We're traveling around the world again for our ongoing series about Global Diabetes — what's it like to live with this illness in parts unknown? Today we are joined by Senthil Nathan, blogging about diabetes from Chennai, India, a country of more than a billion people. He reminds us that India is a land of diversity, so whatever he shares here "has to be taken as a microview of a land in which people speak a different language every few hundred kilometres." Gotcha.
A Guest Post by Senthil Nathan
My name is Senthil Nathan. I was diagnosed with Latent Onset Autoimmune Diabetes of Adulthood (LADA) at the age of 23. I was diagnosed first as a Type 2 diabetic and was on oral medication for the first four years. I am 28 years old now. I was put on insulin last year as my blood sugar levels could not be brought under control. My most recent A1C is 6.5. I am doing better than ever now. I have to thank the Internet for the education and information that I could not get from doctors and medical professionals in India. I have been active in Twitter over the last two years and now have a few good doctors as friends. This has helped me to understand the facts and the myths in relation to diabetes.
There is no proper data available in the public domain about the number of diabetics in India or about what percentage of them are insulin dependent. There are more diabetics diagnosed every year in India than in any other country. Many people do not reveal that they have diabetes, so even independent surveys cannot get correct statistics. So I will leave it out there for all of you to guess the numbers. Conservative guesstimates say diabetics are about 10% of our population of 1.2 billion. (Some estimates say roughly 51 million have diabetes in India.) With the vast majority of our population living on less than $2 per day, it can be assumed that there are many diabetics who die every year without even getting diagnosed. There is very little that our government does to spread awareness about diabetes. I do not blame our government. It has bigger tasks on hand than caring about a disease that is more of a slow killer.
Culturally, people view diabetes as a disease you get in your 50's and it is quite normal to be diabetic as you grow older. Type 2 diabetes is often viewed as a "rich man's disease," because the poor in India often do manual labor, so usually Type 2 diabetes doesn't affect them. Diabetes is mostly viewed as disease for the obese and as something you get only if you don't do manual labour, which in India means you should be rich.
Life expectancy in India is only about 60 years. If you are poor, physically active throughout the day and not eating much, then if you get diabetes, you will typically be older, like in your 50's. Many poor people die in their 60's without even knowing the cause for death.
There is very little discussion that goes on about how people can change their lifestyle and try to prevent or postpone the onset of Type 2 diabetes. It is always a reactive approach after diagnosis instead of a proactive approach. There is no concept of "pre-diabetes."
Medical insurance penetration is very low in India, reportedly less than 10% of our population. In most cases, patients pay out of their pockets, and so many have very little in their pockets to begin with. Pre-existing illnesses like diabetes are not covered by medical insurance in the vast majority of instances. You end up earning money for your illness. There is no one else who will help you. The public hospitals do provide free service to citizens, but this does not work well for a chronic illness like diabetes.
Thankfully, healthcare costs for purchasing medication and supplies in India are not as expensive compared to the Western world. Having said that, I really do not know how many poor children die because of undiagnosed or improperly treated Type 1 diabetes in India every year (blame the lack of official statistics in the public domain). Medication available in India is as good as any country, like the U.S., but the cost becomes higher with latest technologies. Insulin pumps are not common, but available if you can import them. All kinds of low- to medium-end glucose meters are available in India.
There are very few non-profit organizations that do charitable work for diabetes in India. With all my tech savvy and online social connections, I could not find one such organization in a metropolitan city like Chennai. So the status in smaller cities, towns and villages is sure to be worse. More than 90% of India's population live in such small cities, towns and rural areas.
I would say the media has of late done a good job of creating awareness amongst the lay public. But it is not enough. There is a lot to be done by governmental and non-governmental organizations and people like me, i.e. people with firsthand knowledge of the disease who have access to social media. It is just that most of us do not know where to start. It is my wish to start an NGO that can help fill this knowledge gap one day. More than universal medical coverage, which is a distant dream in India, I would like to see more awareness spread and would like to see more people come out and talk about living well with diabetes.
Thank you, Senthil. Anyone interested in helping out Senthil with advocacy efforts in India can reach him on Twitter: @4SN