In the last decade, Kyrgyzstan faced a double increase in the number of patients with diabetes. The government provides them with insulin free of charge, but drugs supplied under the state guarantee programme were not suitable for all. At times, there are not enough funds to purchase other types of insulin.
“Help me see my mother and this world again!” such messages began to appear on social media in early 2020. 29-year-old Nursulu (not her real name) asked all concerned citizens to help her raise 10 thousand dollars for the eyesight recovery surgery. The girl has been suffering from diabetes for 19 years, and it caused some complications.
In addition to vision loss, Nursulu had problems with kidneys and legs – it was difficult for her to walk and move. We will never know whether she could raise the right amount. Nursulu died from complications caused by diabetes in the summer of 2020.
As of January 1, 2020, Kyrgyzstan had 62,878 registered patients with diabetes, according to the State Endocrinology Centre at the Ministry of Health and Social Development. Out of them, 2,499 patients have type 1 diabetes. The incidence rate grows every year.
What is diabetes?
When a person has diabetes, all the family suffers with them. It’s even harder to have a sick child – parents must control their condition day and night. Constant diet, strict blood glucose monitoring, injections a few times a day – this is just a small part of what people with diabetes have to face.
What is diabetes? Let’s find it out with Natalia Dobrynina, an external endocrinologist of the health ministry.
Diabetes is not one disease, but a group of diseases that have one symptom in common – high blood sugar level.
With type 1 diabetes, the body stops producing insulin at all. Most often, this type of diabetes develops rapidly, and the disease develops very rapidly. In this case, seek medical care within a relatively short period from the onset of the symptoms, from one month to six months. For type 1 diabetes, insulin is the main treatment, and no other pills can help.
In type 2 diabetes, insulin is present in the body temporarily, but the sensitivity of the body’s cells to it is broken. So people live with a relatively high blood sugar level, but they feel good.
These are usually senior citizens, but in recent years there have been cases of type 2 diabetes in younger persons. Adolescents are also at risk, especially those who are obese and those who have genetic predisposition to diabetes.
These two types of diabetes are the most common ones. In recent years, gestational diabetes has been well diagnosed. It develops particularly in women during pregnancy, as blood sugar levels change during physiological processes. When the pregnancy ends, gestational diabetes goes away. Most people don’t develop it again, but they’re still at risk.
Both types of diabetes are characterised by:
- Excessive thirst and dry mouth,
- Frequent urination,
- Rapid weight loss, despite a good appetite,
- Weakness or tiredness, rapid fatigue,
- Blurred vision,
- Low libido,
- Numbness and tingling in fingers, toes, hands and feet,
- Heaviness in feet,
- Dizziness,
- Lingering infectious diseases and delayed healing,
- Leg cramps.
Many people with type 2 diabetes do not know about their condition for a long time because the symptoms are not as obvious as the symptoms of type 1 diabetes.
According to the law, they have a right to:
- Free treatment (outpatient and hospital) in public hospitals. Public clinics do not charge a patient for a visit, examination, consultation;
- Insulin and injection aids (syringes, needles);
- Free basic laboratory analyses – full blood count, urinalysis, blood glucose, cholesterol;
- Insulin dependent patients may receive preferential prescriptions for blood glucose test strips. Since 2019, the allowance is 500 strips per year;
- Patients with type 2 diabetes have a right to get 600 Glibenclamide* tablets free of charge, from this year on, they have privileges when buying Metformin* under additional package. (* – blood glucose lowering drugs)
Living with diabetes
28-year-old Aigerim developed diabetes in childhood and has been living with it for more than 18 years now.
What I remember is that a few days before hospitalisation my brain was a little fuzzy, I had more difficulties with thinking and comprehending. Later I learned that those were the symptoms of high blood sugar level.
Once, I got back from school and my mother looked at me anxiously. It turned out that I lost so much weight that I seemed to fade away. And then we went to the hospital. They took a lot of tests and confirmed my diagnosis, diabetes.
That’s when my life with diabetes began – injections five times a day, constant blood sugar level check, hospital treatment once a year. I still remember my mother’s tears, fear, confusion, and the question: how to move on? In the beginning, I was ashamed of my disease and tried to hide it from people. But as time went on, I grew up, and somehow I accepted my fate. Luckily, diabetes didn’t affect my studies or my life much. Everything was going its way until 2015, when they stopped giving me insulin, which was suitable for me.
Insulin situation
Thanks to the Diabetes Association, synthetic analogues of insulin appeared in Kyrgyzstan quite long ago – more than 20 years ago. They were introduced gradually. First, they didn’t give them to children and adolescents; they started with adult patients. Later, when doctors realised that the course of diabetes did not change, the quality of life did not deteriorate, and the lifestyle became more agile, analogues were given to children. Until 2015, both adults and children were getting that insulin.
But because the number of patients who wanted to receive synthetic insulin analogues was increasing and public funding did not cover all the needs, it was decided to supply them to children and adolescents under 18 only.
All other diabetics (according to the City Endocrinology Dispensary, nearly 600 patients) should have switched to genetically engineered insulin.
What is the difference between types of insulin?
There are two types of insulin: rapid-acting and long-acting. The first type should be taken at the start of the meal. It helps the body to use glucose released into blood after the meal. The long-acting insulin is needed to monitor glucose level at night and in between meals.
They both are needed to type 1 diabetics for qualitative compensation of diabetes.
The genetically engineered insulin is a common substitute for hormone insulin, which is produced in the pancreas. To manufacture it, not only genetically modified hormone of humans, but also synthetic substance are used.
There are also synthetic-made analogues of insulin.
Genetically engineered and synthetic-made analogues of insulin differ by onset, peak and duration. If the synthetic-made analogue starts acting 5-15 minutes after the meal, the genetically engineered analogue starts acting in 20-30 minutes. Therefore, genetically engineered insulin is not very comfortable in use, especially for students or people with busy schedule.
“Genetically engineered insulin was not suitable for me, so I decided to buy it myself,” Aigerim said. “In Bishkek pharmacies, one pack of long-acting insulin reaches 48 dollars, and rapid-acting – 35 dollars. One pack of five cartridges is hardly enough for three weeks. I need to buy almost two times a month. Generally, I have to spend up to 166 dollars at once. Moreover, insulin is not always available in Bishkek. I have to ask my relatives in Moscow to buy the drug and send it through some acquaintances who go to Bishkek. Constant buying of drugs hits me in the wallet, but I have no other choice.”
Temporary hope
In November 2019, diabetics under 29 had hopes to finally receive the synthetic-made analogue of insulin. The health ministry signed the order on provision of type 1 diabetics with insulin analogues funded by the state.
“However, unfortunately, the funds were not allocated then, and insulin was purchased for children under 18 only. The order failed for more than a year. We could provide insulin to patients under 29 only in November 2020,” Nazgul Omurakunova, chief doctor of the City Endocrinology Dispensary, said.
According to her, in 2020, insulin was bought for 108 million som (1,275 million dollars).
“Later on, insulin was bought for 93 million som (1,098 million dollars), but the money was taken from the 2021 budget. According to the budget estimate, this year insulin will be purchased for nearly 63 million som (743,7 thousand dollars),” Omurakunova said.
According to endocrinologists, given the specific nature of diabetes and the difference between insulins, patients must have a choice – what insulin they want to get and what insulin is better suitable for them. The main thing is not to have the medication substituted because insulin is a protein hormone and if one kind is used today, and another type is used tomorrow, the quality of life may deteriorate very much.
Moreover, patients should check themselves personally and be responsible for their own health. Every diabetic must strictly observe all medical prescriptions, keep a diet and control blood sugar levels. Without self-control, the drugs and the experts can do nothing.
How to protect oneself from diabetes?
Recommendations of the State Endocrinology Centre at the Ministry of Health and Social Development:
- Change your lifestyle, stabilise your weight.
- Pay attention to hereditary background. Particularly, type 2 diabetes can often be inherited between generations.
- Break old habits.
- Control blood sugar levels; undergo medical tests at least once a year.
- If initial symptoms (thirst, dry mouth, enuresis, tiredness) arise, consult your endocrinologist immediately.
This publication was produced as part of the mentorship programme under the Development of New Media and Digital Journalism in Central Asia project delivered by the Institute for War and Peace Reporting (IWPR) with support from the UK Government. It does not necessarily reflect the official views of IWPR or the UK Government