International Insulin Foundation
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      • Kyrgyzstan>
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                  • Executive Summary of Mali Report
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                        • Executive Summary of Mozambique Report
                          • Diabetes UK Mozambique Twinning Project
                          • Nicaragua>
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                              • IIF's Project in Nicaragua
                                • Executive Summary of Nicaragua Report
                                  • Informacion en espagnol>
                                    • El sistema de salud nicaragense
                                      • El proyecto del IIF en Nicaragua
                                        • Resumen Ejecutivo del relatorio del IIF
                                      • Vietnam>
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                                          • IIF's Project in Vietnam
                                            • Executive Summary of Vietnam Report
                                              • Information in Vietnamese
                                              • Zambia>
                                                • Zambia's Health System
                                                  • IIF's Project in Zambia
                                                    • Executive Summary of Zambia Report
                                                  • Reports
                                                    • Country RAPIA Reports
                                                      • Diabetes Foundation report on insulin-requiring diabetes in sub-Saharan Africa
                                                        • Diabetes Foundation report on implementing national diabetes programmes in sub-Saharan Africa
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                                                                          Frequently Asked Questions

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                                                                          What is the IIF?
                                                                          The International Insulin Foundation (IIF) aims to prolong the life and promote the health of people with diabetes in developing countries by improving the supply of insulin and education in its use.

                                                                          How is the IIF funded?
                                                                          The IIF has received funds for its projects from the:
                                                                          • The World Diabetes Foundation - which is dedicated to supporting prevention and treatment of diabetes in developing countries. We focus on the following areas:
                                                                            • Awareness of diabetes
                                                                            • Prevention of diabetes and its complications
                                                                            • Education and training of patients and health care professionals
                                                                            • Improvement of access to essential medicines in diabetes
                                                                            • Enhancement of detection, treatment and monitoring of diabetes
                                                                          • Diabetes Foundation – UK based charity, which supports research into diabetes and particularly juvenile (insulin-dependent, Type) diabetes and also provides information to people interested in and affected by diabetes.
                                                                          • World Health Organisation – WHO Essential Drugs and Medicines (EDM) Group works globally, regionally and at the country level to address the problems of access, rational use and drug quality.
                                                                          • Barnett & Sylvia Shine No 2 Charitable Trust
                                                                          • Donations from organisations and individuals
                                                                          What is the structure of the IIF?
                                                                          The IIF a Board of Trustees, and a Management Team:

                                                                          Trustees:
                                                                          John Bowis MEP
                                                                          Professor Maximilian de Courten
                                                                          Professor Geoffrey Gill, Secretary

                                                                          Professor Harry Keen, Treasurer
                                                                          Professor Ayesha Motala
                                                                          Dr. Kaushik Ramaiya
                                                                          Professor Solomon Tesfaye
                                                                          Professor Nigel Unwin
                                                                          Professor John Yudkin, Chairman


                                                                          Past Trustees
                                                                          Professor Robert Beaglehole
                                                                          Dr. John Day
                                                                          Professor Jak Jervell
                                                                          Professor Jean-Claude Mbanya
                                                                          Professor Stephen Tomlinson
                                                                          Dr. Peter Watkins


                                                                          Management Team:
                                                                          David Beran, Project Coordinator
                                                                          Professor Geoffrey Gill
                                                                          Professor Harry Keen
                                                                          Professor John Yudkin

                                                                          What is the IIF’s vision?
                                                                          To create sustainable nation-wide access to affordable and reliable sources of insulin, in developing countries, through projects that improve distribution and the educated use of insulin by people with type 1 diabetes currently unable to obtain it.

                                                                          What are the objectives of the IIF?
                                                                          To improve the access of insulin for people with Type 1 diabetes
                                                                          • To improve efficacy and sustainability of diabetes management for people with Type 1 diabetes
                                                                          • To collect accurate information on diabetes prevalence, incidence and morbidity/mortality in participating countries to help local country health authorities plan for future health programmes
                                                                          • To advocate and foster research into improving the access to insulin
                                                                          • To secure commitment by government health departments or other competent health organisations to give the highest priority to the sustained provision of insulin to those who need it

                                                                          In which countries will the IIF work?
                                                                          The Pilot of the RAPIA has been carried out in Mozambique. A second implementation of the RAPIA has been carried out in Zambia and the third implementation in sub-Saharan Africa was carried out in Mali. These implementations have been funded by the Diabetes Foundation and WHO. In collaboration with Handicap International the IIF carried out the first implementation of the RAPIA in Latin America in Nicaragua in 2007. With the support of the International Diabetes Federation the IIF is carrying out the RAPIA in July-September 2008.

                                                                          Why focus on diabetes in the developing world, when there are other more pressing medical and social needs in these countries?
                                                                          Leonard Thompson was given his first injection of insulin on 11 January 1922 in Canada. He was the first patient to be treated with insulin for Type 1 diabetes. By that time he was 14 years old, and weighed only 29kg. Having survived some 2½ years from his diagnosis, he had done better than most people with Type 1 diabetes in the pre-insulin era.

                                                                          80 years after Leonard Thompson received insulin, it is still not available on an uninterrupted basis in many parts of the developing world.

                                                                          In consequence, the life expectancy of a child with newly diagnosed Type 1 diabetes in much of sub-Saharan Africa may be as short as one year. In addition, restricted access to insulin will result in debilitating complications such as amputations and blindness and a much reduced life expectancy.

                                                                          It is estimated that in the 41 nations defined by the World Bank and the IMF as “Highly Indebted Poor Countries” there are 19,000 people with Type 1 diabetes, almost all of whom find the availability or expense for insulin a major hazard to life and health.

                                                                          Even when insulin is available, its purchase may consume as much as half of the family’s weekly income. Thus the current situation for many patients with Type 1 diabetes in the developing world has many parallels to the time of insulin’s early availability in the industrial world.

                                                                          It is recognised that the severe financial constraints faced by Ministries of Health in the world’s poorest countries limits spending on pharmaceuticals to as little as $2 per day. This may mean a choice between providing insulin for one child with Type 1 diabetes (at a cost of some $100-$150) or providing essential drugs to as many as 50 to 100 others.

                                                                          Nevertheless there are few other conditions where the replacement of a natural hormone, which the body has stopped producing, can make the difference between death and potentially long term survival.

                                                                          The establishment of the International Insulin Foundation is an attempt to embark on a concerted effort to improve the prospects for people with Type 1 diabetes in the world's poorest countries.

                                                                          What is Diabetes?
                                                                          Diabetes is a chronic condition that affects people of all ages in all areas of the world. Improper care can lead to serious health complications such as blindness, kidney failure, neuropathy (degeneration of nerves and nervous system), amputation, heart attacks and erectile dysfunction.

                                                                          There are two main types of Diabetes:

                                                                          Type 1 diabetes also referred to as Insulin Dependent Diabetes Mellitus or IDDM is caused by an autoimmune process that destroys insulin producing cells in the pancreas (pancreatic islet beta cells).

                                                                          Type 2 diabetes or Non Insulin Dependent Diabetes Mellitus, NIDDM. This form of diabetes once referred to as adult onset diabetes, as it appeared in people above the age of 40, has now been found to occur in extremely obese children and young adults. Type 2 is closely linked with obesity, a sedentary lifestyle and poor eating habits. Due to the increase in “Western” lifestyles the prevalence of Type 2 diabetes is becoming a global Public Health concern.

                                                                          A third type of Diabetes is known as Gestational Diabetes Mellitus (GDM). This variety of diabetes occurs during pregnancy and ends after giving birth. Monitoring of blood glucose levels is vital to avoid health complications for the mother and child.

                                                                          With both types of diabetes blood glucose levels become high and may cause symptoms, such as:
                                                                          • Excessive thirst (polydypsia)
                                                                          • Frequent urination (polyuria)
                                                                          • Fatigue
                                                                          • Blurred vision
                                                                          • Weight loss 

                                                                          What is Insulin?
                                                                          Insulin is the body’s hormone that regulates glucose metabolism. Insulin is vital in the survival of patients suffering from Type 1 diabetes and in some patients suffering from Type 2. Insulin is a treatment for Diabetes and not a cure. Insulin injections must be administered daily throughout the life of the patient. Dosage of insulin injected by the patient varies from person to person based on age, nutritional status and activity.

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