With Ukraine’s conflict zone cut off from insulin supplies, concerns escalate for people with diabetes

By Tasnim Ahmed, CNN

Continuing to face attacks from Russian forces, Ukrainian hospitals are strained by growing numbers of casualties and finite medical supplies. There are shortages across all types of medication, but limited access to insulin supplies has led to an uptick in conditions related to uncontrolled diabetes.

“There’s been significant shortages of insulin across the country and many, many actors and people in different areas calling out for that supply,” Kate White, an emergency program manager for Doctors Without Borders, told CNN.

According to Valentina Ocheretenko, chair of the Ukrainian Diabetes Foundation, the country has enough insulin to supply its needs for three months. The challenge is getting it to the people who need it.

There are over 2.3 million people with diabetes in Ukraine, according to the International Diabetes Federation, making up 7.1% of the population. For some people with type 1 diabetes, immediate access to insulin is a necessity for survival.

Aid groups face logistical issues

“We have enough insulin in the country, and a lot of humanitarian aid … is bringing more and more, but we have big problems with logistics,” Ocheretenko told CNN.

Most of Ukraine’s insulin supply is imported or made domestically by two pharmaceutical manufacturing companies, Indar and Farmak, both of which are in Kyiv, said Dr. Orest Petrychka, medical director of the Clinical Center of Endocrinology Lviv. Insulin is provided to people who need it for free in Ukraine.

“About the patients in the conflict zones, I am afraid they can be cut off from the supply of insulin … because of actions of targeted terror held by Russian troops or by the physical impossibility to supply this insulin to patients … from the pharmacy,” Petrychka told CNN.

When the war started, supplies were distributed from Kyiv by Ukraine’s Ministry of Health.

“Now what we’re seeing, obviously, is quite intense fighting around Kyiv, which compromises that system,” White said. “So it’s about working with others on the ground to figure out a way the supplies can still get to all the places that they need to.”

Hundreds of facilities in the conflict zone

World Health Organization Director-General Tedros Adhanom Ghebreyesus said Wednesday that there are over 300 Ukrainian health facilities along conflict lines or in areas that are under Russian control. In a statement Thursday, Tedros also said that attempts to send crucial supplies to conflict zones have been unsuccessful.

Roads have been destroyed, curfews have been set, and some pharmacies are being looted, a resident of the occupied city of Kherson told CNN. All of these factors add to the difficulty in accessing life-saving medication like insulin.

“There’s cities in the east that are inaccessible or barely accessible and are desperate for any kind of supplies they can get,” said Chris Skopec, executive vice president of global health for Project Hope, an organization that is providing disaster relief in Ukraine, including supplies of insulin.

Skopec, who was in Lviv last weekend to coordinate relief efforts, said that as more Ukrainians become displaced and as health care facilities fall along conflict lines, hospitals in western Ukraine are finding themselves serving twice as many people as usual.

At the same time, although these hospitals may have enough medical supplies in their own reserves, they are sending a portion of their stock to eastern Ukraine, where resources are scarce.

“There’s no hospital that has been unaffected by this, even if they’re not in … a really devastated area. Everybody is feeling the pressure on this,” Skopec said.

Other threats to insulin supply

Dr. Nuha El Sayed, vice president of health care improvement at the American Diabetes Association and an endocrinologist at Harvard Medical School, said glucose testing supplies are also needed.

People with diabetes who use insulin need test strips to measure their blood sugar level to determine how much insulin they need. Without the right testing supplies, it’s like using “insulin in the dark,” El Sayed said.

Another of the association’s concerns is appropriately dosing and storing insulin. With supplies running short, people may not have guaranteed access to their regular type of insulin, and dosing depends on the type.

The American Diabetes Association has released guidelines on switching insulin regimens in a humanitarian crisis, which may be especially helpful for aid workers who may not be trained in insulin delivery.

Freezing weather in Ukraine is another threat to the insulin supply. El Sayed said insulin can become ineffective in low temperatures without proper storage, especially as the attacks leave some without electricity or heat.

Bordering nations struggle to keep up

Ukraine isn’t alone in facing the effects of war on dwindling medical supplies. As over 3 million refugees seek asylum in bordering nations such as Poland, Romania and Moldova, these countries are also struggling to keep up.

Skopec said Poland has limited the number of agencies that are authorized to buy medical supplies there.

“As an NGO, we can’t just go into a massive medical supply vendor and purchase their goods in Poland and send them to Ukraine,” Skopec said. “And that’s smart of them. … They can’t support and sustain — and were never designed to — the entire medical supply chain of Ukraine today.” Instead, many nongovernmental organizations are relying on support from other countries in the European Union.

“People are coming across the border and have no idea where they’re going to go,” Skopec said. “Access to chronic medications for chronic conditions — hypertension, diabetes — kept coming up. … How do we access this care?”

Hospitals are now not only seeing the direct casualties of war, they’re seeing the indirect casualties: people with chronic diseases, left without any access to care.

“People have lost access to their medication, to their normal health care provider and to the normal place where they would go when they had an issue with their health,” White said.

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CNN’s Nick Paton Walsh and Tim Lister contributed to this report.