A 57-year-old man from Dhading district arrived at the outpatient department of Bir Hospital on Wednesday for treatment of a burning sensation of cramps in his legs and feet. Though the patient was unaware of his diabetic problem, tests showed dangerously high blood glucose levels—fasting blood glucose 270, post-meal 340, and HBA1C level 10.7.

Doctors say a healthy person's fasting blood glucose level should be less than 100 mg/dl, post-meal blood sugar level below 140 mg/dl, and HBA1c level below 5.7 percent.

“We have to carry out multiple tests to know if the high blood glucose has affected the vital organs—kidney, eyes, blood vessels and others,” said Dr Dipak Malla, assistant professor at the National Academy of Medical Sciences. “These types of patients, from remote villages, who have been suffering from high blood pressure but are unaware of it, often visit our hospital.”

Diabetes, a chronic disease, occurs either when the pancreas does not produce enough insulin (a hormone that regulates blood glucose) or when the body cannot effectively use the insulin it produces.

The problem has been emerging as a major public health problem in Nepal. A study carried out in 2020 shows that 8.5 percent of the population, or two million people, have been suffering from diabetic problems.

The alarming rise in diabetic patients is a global problem, but in low and middle-income countries like Nepal, the disease has drastically increased, with 450 million adults aged 30 and over with diabetes globally (59 percent) who did not receive treatment in 2022, according to a new report.

The report titled “Over 800 million adults living with diabetes, more than half not receiving treatment, global study suggests”, which appeared in The Lancet, a leading international medical journal, on Wednesday, showed that the global rate of diabetes (type 1 and 2 combined) in adults doubled from approximately 7 percent to about 14 percent between 1990 and 2022, with the largest increase in low- and middle-income countries (LMICs).

Of the 828 million adults with diabetes in 2022, over a quarter (212 million) lived in India with another 148 million in China, followed by the USA (42 million), Pakistan (36 million), Indonesia (25 million) and Brazil (22 million).

People living in North America, Australasia, central and Western Europe, and

parts of Latin America and East Asia, and the Pacific saw a significant improvement in treatment rates for diabetes from 1990 to 2022, contributing to widening global inequities in diabetes treatment.

“Our study highlights widening global inequalities in diabetes, with treatment rates stagnating in many low- and middle-income countries where numbers of adults with diabetes are drastically increasing,” said professor Majid Ezzati, of Imperial College London, a senior author of the report.

“This is especially concerning as people with diabetes tend to be younger in low-income countries and, in the absence of effective treatment, are at risk of life-long complications—including amputation, heart disease, kidney damage or vision loss—or in some cases, premature death.”

Obesity and poor diet are important drivers of the rise in type 2 diabetes rates and their variation across countries. Diabetes rates were either already high or increased more in some of the regions where obesity was or became prevalent between 1990 and 2022. This was compared to many high-income countries, especially those in the Pacific and western Europe, where, in general, obesity and diabetes rates did not rise or rose by a relatively small amount.

The study highlights the urgent need for financing of medicines and comprehensive diabetes programmes that enable early detection and effective treatment of diabetes in LMICs.

Experts and endocrinologists in Nepal also said that diabetes problems could be far more than what is estimated. What concerns them much is that even young people suffer from high blood sugar.

“Young people in their mid 20’s and early 30’s are also suffering from diabetic problems,” said Dr Jyoti Bhattarai Kunwar, a senior endocrinologist. “Many patients do not have easy access to proper treatment. When patients do not get access to proper treatment, problems will not be diagnosed on time. Detection of diabetes must be an urgent priority.”

Doctors say that patients could suffer from major health problems—blindness, kidney failure, heart attack, stroke, multi-organ failure, and lower limb amputations if left with high blood sugar. One could think that diabetes is like any other health problem, but serious health problems start when one suffers from high blood glucose.

“The number of patients suffering from high blood glucose has been raised alarmingly of late,” said Dr Ansu Mali Joshi, a senior endocrinologist. “A sedentary lifestyle, changing eating habits, and junk foods have been fuelling the problems. A healthy diet, regular exercise, and stress-free life must be promoted to reduce the problems.”