Supplies, Cost and Access in India

Type 1 diabetes requires insulin, syringes or pens, test strips and a meter, every month, indefinitely. In India most of that is paid out of pocket.

The scale of this is documented rather than anecdotal. In one review of childhood diabetes in India, families in low socioeconomic groups spent a median of 59% of their annual income on diabetes care. That is not an inconvenience — for many households it is the defining problem of the diagnosis.

What follows is a pattern clinicians see often: quiet rationing. Strips get used less than advised, doses get stretched, a pen gets used past its life. It is understandable and it is dangerous, because missed insulin is a leading route into ketoacidosis.

So the most useful thing to do is say it out loud. Tell your care team what you can actually afford. A team that knows the real budget can often help — a simpler regimen, human insulin instead of costlier analogues where appropriate, a realistic testing schedule, or a referral to a support programme. A team that does not know will keep prescribing a plan you cannot follow.

Also keep buffer stock where you can, split between two places, and never let insulin run to the last pen before reordering.