For a long time in the tea shops of Dharan and the busy
streets of Kathmandu, diabetes was called the "sugar" disease, a
problem for the elderly or the very wealthy who sat too much and ate too well.
But the quiet hallways of the B.P. Koirala Institute of Health Sciences
(BPKIHS) tell a very different, more frightening story. New research shows that
diabetes is no longer waiting for old age to strike; it is claiming the lives
and limbs of Nepal’s young adults and children at an alarming rate.
As a health journalist looking at the latest data from
Eastern Nepal, the picture is clear: we are facing a medical emergency that is
being ignored because of a lack of awareness and a healthcare system that is
struggling to keep up.
A Biological Mystery in the Terai
One of the most interesting pieces of this puzzle comes
from Dr. Apeksha Niraula and her team. They looked at the "secret"
markers in the blood of young patients, such as autoantibodies like GADA and
IAA. These are the proteins that tell us if a person’s own immune system is
attacking their pancreas. In the West, most children with Type 1 Diabetes
(T1DM) have these markers. However, in Eastern Nepal, only about 18.5% of patients
tested positive for GADA.
This suggests that diabetes in Nepal might be different.
Some researchers wonder if it’s environmental or related to the "hygiene
hypothesis," where our bodies react differently because of the way we live
in South Asia. Whatever the reason, it means we cannot simply copy-paste
medical solutions from the West; we need a "Nepal-focused" approach
to understand why our children are getting sick.
The Emergency Room Entrance: A Life-Threatening
Start
For many Nepalese families, the first time they hear the
word "diabetes" is in the Intensive Care Unit. A study by Dr. Dipak
Muktan found that a staggering 64% of children were only diagnosed after they
developed Diabetic Ketoacidosis (DKA). DKA is a terrifying, life-threatening
condition where the blood becomes acidic because of a total lack of insulin.
Imagine being a parent in a rural village, watching your
child lose weight and constantly ask for water. You might think it’s just the
heat or a stomach bug. By the time the child is unconscious or vomiting, it is
almost too late. These children arrive at BPKIHS gasping for air, with their
bodies failing them. The study showed that polyuria (excessive peeing) was
present in 92% of these cases, yet it was overlooked until the emergency hit.
This isn't just a medical failure; it's a social one.
Parents, especially those from rural areas with less formal education, often do
not recognize the early warning signs. In fact, nearly half of the primary
caregivers are mothers who have not had the chance to attend school, making it
even harder for them to manage a complex disease like diabetes once the child
comes home.
The Crisis of the "Productive Years"
It is even more shocking to look at young adults between
the ages of 20 and 39. This is supposed to be the most productive time of life when
people work, get married, and start families. Yet, a study of 133 young
patients at BPKIHS found that over half of them (52%) already had serious
complications by the time they were seen by a doctor.
The numbers are heartbreaking: 30% had nerve damage
(neuropathy), 25% had kidney damage (nephropathy), and 11% were already losing
their sight to retinopathy. These are problems we usually see in 70-year-olds,
not 30-year-olds. The mean duration of the disease in these young people was
about five years, meaning many had been walking around with high blood sugar
since their early twenties without knowing it.
Why is this happening? Part of the answer is the changing
lifestyle in Nepal. As people move from active farming to sedentary city jobs,
obesity is rising. The mean BMI in these young patients was nearly 25, which is
high for the Nepalese body type and is a major trigger for Type 2 Diabetes
(T2DM). We are seeing a "graying" of youth, where their bodies are
aging much faster than their years.
The Human Face of the Disease: Shamans and
Stigma
To understand diabetes in Nepal, we have to look beyond the
laboratory. A fascinating study on the "lived experiences" of
patients at Patan Hospital revealed the deep cultural struggles of living with
"Sugar".
Many families do not go to a doctor first. When a child
starts acting strange or losing weight, five out of twenty-two participants in
one study reported visiting a shaman (Dhami-Jhakri) before a hospital. This
delay, rooted in traditional beliefs, often leads to the child ending up in the
ICU in a coma.
Even after a diagnosis, the struggle continues in the form
of social stigma. Young people described the shame of having to inject insulin
in public. Some hide their condition from their in-laws or employers for fear
of being treated differently. One young woman even described her family’s deep
worry about her "marriage prospects," fearing that no one would want
to marry a girl who depends on a needle to stay alive.
Then there is the financial weight. While programs like
"Life for a Child" provide free insulin up to the age of 25 at some
hospitals, the costs for those older or in remote areas are crushing. Families
talk about "financial crises" caused by the constant need for
medicine and blood tests, leading some to skip essential health checks just to
save money.
Diabetes and Motherhood
The danger also extends to the next generation. At BPKIHS,
a study on diabetic pregnancies found that complications were common for both
mother and baby. About 61% of diabetic mothers had to undergo a C-section,
often due to high blood pressure complications like preeclampsia. For the
babies, there is a risk of macrosomia (being born too large), respiratory
distress, and even stillbirth if the mother’s sugar isn't tightly controlled.
This shows that diabetes is a cycle that can harm a family before a child is
even born.
The Knowledge Gap
Perhaps the most frustrating part of this epidemic is how
little people know about how to manage it. A study on health literacy found
that nearly 40% of diabetic patients had "poor health literacy". This
means they don't understand how to take their medicine, what to eat, or why
they need to exercise.
In another group of hospitalized patients, 75% were on
insulin, but only 25% knew how to give the injection to themselves. They were
completely dependent on others for a basic task of survival. This highlights a
desperate need for health education in the Nepali language and better
counseling in hospitals.
The Path Forward: A Call to Action
The researchers and patients in these studies have a clear
message for the government and the public. We cannot wait for the complications
to appear. We need:
Community Awareness: We must teach parents and
schoolteachers the early signs of diabetes, the constant thirst and the
frequent bathroom trips, to stop the surge of DKA deaths.
The "School Health Nurse" Program: This
needs to be strengthened so that children can safely take their insulin and eat
properly during school hours without feeling like outcasts.
Expanded Support: The
age limit for free insulin should be extended, and centers like BPKIHS and
Patan Hospital should have their programs expanded to every province.
Literacy over Medicine:
Giving someone a vial of insulin without teaching them how to use it is like
giving someone a car without a steering wheel. We need "information
booklets" in Nepali and dedicated diabetes educators in every hospital.
Diabetes in Nepal is no longer a silent killer; the studies
have given it a loud, clear voice. It is the voice of a 10-year-old in the ICU,
a 30-year-old who can no longer walk because of nerve damage, and a mother
worrying about her child’s future. It is time we start listening.
