Losing access to diabetes care: testimonies from around the world

Managing diabetes is complicated. Even with access to the best tools and technology, it requires constant blood sugar level monitoring and daily treatment in the form of medication or insulin.

If corporate decisions, displacement, or conflict leave a person living with diabetes without sustained access to affordable care, diabetes can quickly become complicated and life-threatening.

People with diabetes share how their lives were impacted when they could no longer access the diabetes medical tools they needed and preferred.

How Lecritia’s diabetes management could be affected by corporate decisions in South Africa:

Only three pharmaceutical corporations – Eli Lilly, Novo Nordisk, and Sanofi – control 90 per cent of the entire insulin market. This means they can set prices as high as they wish, decide which insulin and delivery devices are on – and off – the market, and therefore, significantly impact the lives of people living with diabetes all over the world.

These corporate decisions have resulted in a double standard in diabetes care, whereby insulin pens and newer diabetes medicines that can simplify treatment and reduce complications are unaffordable or simply unavailable for people with diabetes living in low- and middle-income countries, despite being accessible in high-income countries. 

Lecritia testifies: 

When I started using the pen, it was so much nicer because all I needed to do was just: twist it, inject, and there you go. But now it’s going to be such a different thing to go back to having the vials and the syringe.”   

Lecritia was diagnosed with type 1 diabetes in 1999 and at first, she managed her diabetes with insulin injections from vials. However, she found the vials and syringes painful, cumbersome, and stressful. Insulin is expensive, so a dropped, broken vial could mean having to ration or go without insulin until it was possible to buy more.

Lecritia was happy to begin using insulin pens when South Africa introduced them nationwide in 2014. Insulin pens are easier-to-use, less painful, more accurate, and more durable than vials and syringes – contributing to an improved quality of life for people with diabetes. 

However, in 2024, Novo Nordisk announced it was completely stopping its production of the main type of insulin pens available in South Africa, human insulin pens. This forced many people with diabetes to switch the way they delivered their lifesaving medication with little warning, and left governments scrambling to provide enough insulin delivery tools to fill the gap.

Although Novo Nordisk has – as of 12 July 2025 – committed to supply analogue insulin pens in South Africa, the price tag of US$3.95 per pen is too high, and will not result in equitable access for everyone with diabetes in South Africa. In order for the South African government to supply everyone who needs them with analogue insulin pens, Novo Nordisk must reduce the price.

In 2024, when reacting to Novo Nordisk’s decision to discontinue the production of human insulin pens, Lecritia said of possibly switching back to managing her diabetes using in vials and delivered by syringes,.

The main fear is just having those vials break, because what am I going to do if I don’t have? There’s no backups. Insulin is quite expensive. So...if that vial breaks, you’re going to be crying.”

How displacement destabilised Ghassan’s diabetes management when on the move from Palestine

Fleeing your home often also means leaving behind a reliable supply of insulin, meaning some people with diabetes end up rationing their supply or even going without, risking severe health consequences or even death.

Ghassan testifies:

When the insulin in vials I carried with me on my journey ran out, I tried to buy some more, but it was too expensive. When the insulin was unavailable, I tried to adjust to my circumstances, I reduced my food intake and exercised and walked around in order to try to keep my blood sugar levels down."

In 2009, when still living in Gaza, Palestine, Ghassan was diagnosed with type 2 diabetes. He managed his diabetes with medication and insulin injections from vials, and felt his life and disease were under control. In 2022, Ghassan decided to leave Gaza to join his sons and seek asylum in Europe. What followed was a difficult eight-month journey from Gaza through Turkey to Greece. 

Cut off from his regular insulin supply and unable to maintain proper blood sugar control, Ghassan endured dangerous glucose fluctuations leading to life-threatening diabetic comas, all while navigating treacherous migration routes.

After months without access to a sustainable insulin supply, he arrived in Athens, Greece, where he connected with MSF who provided him with insulin pens and closely monitored his condition. 

In 2024, when speaking about his experience of managing his diabetes whilst migrating, Ghassan said:

Obviously getting access to any insulin was the main thing, but it would have been so much easier for me with pens, which are convenient, and the injection is light and painless.”

What conflict meant for Sana’s access to diabetes medical tools in Lebanon

The consequences of conflict and war can be vast and catastrophic, and can include overstretched healthcare systems, medical facility closures, and supply chain disruptions, all of which can limit access to and availability of essential medical tools and treatments. In some contexts, people may be displaced and be unable to access their public health facilities, or facilities may close or face shortages, meaning that people have to purchase what they need themselves at high prices, find more affordable alternatives, or go without. Living through conflict and its consequences can heighten stress levels which, for people with diabetes, can lead to dangerous blood sugar fluctuations. If left untreated, this can cause health complications like heart disease, blindness, and nerve damage. 

Sana testifies:

The war was a very stressful period, and my blood sugar would go up, but I would try to ration what we had. We had very little medication. Sensors which are costly, have become impossible for us to afford after the war.”

Since her diagnosis of type 1 diabetes in 2021, Sana, 14 years old, has been a patient at MSF’s clinic in Baalbek-Hermel, Lebanon. As part of MSF’s diabetes management in Lebanon, Sana was using continuous glucose monitoring (CGM) – what she calls sensors – to keep track of her blood sugar levels, and which she was able to access for free through MSF’s clinic. Sana liked using a CGM, as she was able to monitor her blood sugar levels independently and inconspicuously.

However, when the war in Lebanon broke out in September 2024 amid an ongoing economic crisis in which people were already struggling to obtain medical care, Sana’s diabetes management changed drastically.