to administer a lower dose of insulin in a bid to conserve the drug”, she said.

Without insulin, DKA, as well as other diabetic complications develop fast, and without urgent medical attention, such children run the risk of dying prematurely.

Oduwole, stressed the need for the Federal Government to start importing insulin, as well as remove import duties on them, saying, “if government was importing insulin and flooding pharmacies with it, then the situation would have been different. So, it is important for all types of insulin to be readily available so that anybody can have access to them. The Federal Government needs to know that there are different types of insulin. In Cameroon, insulin is given free to children with diabetes and it has no import duties. But in Nigeria, it is not like that,” she said.

It was in a bid to discuss solutions to these problems and other critical aspects of diabetes management, that medical professionals from Ghana, Cameroon, and Nigeria, gathered recently in Lagos, to brainstorm.

There, they explained that diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.

Insulin is a hormone made by the pancreas. It acts like a key to let glucose from the food pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Once this happens, insulin helps glucose get into the cells.

However, the experts maintained that not being able to produce insulin, or inability to use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Raised glucose levels in the body, over a lengthy period, is associated with damage to the body and failure of various organs and tissues.

It is estimated that about 415 million people have diabetes globally, out of which Nigeria accounts for more than five million.

“Not only that, about 50 per cent of this number do not even know they have the disease until they come down with one of the numerous complications associated with the disease, some of which are life threatening,” they said.

Professor of Medicine and Endocrinology from the University of Yaounde, Cameroon, Jean Claude Mbanya, in his presentation titled: “Challenging the Status Quo in the Current Management of Diabetes in Sub-Saharan Africa,” revealed that the burden of diabetes in Africa and around the world is assuming an epidemic proportion and must be checked before it is too late.

He said there must be spirited efforts by Africans to show more consciousness about the disease and educate the people, especially people living with diabetes to be fully involved in the management of the disease.

“You must change the way you take care of patients,” he urged the caregivers,” saying only education and empowerment added to the various therapies required for diabetes management would halt the growing incidence of the disease in Africa.

Prof. Oduwole, who spoke specifically about management of type 1 diabetes said, “Type 1 diabetes is usually diagnosed in children and young adults. In this type of diabetes, the body does not produce insulin. The body breaks down the sugars and starches into a simple sugar called glucose, which it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. Thus affected children will require insulin therapy and other treatments to manage their condition,” she said.

Oduwole told the summit that ignorance about this condition in children, both on the part of medical personnel and the public has compounded the diabetes problem in children.

National President, Diabetes Association of Nigeria (DAN), Dr. Mohammed Alkali, in his presentation titled “The Diabetes Patient Perspective,” also identified ignorance as one of the challenges facing people living with diabetes in the country. This, he said, is compounded with false beliefs and spiritual or religious interference.

Alkali further revealed that lack of knowledge about the disease has also resulted in stigmatisation of people living with diabetes. This, he further said, has resulted in concealment by some patients.