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Omair Ahmad is a Delhi-based writer. His last book was Kingdom at the Centre of the World: Journeys into Bhutan (Aleph, 2013).

A practical pancreas

An insulin pump and infusion set.

n January this year, an Australian boy named Xavier Hames received an artificial pancreas. Hames is four years old, and for the last two years of his life, he has been living with Type 1 diabetes, and the host of injections and pin pricks that come with that ailment. While we often refer to "diabetes" as a single ailment, there are at least three major forms. The first, Type 1 diabetes, the one that Xavier Hames is affected by, involves the person's immune system attacking the insulin creating cells in the pancreas. Insulin is the protein that monitors blood sugar. Most of what we eat is translated into sugar, which gives us energy, but too much blood in your sugar can be toxic and lead to damages in your veins and arteries. Insulin converts sugar into fat, storing the energy for later. When you have low amounts of sugar, the fat is broken down by your body and translated into sugar again. This is where Type 2 diabetes comes in. This is when the body becomes resistant to insulin, or cannot translate sugar into fat. While no known cause for Type 1 diabetes has been identified, Type 2 diabetes is often caused by obesity. If you already have enough fat, the body is understandably reluctant to add more. The third type of diabetes is "gestational diabetes", and occurs briefly among pregnant women and is related to the body having difficulty balancing the sugar levels for mother and child.

Type 1 diabetes can occur very early, as it did in the case of Xavier Hames, and can only be controlled by the infusion of insulin in a controlled fashion. For most of us who know diabetics like this — my mother is diabetic — this means constantly measuring your blood sugar by pricking your finger and measuring the blood level with an instrument, and administering insulin through injections. The nuisance value of this is immense. For my mother, who needs to take four injections a day (one with every meal, and one long-term) this means carrying injections everywhere, as well as finding a place where she can self-administer the insulin. If she is feeling unwell, she checks her blood sugar level by pricking the edge of her finger, squeezing blood out, and inserting it on a small test strip, to insert it into a machine. While technicians have made ever finer needles and better instruments to measure levels, this is still an incredible amount of irritation to deal with on a daily basis. The search, therefore, has been to find a self-regulating unit, an artificial pancreas.

he machine surgically inserted into Xavier Hames' body will act like one, measuring and regulating the flow of insulin in Hames' bloodstream. Previous pumps had been surgically inserted, but those were technologically inferior in that they would supply a steady dose of insulin. This is not what the pancreas does. It only supplies insulin when needed. Too much insulin in the bloodstream can lead to hypoglycaemia, all the sugar is being converted into fat, depriving your body of energy. This can lead to seizures and even death. Therefore earlier pumps needed the patient to carefully monitor their blood sugar.

While this is incredibly heartening news for those with Type 1 diabetes, it is not so much so for the poor with diabetes. The fine injections, blood sugar testing equipment, insulin, and insulin pumps are very expensive. Hames' pump comes at a price of over $8,000 or close to Rs 5,00,000. That doesn't include the cost of surgery. While this may be affordable for the newly wealthy upper middle class of India, it will not be for most. India has more than 60 million people with diabetes, exceeded only by China, which has about 90 million. The majority of these cases are not Type 1 diabetes, but Type 2 diabetes, which is set off by obesity. Such cases have skyrocketed in the recent past.

A 2014 paper titled "The current state of diabetes mellitus in India" by Seema Abhijeet Kaveeshwar and Jon Cornwall, therefore, makes interesting reading in this context. The main issue is that despite the huge number of people with diabetes in India, and despite the high cost of this disability, there has been very little research done on the subject. What research has been undertaken suggests odd anomalies. It seems that Type 2 diabetes in India is set off at much lower levels of obesity than in Europeans, so being only a little overweight makes you much more vulnerable, while at the age of Indians getting Type 2 diabetes is much lower, between ages 20 and 40, while in Europeans is largely those over 50 years of age who are susceptible. And funnily enough, people from North India have lower rates than South Indians. All of which would make you think that instead of underspending on health, the Indian government could possibly undertake a little more research on this subject that makes the lives of so many of its citizens unnecessarily unhappy.

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