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AFFORDABLE MEDICINE – INSULIN4ALL

“#Insulin rationing is a crime against humanity. It shouldn’t happen. It is like a genocide; you’re not using machetes but you are systematically killing people”

These were the words from my mouth as i sit as a panelist in the Insulin4all panel of The Affordable Medicines Now Conference in Washignton D.C.

The Affordable Medicines Now is a training conference designed to build skills, knowledge and community among the activists (advocates) who power the movement for affordable medicines at the state, federal and international levels.

Hosted by O’NEILL INSTITUTE FOR NATIONAL AND GLOBAL HEALTH LAW and PUBLICCITIZEN with partnership from various local and international orgaisations; the objective was clear “Medications must be affordable” and its absolutely essential for us all to hold all stakeholders responsible.

From Rep Ro Khanna to Rep Peter Welch to Senators Cory Booker, Tina Schakowsky the messages were clear:

Medical innovations are from universities, public institutes of health (supported with tax payers money); while most of the medical innovators are not after the billions, their innovations are branded by MBA guys and profiteered.
Prescription drugs should be affordable.
The loopholes in governance that allows massive profiteering must be blocked and congress and governments must work in unison to ensure affordable health is for all.

In the midst of the well organized, highly educative meetup is my meeting Ola Ojewunmi a nigerian american disabled activist, founder @ProjectASCEND,cancer and 2 organ transplant survivor who spoke on the intersectionality (I was awed at the strength and resilience of Ola and i believe a lot of african feminist have a lot to learn from her view on intersectionality)

More about the event can be found below

INSULIN4ALL AND HOW IT AFFECTS AFRICA

Africa although experiencing significant economic changes faces an epidemic of chronic non-communicable diseases (NCDs) including diabetes.

Some 425 million people worldwide, or 8.8% of adults 20-79 years, are estimated to have diabetes.
About 79% live in low and middle income countries. The number of people with diabetes increases to 451 million if the age is expanded to 18-99 years.

In Africa, an estimated 15.5 (9.8-27.8) million adults aged 20-79 years have diabetes, representing a regional prevalence of 2.1 (6%).

Africa also has the highest proportion of undiagnosed diabetes; over two-thirds (69.2%) of people with diabetes are unaware they have the disease and almost a third of them need insulin – both insulin-dependent type 1 children living with diabetes and people living with type 2 diabetes who need to take insulin.

An estimated 50,600 children and adolescents under the age of 20 are living with type 1 diabetes with nigeria being the 9th largest country with children living with diabetes worldwide.

INSULIN PRICING AND ITS TOLL ON AFRICA

Availability of insulin:

The inconvenience and additional travel costs as a result of unavailability of insulin in some localities will definitely lead to disrupted treatment and eventual poor management of blood glucose and eventually lead to complications.

Affordability of insulin

The pricing cost of insulin is high which makes it unaffordable.
In Nigeria, for instance it costs about 12usd to get a vial of insulin which may look relatively cheap as compared to a country like The United State of America; however for a country like nigeria where 92.1% live in poverty this is equivalent to a 10 working day wages.

Policy implications

The out of pocket cost of hospital visits, insulin and other consumables makes it difficult for People living with diabetes to maintain their blood glucose and also visit hospitals regularly for checkups.

Lack of healthcare workers and facilities factor in the lack of adequate care for example in countries like uganda, sierra leon,the gambia to mention a few.

Only 11 countries of the 58 countries in africa has universal health coverage.

Religion and Culture

A major issue affecting diabetes care especially with children living with diabetes is the tendency of parents and caregivers to quickly fall back to alternatives in cases of inability to buy insulin or visit hospitals.
Top of the list of alternatives are the religious and traditional centers.
Major setback to these care is the limited understanding and unwillingness to refer peopele to hospitals for adequate care.
This most often leads to complications and in some cases death.

It is to this end that it is important for us all as individuals to demand for action from the executive and legislative arms of government into ensuring
Insulin access being a high priority for government

Diabetes programmes must be integrated and evidence based, highlighting the scale of the problem and areas for effective intervention

1)Reduction in the purchase price of insulin and medical devices
2)Improving geographical access to insuilin by ensuring NCD clinics are available at primary care health centers closer to people in rural areas
3)Incorporate Insulin into healthcare coverage schemes

References:

Drug Revolving Fund (DRF) BY PHARM BUKOLA FABIYI

I was engaging my followers on the need for constructive methods of essential medicine financing when Pharmacist Bukola Fabiyi mentioned “Drug Revolving Funds” as a potent and strategic means of ensuring people do not die due to live saving medications like insulin.

So i pleaded with her to submit an article about this which she did and i hope our readers can begin to task the government at local, state and federal level into making sure the right things are done towards ensuring essential medicines are made available, affordable and accessible to everyone irrespective of the social status.

Drug Revolving Fund (DRF)

The Bamako Initiative (BI) was introduced by WHO/UNICEF in the late 1980’s to improve access to essential drugs for the most vulnerable in the society and thus improve the health outcomes (Chukwuani et al., 2006).

Essential medicines, as defined by the World Health Organization (WHO), are the medicines that “satisfy the priority health care needs of the population”. These are the medications to which people should have access at all times in sufficient amounts.

Essential medicines selected for diabetes are “Insulins and analogues” and “Oral blood glucose lowering medicines”

The DRF is a method of financing medicine in which, after an initial capital investment, drug supplies are replenished with monies collected from the sales of drugs according to the world health organization. It is an effective strategy for ensuring regular drug supply in the healthcare delivery system.

This scheme according to the research conducted by ogbonna however has not been successful due to the following reasons:

  • Poor management
  • Mis-application of the Fund
  • Purchasing of drugs at exorbitant prices
  • Lumping of the proceeds of the fund into a general account
  • Non-reimbursement of the cost of drugs for exempted patients.

According to Gazelle News, May 14, 2013, it stated that 17 states went to understudy and adopt Ekiti’s unified DRF.

A case study was also carried out and evaluated on the efficiency in the drug supply system in Kano state in 2013. Kano state was able to increase their procurement significantly from N133 million in 2008 to N1 billion in 2013 without additional financial support. This was managed and supported by key institutions.

To ensure the success of DRF, quality medicines must be identified, the medicine must be affordable and the monitoring and evaluation of the DRF facility must be achieved in accordance to the set performance targets (Ogbonna and Nwako, 2016).

The Central medical stores in Lagos was renovated in 2013 through funding from Non-Governmental Organisation and Federal Ministry of Health (NGO/FMOH). The Lagos state ministry of health has gone into collaboration with PATHS (Partnership for Transforming Health Systems) and private suppliers of medicines to enhance the operation of sustainable DRF system.

References:

Ogbonna, B. O., and Nwako, C. N. (2016) Essential Drug Revolving Fund Scheme in Nigeria, from the Edge of a Precipice towards Sustainability. Journal of Advances in medical and Pharmaceutical Sciences. Vol 8(2), Pp1-8.

WHO (2009) How to establish a successful revolving drug fund: the experience of Khartoum state in the Sudan. Available [online] from here

PAMOJA 2018

The Diabetes Youth Care of Ghana, Sonia Nabeta Foundation of Uganda and the Global Advocacy organization T1International organized a diabetes camp and advocacy training for children living with diabetes in Africa.

Thanks to the generous support of T1International.

Omolade Onafowokan represented The Nigeria Diabetes Online Community (NGDoc) on an all expense paid trip  to Accra Ghana courtesy T1International and domestic support from NGdoc.

The diabetes advocacy training has already been yeilding results as Omolade has embarked on a project which aims at creating diabetes awareness among young school children “Catch them young”

According to an article sent to us by Omolade:

Many people lack knowledge about diabetes in Nigeria and awareness through diabetes education can reduce discrimination among peers and other people in Nigeria.

After the diabetes advocacy training that took place at Ghana, I went to schools in my community to give a health talk about diabetes education. I realized that diabetes is easier to ignore, if you don’t have first hand fact and initiative. Some people lack diabetes education and this brings about misconception about diabetes.

Increase diabetes awareness and education will undoubtedly help to reduce the health complication; Diabetes education program can enlighten and motivate a community as a whole.

On the 21, September 2018. I visited schools in my locality to talk to the students and staff about diabetes because I personally saw diabetes education as a way of helping individuals with diabetes, pre-diabetes to understand the importance of blood sugar, sign and symptoms of  hypoglycemia management of diabetes, healthy eating habits life style etc.

I also observed that diabetes education is a means of setting solid foundation for better diabetes care, it is designed to provides individual with necessary skills and knowledge for successful diabetes management into their daily life because the ailment goes beyond families.

In addition, it allows people to engage in their own health as a means of putting what they have learnt into action.

In conclusion, diabetes education among student will help to reduce misconception discrimination among peers and it will give maximum effectiveness. 

Omolade Onakowokan

We wish Omolade the very best in her endeavors and we wish to specially thank TiInternational who made her flight, accommodation and training possible.

Are you a young Nigerian child living with diabetes and you wish to reach out to us. Follow us on our social media platforms Twitter and Instagram: @theNGdoc; Click to join our Facebook and whatsapp groups

PHOTO SPEAKS:

Nigeria’s Health Minister Inaugurates Diabetes Awareness Committee

Prof. Isaac Adewole, Nigeria’s health minister has recently inaugurated the National Steering Committee for the Diabetes Awareness and Care Project (DAC) in Abuja.

At the inauguration, he said the federal government was committed to safeguarding the health of Nigerians and improving diabetes care in the country.

He said: “The Non Communicable Disease Division of the Federal Ministry of Health in Collaboration with the Health Strategy and Delivery Foundation (HSDF), with the support from the World Diabetes Foundation (WDF), has embarked on this project, which will first be implemented in two states of the country namely FCT and Imo Sates,” he added .

Adewole said the aim was to increase diabetes awareness and improve the two way referral state between Imo state and the Federal Capital territory.

He emphasized that “the finalization of the National Guideline for prevention and control of diabetes in Nigeria which took place earlier this month is an integral part of this project”

“It is expected that the Guideline will ensure standardized protocol for medical care and patient self – management education to prevent acute complication and reduce the risk of long term complications among Nigerians living with the disease”.

Adewole said that the project was to last for three years- from 2018 to 2021. He also commended the World Diabetes Foundation and Health Strategy and Delivery Foundation for the support and efforts to ensure the project becomes a reality.

In his welcome address, the Permanent Secretary, FMOH, Mr. Abdallahi Mashi, who was represented by the Director, Public Health, Dr. Evelyn Ngige, said that the prevalence of diabetes in Nigeria was increasing with current WHO figures estimates at 3.4 per cent, while local studies carried out by researchers have figures from 3-10 per cent.

This is a step in the right direction and we hope it improves diabetes awareness and gets proper implementation.

 

The Kim Kardashian-style keto diet can increase risk of diabetes, new study warns.

The keto diet, favoured by Kim K , has become increasingly popular in the Nigerian space for a few years now . In a recent report by researchers in the Journal of Physiology, keto diet is said to be linked with an increasing risk of developing type 2 diabetes.

Keto diet became popular for its perceived ability to cause weight loss and reverse type 2 diabetes but ironically, a study by ETH Zurich and University Children’s Hospital Zurich found that this low carb but high fat diet contributes to insulin resistance, making it difficult for the body to respond to normal level of insulin, increasing the blood glucose level and causing your pancreas to get to do more work.

Insulin is an hormone released into the blood by the pancreas and used to control blood sugar levels , it also signals the liver to stop producing sugar. If this mechanism is impaired, the liver would no longer respond and would continue sugar production. This is called insulin resistance.

This increased risk was noticed during the early stage of the diet, according to the study which compared different diets; a high fat diet and a ketogenic diet in two groups of lab mice.

Keto diet was invented in the 1920s as a way to cure epilepsy.

The difference between keto diet and regular low carb diet is that it restricts both carbohydrate and protein intake instead of just carbohydrate intake. It is said to create a lower insulin environment and ultimately reduce fat stores.

Researchers however say more research has to be done in this area.

 

 

 

Source : Eurekalert

Late-night snacking: Why you should quit this habit NOW

LATE-NIGHT snacking can be very indulging but not only does it increase our waist lines, it affects our sleep.

It also puts us at risk of diseases such as diabetes and increases the level of the stress hormone cortisol in our bodies.

Here’s why you should ditch the habit. 

Our bodies crave high-sugar, high-fat and high-salt foods, with typical late-night snack foods including fizzy drinks, juice, chocolate, ice cream and alcohol, some people even take major heavy meals like ‘a bowl of rice’ or ‘eba’ late in the night.

It can be a really difficult habit to stop especially in urban areas like Lagos where heavy traffic might cause you to get in late hungry and necessarily need to eat.

Drinking alcohol also makes us more likely to make bad food choices and indulge our cravings for greasy takeaway food such as deep fried chicken, chips and pizza.

Here are five reasons you should give up the bad habit of snacking before bedtime.

Weight gain

Eating in the hours just before we go to sleep leaves us little time to burn off those extra calories. We eat and then head on to bed without having to use the food for any activity and so we get to store up fat. There is a significant relationship between late-night snacking and a higher body fat percentage.

Impaired hormone response

This is a disturbing effect of late night eating over a long period of time.  Eating late at night can reduce the ability of insulin to remove glucose from the blood.

Over a prolonged period of time, late-night eating may lead to an increased risk of diabetes.

 

Poor sleep

Eating or drinking just before bedtime can negatively affect your sleep quality and quantity, There is a significant association between high intakes of sugary foods and caffeine before bed and poor slow-wave sleep and rapid eye movement (REM) stages of sleep.

Your body spends some of the energy it needs to help repair the worn out body tissues to digest your ingested food. Taking alcohol at night can also cause you to be sleepy the next day.

Increased food intake the following day

Ironically, eating a big meal late at night doesn’t mean you will consume less the next day. You’ll want to eat more!

Eating late at night may enhance the amount of food you consume the following day due to the impaired insulin response and poor blood sugar control leaving you feeling hungrier overall

Increased cortisol

Interestingly, researchers have found a link between eating late at night and higher levels of the stress hormone, cortisol. As well as being an overall health hazard, high levels of cortisol in the body pose a risk factor for increased abdominal fat.

The findings may also suggest that the more stressed individuals are, the more likely they are to eat late at night rather than earlier on in the day.

To break the habit of late-night snacking, its good to eat a balanced dinner with a focus on protein to keep us fuller for long, and de-stressing with a bath, a walk or a movie to give ourselves time to wind down from the day.

Everyone is different, identify your own triggers for late night eating and avoid them. If you can’t, then you can get healthier snacks options e.g bananas, an apple, greek yoghurt , carrots or even water!

 

TAKING DIABETES TO HEART SURVEY

Taking Diabetes to Heart is a new multi-country study, developed by the International Diabetes Federation (IDF) in partnership with Novo Nordisk, focused on Cardiovascular disease (CVD) awareness and knowledge among people living with type 2 diabetes. The purpose of the study is to help IDF better understand people living with type 2 diabetes.

There is a low data input from the African region and to avoid data misinterpretation, there is an extension of the deadline to accommodate more data especially from Africa.

We encourage everyone  Africans especially Nigerians living with type 2 diabetes to  take the survey.

It would only take a few minutes of your time.

Click here to take the survey

There are several ways that you can get involved with Taking Diabetes to Heart:
If you are living with type 2 diabetes, we encourage you to take the Taking Diabetes to Heart
survey here here
If you know someone with type 2 diabetes, please invite them to take the survey. If you are a clinician, kindly share to your network.

If you are active online and on social media, you can promote the survey to your network by
using the hashtag #TD2♥ or #T2DH

DIABULIMIA; The Deadly Eating Disorder Affecting Women With Diabetes

On August 4, 2017, Ms Megan Davidson, 27, commited suicide after battling with diabetes and diabulimia.

Megan was driven to suicide after her battle with her eating disorder and diabetes.

She died three days after she was discharged from mental health services after they thought she did not to have clinical depression and had full capacity according to the inquest.

On the morning of her death she had texted therapist, Renata Harris, saying: ‘Please make sure the emergency services find my body so my parents don’t have to.’

The 27-year-old’s body was found by police who had eventually been alerted by the therapist who received Ms Davison’s text message.

Ms Davison had previously tried to kill herself at the end of 2016 through an overdose.

The therapist decided the text had no ‘immediate implications’ and so did not tell anyone about it for almost an hour.

When police were contacted they went to Ms Davison’s home in Cheshunt, Hertfordshire, and found her body.

 

Megan is not alone,

The word diabulimia is a merger of the word diabetes and bulimia.

Though this word is not officially recognized, Diabulimia describes the situation where somebody deliberately and regularly reduces the amount of insulin they take due to concerns over their body weight and/or shape.

The American Diabetes Association indicates that 30-40 percent of female teenagers and young female adults with diabetes alter or skip insulin to control their weight. “If you have diabetes, then the risk of developing an eating disorder is about twice as likely than if you didn’t,” says Ronald Steingard, M.D., of Walden Behavioral Care in Waltham, MA and research consultant for Harris Center for Eating Disorders at Harvard University.

 

Individuals suffering from diabulimia intentionally misuse insulin for weight control, including:

  • Decreasing the prescribed dose of insulin
  • Omitting insulin entirely
  • Delaying the appropriate dose
  • Or, manipulating the insulin itself to render it inactive

 

On the long term, there is severe hypoglycemia and weight loss because the body would break down fats for energy since there is no insulin to help the tissues utilize glucose effectively.

Diabulimia is a mental health issue and health care providers should be able to recognize this and refer appropriately for psychological help if need be.

Although, this might not be popular among Nigerians, it just might  be because we do not have enough statistics and so many people with mental health issues do not regularly reach out for help.

Warning signs and symptoms of diabulimia

Emotional and behavioural

 

  • Secrecy about diabetes management
  • Increased neglect about diabetes management
  • Avoiding diabetes related appointments
  • Fear of low blood sugars
  • Fear that “insulin makes me fat”
  • Extreme increase or decrease in diet
  • Extreme anxiety about body image
  • Restricting certain food or food groups to lower insulin dosages
  • Avoids eating with family or in public
  • Discomfort testing/injecting in front of others
  • Overly strict food rules
  • Preoccupation with food, weight and/or calories
  • Excessive and/or rigid exercise
  • Increase in sleep pattern
  • Withdrawal from friends and/or family activities
  • Depression and/or anxiety
  • Infrequently filled prescriptions

 

Physical 

  • A1c of 9.0 or higher on a continuous basis
  • A1c inconsistent with meter readings
  • Unexplained weight loss
  • Constant bouts of nausea and/or vomiting
  • Persistent thirst and frequent urination
  • Multiple DKA or near DKA episodes
  • Low sodium and/or potassium
  • Frequent bladder and/or yeast infections
  • Irregular or lack of menstruation
  • Deteriorating or blurry vision
  • Fatigue or lethargy
  • Dry hair and skin

It would be of immense help if

  • Psychological factors should always be considered, assessed and excluded in all episodes of DKA.
  • Sufficient time, resources and training must be in place to enable diabetes healthcare professionals to identify and support people with diabulimia effectively.

References

1) Colton, P. A., Olmsted, M. P., Daneman, D., Farquhar, J. C., Wong, H., Muskat, S., & Rodin, G. M. (2015). Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence. Diabetes care, 38(7), 1212-1217.

2) Svensson, M., Engström, I., & Åman, J. (2003). Higher drive for thinness in adolescent males with insulin‐dependent diabetes mellitus compared with healthy controls. Acta Paediatrica, 92(1), 114-117.

  1. http://www.dailymail.co.uk/news/article-5554981/Patient-27-killed-asked-therapist-note-send-Dignitas.html
  2. Nationaleatingdisorders.org

Herbalist defrauds diabetes patient of 190 million for cure in Lagos

 

 

Diabetes is a condition that sadly has no cure but what is even more saddening is that there are people out there who are exploiting innocent people just in the bid to get them cure.

This was the case of Adeniyi Adewunmi, a self-acclaimed herbalist who allegedly swindled a businessman of 190 million claiming he’ll cure his diabetes.

The case was brought before an Igbosere Magistrates’ Court in Lagos where the accused, aged 43, is standing trial on a four count charge on conspiracy, fraud and stealing.

The Prosecutor, Friday Mameh said before court that the offences were commited between Feburary 2016 and January 2018.

“The accused and others still at large approached the complainant, one Mr Lawrence Akanbi, and told him that he is suffering from diabetes, asthma and spiritual attack”.

“The complainant believed because he was actually suffering from the ailments stated by the accused”.

“The accused used the opportunity to ask the complainant for money till the money amounted to N190m,” Mameh said.

The complainant, hoping for a cure, noticed his symptoms were rather getting worse and the accused arrested by the police.

The accused however denied the allegations.

The Magistrate, Mrs F.O. Botoku, granted him bail in the sum of N20m, with two sureties who must not be less than grade 16 in the civil service  in like sum.

The case was then adjourned the case until Feb. 12 for trial.

 

 

 

Source : The Punch Newspapers

Baby’s Coming; Coping With Diabetes in Pregnancy.

Before the discovery of insulin, the chances of having a baby with diabetes was really slim, but thanks to Banting and Best, the discovers of insulin, this century has seen better outcomes for mothers living with diabetes and their children. In Nigeria 1.7 percent of pregnant women have diabetes out of which 61 percent is gestational diabetes.

Pregnancy in itself is a diabetogenic state i.e pregnancy raises blood sugar levels in normal conditions . Diabetes may complicate pregnancy because a woman had diabetes before pregnancy  (pregestational diabetes which can be type 1 or type 2)or she developed diabetes during the course of her pregnancy (gestational diabetes). Gestational diabetes usually resolves few weeks after the baby is born. However, in about 60-70 percent of women, there is a recurrence in subsequent pregnancy.

 

The challenge

The body is more resistant to insulin during pregnancy to allow more glucose available to sustain the growth of the baby. This makes the body require more insulin production. In people with gestational diabetes, the pancreas can’t keep up with the production of insulin required and so the blood has excess glucose.

The main effects of diabetes in pregnancy is that it increases the risk of miscarriages in early pregnancy it increased risk of babies with congenital malformations e.g with cardiac problems . This is in people with poorly controlled diabetes. It is not uncommon to see people with diabetes developing hypertension and infections in pregnancy.

Too much glucose gets into the baby’s blood and causes accelerated growth of organs especially in the middle and late stages of pregnancy.  This results in big babies, too big to enter the birth canal and can cause the baby’s shoulder to be stuck (shoulder dystocia) making caesarean section necessary in some cases.

Shortly after birth, your baby may have low blood sugar (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose.

The baby is at risk of hypoglycemia immediately after birth because the baby was used to having excessive insulin action while in the womb. It is recommended that the mothers breast feed their babies shortly after birth to help reduce this.

There is also a a higher risk of having breathing problems because the lungs do not mature well enough and the baby might have neonatal jaundice.

Who should be more concerned?

Women above 35 years

People whose immediate relatives have diabetes

People who have had big babies (4.5kg and above) in the past.

People who weigh beyond 90kg or have a BMI above 30.

People who have had stillbirths without a known cause.

People who have had babies with birth defects

People with polycystic ovarian syndrome.

 

What to do?

Mums-to-be  need to check their sugar levels early in pregnancy during their first trimester.

A woman with diabetes or impaired blood sugar levels should consult with a doctor- both an obstetrician and a physician- even before the start of pregnancy. A dietician also plays a role of helping to maintain a healthy diet.

A diet of someone with gestational diabetes should be between 1500-2000 calories and there should be good combination of carbohydrates with protein and fats.  An HbA1c of between 4-6 is the usual target.

It is also important to take folic acid (5mg) before aiming at pregnancy for people at risk.

People living with diabetes before pregnancy would need to really monitor their sugar levels closely has pregnancy can alter their feeding patterns and they might require higher levels of insulin.

A woman who has had diabetes in previous pregnancy is advised to have yearly medical checks as she’s at risk of developing type 2 diabetes in the future.

The pre-pregnancy states are very important. A woman with good glycemic control before pregnancy is more likely to have a better outcome.