Wednesday, November 14, 2007

A Slightly Different Spin on World Diabetes Day

When I began blogging back in 2005 (I was on back then, too, Kerri!), there were only a few of what I like to refer to as D-Bloggers. Since then, the community has grown substantially, creating an online community of hundreds (maybe even a thousand or more?) of us. World Diabetes Day is "celebrated" on Banting's birthday. I say "celebrate" because in spite of progress, this is really not a day anyone should celebrate (I certainly don't), as its a chronic disease that requires ongoing and expensive maintenence tools. Diabetes sucks, there's no better way of stating the obvious, and treatment has improved slightly, but its arguably the most challenging chronic condition to try and manage, and the new tools frankly haven't made life dramatically easier because we are tasked with trying to replicate a physiological response with non-physiological treatments -- a huge flaw.

The theme of this year's World Diabetes Day campaign is Diabetes in Children and Adolescents. In many parts of the world, insulin, a life-saving hormone required for survival, is simply unavailable (or is available but remains inaccessible for reasons of economy, geography or constraints on supply). As a consequence, many children die of diabetes, particularly in low and middle-income countries. The World Diabetes Day 2007 and 2008 campaigns set out to challenge this and firmly establish the message that 'no child should die of diabetes'.

That is what my diatribe today is about. I'd like to call your attention to Insulin For Life (IFL), which is an Australia-based not-for-profit, non-government organization which was established in 1999 that aims to donate unused insulin, glucose test strips and other diabetes supplies that are urgently needed in many parts of the world, to help develop and implement sustainable improvements insulin supply in countries in need, and to mentor similar programs around the world.

For that reason, its worth calling attention Saudi Arabia's recently announced plans to develop its own (with help from scientists in Brazil) domestic supply of insulin which is actually quite admirable. Although Saudi Arabia can easily afford it, and many other countries cannot, I still support their efforts. The more suppliers of insulin in this world, the better as far as I'm concerned. The oligopoly has resulted in poor quality, and increased cost with little innovation. Saudi Arabia's insulin manufacturing plans were driven, in no small part, based on last year's uproar in the Islamic world about a newspaper in Denmark (home to Novo Nordisk, Saudi Arabia's largest insulin supplier) which pubished some comics which were deemed offensive to the Islamic faith. That brought the country to realize that they really had few viable alternatives other than Eli Lilly and Company from the U.S., or the French-German company Sanofi Aventis. (Although a handful of manufacturers still exist in Poland, Russia, Argentina and India, the fact remains that the number on a worldwide basis is pretty small). Regardless of your personal feelings on Saudi Arabia's insulin plans, the fact is that there are simply too few suppliers of insulin in this world, and we should support MORE manufacturers of insulin, not the trend of less we have witnessed in recent years which enabled Novo Nordisk to acquire Brazil's largest insulin supplier (Biobrás) a few years ago. Insulin should not have to be shipped to Africa or Asia from Denmark, Germany or Indiana, it should be accessible locally just as other medical treatments are.

That point aside, I had the great pleasure of meeting two of the people from Insulin for Life, a truly incredible organization two years ago at the American Diabetes Association Scientific Sessions Vendor Exhibition in Washington, DC. I must admit that I was very disappointed that the ADA relegated such noble organizations as this to the periphery of the floor (although at least they were on the same floor, unlike at the 2000 conference in San Antonio). Meanwhile, muli-billion dollar diabusinesses such as Novo Nordisk, Eli Lilly and Metronic Minimed just to name a few who had elaborate displays that commanded the attention of healthcare professionals with information about more accurate and/or simpler blood glucose monitors and insulin delivery systems, while nonprofits like Insulin for Life (as well as advocates for curing diabetes) were woefully underrepresented and the few that were there were relegated to the periphery of the display floor.

Without the attention-grabbing gimmicks of the companies selling diabetes management products, unfortunately, their messages sometimes get lost and healthcare workers return home, telling their diabetic patients only about all the new technology that can help them manage their condition, not about how they could donate their unused insulin (or all their own free samples that salespeople leave at their offices) to needy children in more remote parts of the world.

On this World Diabetes Day, and in the name of Diabetes in Children and Adolescents, I support efforts to produce MORE suppliers of insulin (and other supplies) in this world, not less as we have seen in recent years. I support India's aspirations to become another global supplier in insulin. Also, while the big organizations like JDRF get a lot of attention, the fact is that smaller organizations like Insulin for Life have a much more immediate impact on the lives of children around the world, and we should support their efforts to get insulin to children and adolescents who need it around the world!



Jillian said...


I completely agree with you. I hope that the result of today, is assistance to those around the world who are in need of treatment which seems so simple to people living in countries like the US where it is more available. On a day like today I feel lucky that I have access to insulin and technology, but sad that this disease affects so many that are not as fortunate.

Sandra Miller said...


I never knew that Insulin for Life even existed.

Thank you for making us all aware of this incredible organization.

BetterCell said...

Bravo!!......Well said.

Kerri. said...

Hey Scott - I just saw your blog mentioned in the Fox News best health blogs. Congratulations on a terrific and thought-provoking post!

-- Kerri.

Anonymous said...


I applaud your effort to draw attention to these small organizations which, as you say, attempt to impact more immediately those who lack resources to manage there diseases. And like you, I feel like competition (the more insuin manufacturers, the better) it a GOOD thing.

Hopefully, new players might consider natural products (as opposed to synthetic), and work to increase the number of tools used to manage diabetes. A conversation with Dr. Teuscher, several years ago, revealed that as he worked in underprivileged areas, he faced increasing challenges as the numbers and types of insulin were diminished. In areas where FOOD is sometimes a luxury, having only peaky, short-acting (now labeled "intermediate") insulins available to manage glucose control is itself sometimes a death sentence.

Education, monitoring, equipment--all important. But probably of paramount importance would be non-peaking, slow-release insulins--you know, the kind that we haven't seen since the removal of Beef Ultralente and some of the true "imtermediate" formulations.

When a child/adolescent is given insulin in an economically-challenged area, and wonder of wonders, has access to a meter that eventually throws out a number like "40" for his enlightenment, what can he do when there is NO FOOD AVAILABLE? The problem is not only lack of insulin, lack of education, or lack of testing equipment--it is also lack of FOOD and lack of APPROPRIATE insulins.


Scott K. Johnson said...

Well said Scott!