Take charge of your diabetes, now more than ever

People with diabetes are at greatest risk of severe Covid-19 disease and even death, but with some help they can weather out the storm.

“So far people with both diabetes and hypertension are at greatest risk of dying from Covid-19 followed by those who have diabetes alone,” said Patrick Amoth, director-general in the Ministry of Health.

The ministry estimates there are about half a million diabetic Kenyans with about 9,000 annual deaths.

Scientists at the Kenya Medical Research Institute (Kemri) say the first step to protect diabetics against the current storm is to make sure they do not come into contact with the virus.

In the short term, Kemri suggests the elderly or people with comorbidities be encouraged to isolate, stay at home or be exempted from duty.

Medics at risk

This is especially recommended for people working in high human contact services such as the hospitality industry or health care.

This, however, could further strain an already short-staffed health service, which generally has an old workforce with about 60 per cent aged over 40.

Data from the ministry shows about 15 per cent of nurses, 10 per cent of clinical officers and five per cent of doctors are aged over 60.

The alternative, says Stanley Ngare, a consultant physician at Kenyatta National Hospital (KNH), is to deploy older and diabetic health workers away from front line clinical duties.

Dr Ngare, who was addressing health workers on Covid-19 and diabetes last week, said so far there is no evidence that diabetics are at higher risk of infection than other people.

But once infected, he said, they are likely to suffer more severe disease and possibly a higher risk of death.

How to ensure safety

To stay safe, Dr Ngare said people with diabetes must do three things; avoid infection by strictly observing recommended hygiene practices like washing hands, wearing face masks, keeping social distance and staying at some.

Secondly, diabetics whether infected by Covid-19 or not, must eat a balanced diet to strengthen their immunity. Finally, they must continue to take medication including insulin, and stay in touch with their doctors.

Insulin, a natural hormone produced by the body, regulates sugar and without it, the body would cease to function. In diabetics, this process is impaired and some have to depend on insulin medication.

“It is alright to tell us to take medicines, but buy with what and where,” asks Grace Wairimu, a diabetic seeking care at Mama Lucy Hospital, Nairobi.

Wairimu, a small scale beautician closed shop three months ago due to Covid-19 restrictions and the fear of infection given her condition. “Now I do not have a source of income to pay the medical bills.”

Scientists at Kemri put the annual cost of treating diabetes at about Sh77,000. This includes both direct and indirect costs.  

This, they say in a study of diabetes care in Kilifi and Bungoma counties, has put 75 per cent of families with a diabetic patient into abject poverty.

“About 23 per cent of the patients had to borrow from friends or family, 30 per cent sold an asset and 36.8 per cent used their savings to pay for the costs of diabetes care,” said Kemri.

In May, another survey in Embu, Kakamega, Kwale, Makueni, Narok, Nyeri, Samburu and West Pokot found frequent stock-outs and high prices of diabetes medicines in the counties.

For example, the two most used diabetes medicines in Kenya – metformin and glibenclamide - were only available in less than half of both public and private outlets.

Where available in public dispensaries and health centres and where it is supposed to be free, it was sold beyond the international recommended prices.

Even in the large Base of the Pyramid (BoP) project run in 28 counties by the Ministry of Health and the Danish drug company Novo Nordisk, which targeted at making insulin cheaper and available, access remains a problem.

The project’s target was to maintain the price of insulin at Sh500 per vial, but an evaluation by the ministry last year found frequent stock-outs at clinics selling at the subsidised price.

This, the evaluation says, has pushed patients to buy at non subsidised outlets at much higher prices.

“Our evaluation has taught us lessons for improvement as we move to cover the rest of the counties with the BoP programme,” promised the ministry.

Better still, mounting evidence shows a good diet can easily see diabetics through the Covid-19 storm.

“Those who adhere to a healthy diet are able to maintain the acceptable blood sugar level, manage their blood pressure levels and maintain the ideal body weight,” said Health Chief Administrative Secretary Rashid Aman.

Dr Aman urged vulnerable groups to eat the right portion of whole grains and cereals, including cassava and potatoes, along with plenty of fruits.

“Eat a lot of vegetables, including traditional vegetables, carrots, proteins, and take low-fat dairy products; fibre is the most important ingredient,” he said.

The crucial role of diet in diabetics was confirmed in March by the world’s largest study involving 8,300 diabetic adults in 22 countries and followed for about nine years.

The study found adequate intake of dietary fibre including vegetables, pulses, whole fruits and whole grains by diabetics saves lives.