Island insulin challenges: fridges, hurricanes and limited choice

In the latest in our new series, ‘Insulin in my country’, we learn about the challenges of treating diabetes in St Lucia.

‘Insulin in my country’ launched on Horizons in September to shine a light on the issues still faced with insulin usage across the world. Access and choice is not equitable, varying hugely from country to country depending on its healthcare system, economic conditions and other factors such as war and climate. In our new series, diabetes specialists from around the globe give their perspective on how this miracle medicine is changing the lives of their patients but also the challenges that have yet to be overcome.

In the latest instalment, Dr Timotheus Dorh, Chair of the International Diabetes Federation (IDF) North America and Caribbean Region, gives an overview of the situation in St Lucia. One of the major issues he highlights is that there are only three types of insulin available – Novolin N, the Novolin R and Novolin 70/30 (although others are available through private pharmacies). He discusses how this affects treatment and the ensuing cost to the state when patients are poorly controlled.

Another hurdle that clinicians face in St Lucia is easing fears and dismantling myths around insulin. For example, there is a common belief that being on insulin means you have severe diabetes, making patients reluctant to use it as they believe that they’re going to die once they’ve been put on it. Following international treatment guidelines is also severely hindered by a lack of testing strips. People have to buy them themselves and therefore many go without.

Dr Dorh also highlights the issue of patients who are illiterate or have inadequate family support. Patients achieve the best outcomes when they have good family support but that isn’t always present, he said, and trying to improve that through coaching and psychotherapy is something they need to work on. Along with lack of treatment support, poor family engagement also means that the patient might not be able to get the right foods or be able to manage their food intake properly.

There are positives – St Lucia has been receiving insulin for just over three decades. It’s available through the public sector free of charge and it’s procured through the Organisation of Eastern Caribbean States (OECS), which ensures quality and consistent supply. Even when facing adverse events such as hurricanes, supply has continued, although he does point out that the electricity to health centres may go down, stopping their ability to store insulin.

While managed well centrally, however, storage in patients’ homes can be problematic as some do not own fridges. This is an issue that rears its head in many countries and serves as a reminder of the hurdles that remain in the way of effective treatment even when insulin is available.

Click here to access Dr Dorh’s presentation in our ‘Insulin in my country’ initiative.
You can view previous instalments of ‘Insulin in my country’ from Afghanistan, Nepal and Cameroon here.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.