Rising food insecurity coupled with strained health care systems has created new challenges for those managing diabetes during the Covid-19 pandemic.
When food is scarce and meals are inconsistent, people with diabetes may experience extreme blood sugar spikes–or dips–that can lead to heart disease, kidney failure, and even death.
In Sudan, where the number of people facing acute food insecurity has increased 65% since last year, pediatric endocrinologist Dr. Omer Babiker says malnutrition has become a serious problem among his patients with diabetes. “We see, on a weekly basis, patients that have malnutrition” said Babiker, the deputy director of the Sudanese Childhood Diabetes Association.
As a result, many patients’ blood sugar has become uncontrolled and some are facing acute complications due to a lack of food. Others have been unable to access health care services because of Sudan’s nationwide lockdown. For Babiker’s patients, the consequences have been severe.
On this episode of the podcast, we speak with Dr. Babiker about how the Covid-19 pandemic is impacting his patients and escalating the risks of their condition.
Direct Relief has partnered with Life For A Child to support diabetic treatment centers, like the Sudanese Childhood Diabetes Association, with funds to purchase diabetes supplies, PPE, and food for patients under coronavirus lockdowns.
It had been five months since Dr. Omer Babiker had seen the patient.
At his last checkup, his diabetes was well managed. His nutrition, acceptable.
But, after months of living through Sudan’s Covid-19 lockdown, the patient’s condition had become uncontrolled and he was suffering severe malnutrition.
“He’s anemic. He’s about to go into heart failure. His diabetes is all over the place.”
Dr. Omer Babiker is a pediatric endocrinologist at the Childhood Diabetes Center in Khartoum, Sudan.
“Malnutrition is an ongoing problem and it got worse because of the pandemic.
Babiker says, before the pandemic, severe malnutrition was relatively rare amongst his patients. Now, he sees one to two cases a week.
According to a recent report, more than 9.6 million people in Sudan are facing acute food insecurity—a 65% percent increase from last year at this time.
And globally, the World Health Organization estimates over 130 million people could be pushed into chronic hunger by the end of 2020.
Disruptions to global and domestic supply chains coupled with high inflation rates have caused the price of staple goods to soar. In Sudan, the cost of wheat has increased by more than 60%.
Rising food insecurity is dangerous all around, but those with diabetes are particularly at risk.
“Nutrition management is a huge part of diabetes management.”
Dr. Julia von Oettingen is a pediatric endocrinologist at the McGill University Health Centre at the Montreal Children’s Hospital in Canada.
“The food that you eat determines how much insulin you need to give yourself.”
In resource limited countries, like Sudan, most patients use a pre-injected form of insulin called NPH, This kind of insulin is cheaper than other types on the market.
NPH is injected once in the morning and once at night, which means patients must use that insulin by eating consistent meals throughout the day.
“If you don’t eat and add, via your food, add to the blood sugar that’s in your bloodstream, the insulin that you’ve pre injected will take all of the blood glucose, all of the sugar out of your bloodstream causing a severe low blood sugar.
These crashes can leave those with diabetes feeling weak, fatigued, and even lead to unconsciousness.
To avoid these unpleasant and potentially dangerous symptoms, patients may forgo daily insulin injections when food is scarce. “Which then causes the opposite risk of having very high blood sugar and getting into a coma from there.”
But food scarcity is not the only challenge for patients with diabetes.
According to a 2017 study, families in Sudan with at least one child with diabetes spent 4x more on medical care than those without a child with diabetes. One third of those costs went towards buying insulin.
For some, the cost of insulin alone can eat up a month’s worth of income.
“So insulin is quite expensive. The cheapest insulin, the older insulin, costs anywhere between say $10 and $25. And a child needs about one to two vials a month, at a minimum.”
Adults need anywhere from 2 to six or more vials a month.
And as the pandemic forces millions out of their jobs, managing diabetes has become even more financially burdensome. In Sudan, the unemployment rate reached 25% in April.
But some of the country’s pediatric patients have found relief through the Sudanese Childhood Diabetes Association.
The organization has 25 clinics across the country that provide diabetic care to children for free. Many of these are in rural communities where healthcare is otherwise not available.
Dr. Babiker and his staff have been sending insulin and supplies to these clinics throughout the pandemic.
“We have about 900 patients. We know about how much they need per month. So we calculate four months supply enough supply to our 25 clinics across the country.”
For many people, getting insulin and food is hard enough. Getting to a doctor is another matter.
Since the government converted many of the country’s hospitals into Covid treatment centers, Babiker says chronic disease management has fallen by the wayside, and the lockdowns haven’t made it any easier for patients to access care.
In July, the government lifted a ban on public transportation that had been in effect since March, but restrictions on interstate travel remain and strict curfews limit the number of daytime hours people have to go places.
Even when they can travel, rising fuel prices have become an additional barrier to health care.
According to Babiker, people could spend up to a day’s worth of income on bus fares, just to get to the nearest clinic.
That means getting much-needed care can be next to impossible.
“Some of them they’re frustrated. They used to come, take their insulin, meet with a doctor and meet with a dietician.”
But now, Babiker says, even those who do manage to find their way to a doctor are often disappointed.
Once they reach the clinic, they may just find it closed.