hildhood diabetes (Type 1 diabetes) is a different type of diabetes than the adult-onset diabetes (Type 2 diabetes). Adult-onset diabetes (Type 2 diabetes) continues to multiply at a pace that a frail healthcare system like ours is struggling to cope with. Pakistan stands at an alarmingly worrying rank (fourth) globally for the number of people living with Type 2 diabetes (estimated to be about 34.5 million). While adult-onset diabetes has a scientifically proven link with unhealthy lifestyles and accounts for more than 90 per cent of the diabetes burden, childhood diabetes accounts for less than 10 per cent of the total diabetes burden. As per estimates, there are about 26,000 children living with Type 1 diabetes in Pakistan. Due to a paucity of data from Pakistan, this figure as per extrapolation of data from neighbouring countries is expected to be around 100,000.

Unlike adult-onset diabetes, which can be treated with lifestyle changes and tablets, childhood diabetes can only be treated with insulin injections. This is a lifelong treatment without which the condition can become fatal. About 24 per cent of the children in Pakistan with childhood diabetes remain undiagnosed.

Whilst Type 2 diabetes has a health and productivity toll nationally and for the affected individual, Type 1 diabetes, apart from the health of the child, has a social and emotional toll for the whole family.

Pakistan is a lower-middle income country with more 25 per cent of its population living below the poverty line. Access to specialist health care (i.e. diabetes specialist in this context) is not always assured. Imagine a child from an underprivileged family with Type 1 diabetes, living in a remote area of Pakistan, difficult access to insulin coupled with the soaring cost of living and insulin. Can it be worse? Amidst this “just trying to be alive” struggle can there be any quality of life? In most such scenarios parents are left with the choice of either keeping the child alive by barely affording insulin or sending him/ her to school and pay the school fee, “if they survive, they may get to school someway down their life” they say.

Every gloomy scenario can have a silver lining but needs advocacy efforts on a national scale as a starting point. For instance:

No child deserves to be deprived of a healthy life and lifesaving treatments like insulin.

Type 1 diabetes awareness campaigns targeted at public and healthcare authorities. This will need a tag team effort between healthcare professional organisations, public healthcare departments and advocacy organisations.

Improved, prioritised and free-of-cost access to insulin and diabetes care for the underprivileged population at the government level through the network of public sector hospitals across the country.

Subsidised insulin pricing for the Type 1 diabetes community. This will need a harmonised consensus between national drug regulatory authorities and the insulin pharmaceutical industry overseen and endorsed by the national health authorities.

Drafting and implementing legislation to protect the rights of children with diabetes in schools to raise awareness and minimise social isolation.

Promoting peer support at local and national levels for emotional well-being and destigmatisation.

Including children and families living with this condition at each stage and step. Nothing shall be about them without them. Familiarity with their lived experience can help shape the advocacy efforts to fit their needs and benefit them. Type 1 diabetes advocacy organisations can be their formal voice in this regard.

No child deserves to be deprived of a healthy life or lifesaving treatment like insulin. It is their fundamental human right. The buck rests with national healthcare stakeholders. If not a quality life, let’s at least give these children a fair chance at living.

The writer, a consultant endocrinologist, is an assistant professor at Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan and a clinical adviser to Meethi Zindagi (a registered not-for-profit organisation advocating for the cause of Type 1 diabetes in Pakistan). He can be reached at atif113_2000@yahoo.co.uk