The Moscow Times
Friday, November 27, 1998
Shortage of Insulin Puts Diabetics at Risk
By Natalya Shulyakovskaya
Yelena Ivankina, 33, has been suffering from diabetes since she was 11. She depends on daily injections of insulin, a drug that lowers sugar levels in her bloodstream, to keep her alive.
But the supply of insulin for her and the other roughly 2 million Russians with diabetes who depend on it for their survival is now endangered: The entire supply of the drug comes from abroad, and the government is having trouble finding the hard cash to pay for it.
Currently, Russia has one to two months' worth of insulin in stock, said Mikhail Balabolkin, the chief diabetes physician at the Health Ministry.
"What sort of solution do we see? The Finance Ministry or Economics Ministry has to find the money to buy insulin," he said. Under Russian laws that the country inherited from the Soviet Union, the government is obliged to provide insulin-dependent diabetes patients with their medication free of charge.
A month's supply of insulin costs up to $40, which is three times more expensive in ruble terms after the devaluation. Altogether, the country needs about $100 million a year to provide its diabetes patients with the drug.
No deaths from insulin deficiency have been reported so far, but there is a growing anxiety among patients and doctors.
"There is panic," said Olga Trofimova, a journalist with Dianovosti, a monthly newspaper dedicated to diabetes.
Some people are rationing their insulin for fear of running out altogether, and doctors in some clinics have reported seeing patients who have allowed their sugar levels to grow dangerously high.
Diabetes patients in remote impoverished regions are the worst off.
"We get heaps of faxes from regional diabetes patient associations appealing for help," said Mikhail Bogomolov, president of the Russia Diabetes Association, which represents 88 regional associations and counts 2.5 million diabetes sufferers among its members.
"The people are writing: 'We are injecting insulin twice a week.' It should be about four times daily."
The situation is especially dire in Kamchatka in the Far East. One case of a patient in a diabetic coma was reported in the Altai region of southern Siberia, Bogomolov said.
Problems also have been reported in Moscow, where medical care is much better.
At the Central Clinical Hospital of the Transport Ministry, patients have come in with their sugar levels reaching dangerous levels.
"People fear for their lives, and they start taking just one type of insulin instead of two, trying to make the drug last longer," said Emma Voycheck, the head diabetes specialist at the hospital, who said she was furious because the government has not made firm promises to assure the supply of insulin.
Health officials in the capital have ordered that insulin distribution be strictly controlled. Now, each patient has to line up for a doctor's appointment every three months to get a specially stamped prescription, Bogomolov said.
Moscow pharmacies keep lists of patients affiliated with them and ration their insulin supplies. Before the crisis, those who could afford the drug and didn't want to waste time in lines could simply buy insulin, but now that is all but impossible, the president of the patients' association said.
Without insulin, patients who depend on regular injections to keep their sugar levels low could fall into a coma and die within five to seven days.
"I have a stash for another two or three months, but I don't know what will happen next," said Ivankina, who is almost blind and has to take strong pain relievers to keep her from fainting from the pain in her legs due to clogged vessels - a side effect of diabetes and years of injections with impure Soviet insulin.
Before insulin was invented in the 1920s, more than 90 percent of the people who suffered from the disorder died. People with diabetes are unable to produce enough of the hormone that breaks up fats and sugars in the body.
More than 9 million people in Russia suffer from diabetes, the World Health Organization says.
Up until 1996, the program to supply insulin to Russia's diabetics was run by the federal government. But then it was taken over by the regions, many of which now have no money for imports. Some of the money still comes from the federal government, which last year spent $30 million, or 30 percent of what was required. This year the amount seems to be lower.
The Health Ministry is hoping to get approval to finance insulin imports with debts to Russia from other countries, Balabolkin said. Already, some of the insulin is brought from India in lieu of the country's debts to Russia.
Since the late 1980s, no insulin has been produced in Russia. The plant in Moscow, as well as two others in Belarus and Lithuania, was closed down because the animal hormone-based drug they produced was too impure and caused too many side effects. Patients then switched to foreign-made genetically-engineered human insulin."I am afraid to go back to Russian insulin," said Ivankina, who stopped using the domestic drug in 1993. "They were giving us gigantic doses with huge needles. Because the drug was so bad, people were going blind, losing their kidneys and legs."
But Bogomolov of the patients' association said that the negative view of domestic insulin was propagated by foreign companies seeking markets in Russia, as well as federal medical authorities seeking to benefit from lucrative drug-supply tenders.
Today, the only Russian plant that produces the raw material for insulin is located in Maikop, in southern Russia, but the final product is still produced in Poland.
Balabolkin said Russia might need close to $200 million to develop its own genetically-generated human insulin industry. Under Prime Minister Viktor Chernomyrdin's government, Russian energy giant Gazprom, which had close links to him, had promised to finance the project, but the idea died out, the Health Ministry doctor said.
And although Russia has some test insulin production lines, even with full financing it could take no less than 18 months to produce a domestic drug.
"It would be stupid to restart production of swine insulin, and production of human insulin takes very large start-up capital," said Vasily Ivanov, a manager with Eli Lilly & Co., a U.S.-based corporation that supplies about one-third of the insulin used in Russia.
"I have not heard of diabetes patients dying because of a lack of insulin so far. All the noise about an insulin shortage is baseless," Ivanov said. "The government has always found ways to bring insulin into Russia."
But this time around, because the financial crisis is so deep the situation could be different. When pressed to respond to the Dianovosti newspaper last week on whether the government would be able to take care of Russia's diabetes patients Health Minister Vladimir Starodubov said, "I am still very careful in my promises."
© 1998 by The Moscow Times. Used by permission.
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