November is Diabetes Awareness Month, and the theme of World Diabetes Day on November 14 is Diabetes and Well-Being, as the spotlight shifts to the workplace. One hundred years after the first insulin injection, there are millions who cannot afford optimal care. It’s not enough to put out statements about awareness while people with diabetes are being failed every day. If we truly care about this chronic disease, it’s time to show it. The resources to transform lives and prevent suffering exist—what’s lacking is the will to prioritise them.
There are now over 550 million people worldwide living with diabetes—many unaware they have it. The disease quietly damages the eyes, kidneys, nerves, heart, and mind, often for years before diagnosis. In Trinidad and Tobago, the situation mirrors the global crisis: limited access to affordable medications, erratic monitoring, and a growing tide of obesity that fuels what can only be called a “diabetes tsunami.”
Diabetes is a disorder of elevated blood sugar—either from an insulin deficiency (Type 1) or the body’s inability to use insulin properly (Type 2). Some women develop gestational diabetes during pregnancy, and rare genetic forms also exist.
In the 1950s, British doctor Philip Hugh-Jones, working in Jamaica, noticed something strange—13 of his patients with diabetes didn’t fit the usual categories of Type 1 or Type 2. They were young, thin, and undernourished, but unlike Type 1 patients, they never developed ketoacidosis. He called it Type J diabetes— for Jamaica.
Seventy years later, researchers believe he was on to something. This unusual form of diabetes, linked to lifelong malnutrition, is now being recognised internationally as Type 5 diabetes.
Unlike Type 1, where no insulin is produced, or Type 2, where the body resists insulin, people with Type 5 can make some insulin, but not enough, because their pancreas never fully developed. Standard treatment with high-dose insulin can actually be deadly if patients don’t have enough food to eat.
Experts estimate that as many as 25 million people worldwide may be affected, especially in parts of Africa, India, Southeast Asia, and the Caribbean.
The International Diabetes Federation has adopted the new name, and researchers are calling for the World Health Organization to follow suit—so these patients can get the right diagnosis and the right treatment before it’s too late.
Insulin, made in the pancreas, is the key that lets glucose enter cells to provide energy. Without it, sugar builds up in the blood, damaging every system over time.
While genetics play a role, it’s our environment that lights the match. Central obesity—that tell-tale ring of fat around the waist—drives insulin resistance. The modern Caribbean diet, rich in refined carbs and sugary drinks but poor in fibre and movement, has set the stage for disaster.
Who’s at risk?
• Age 40 or older (although younger persons are being diagnosed daily—it has been compared to “a car crash in slow motion”)
• Family history of diabetes
• Afro- or Indo-Trinidadian or Hispanic heritage
• Past gestational diabetes or large babies
• High blood pressure, cholesterol problems, polycystic ovaries, or darkened skin around the neck (acanthosis nigricans)
• Diabetes often hides until complications emerge. Subtle blood-sugar abnormalities may smoulder for up to 20 years before diagnosis—a silent countdown to catastrophe.
Spot the signs
• Constant thirst and urination
• Blurred vision, fatigue, or weight loss
• Numbness or “pins and needles” in hands and feet
• Frequent infections
Diagnosis requires blood tests—not guesswork.
• Fasting glucose ≥ 126 mg/dl or HbA1c ≥ 6.5 per cent confirms diabetes.
• Prediabetes lurks between 100–125 mg/dl fasting or 5.7–6.4 per cent HbA1c.
People with diabetes can live full, vibrant lives—but only through consistent care.
Diet: Complex carbohydrates are not enemies— fruits, vegetables, beans, and whole grains provide steady energy. Portion control matters: one handful of rice, a palm-sized piece of meat. Avoid sweet drinks and limit alcohol.
Exercise: 30–60 minutes daily reduces glucose, blood pressure, cholesterol, and even depression.
Monitoring: Regular finger-stick tests, HbA1c every 3–6 months, and annual eye, dental, and foot checks.
Low blood sugar (hypoglycaemia)—below 70 mg/dl—is a medical emergency, often caused by missed meals or medication errors. Symptoms include sweating, trembling, anxiety, and confusion. A small sweet drink or glucose tablets can save a life—but never drive or operate machinery if unwell.
Depression and anxiety stalk those with chronic disease, doubling their risk of death. Mental health support should be part of every diabetes clinic. Ignoring it turns treatment into mere arithmetic—numbers without humanity.
Diabetes management demands resources: insulin, blood tests, clinic visits, education, and access to healthy food. Yet for many across Trinidad and Tobago, these remain out of reach.
Imagine being told you need daily insulin and realising that you simply can’t afford newer formulations or pens. The cost of survival shouldn’t depend on your payslip.
The result? Those with means enjoy cutting-edge therapies and regular specialist reviews, while the poor ration doses or skip treatment entirely. Insulin rationing—a silent crisis—is not a failure of personal responsibility, but a symptom of healthcare inequality.
Modern diabetes care has advanced rapidly. Medications such as GLP-1 receptor agonists and SGLT2 inhibitors don’t just control blood sugar—they reduce heart and kidney complications and even help with weight loss. Yet for most local patients, these breakthroughs might as well exist on another planet.
Price tags, procurement gaps, and policy inertia keep them locked behind pharmacy counters. The science of hope exists— what’s missing is the political will to deliver it.
Managing diabetes isn’t just about medicine—it’s about meals. But try finding fresh produce in some of our communities. Fast-food chains thrive, while fruits and vegetables are scarce. We tell patients to “eat better,” but for many, “better” simply isn’t available or affordable.
This is the cruel irony of diabetes care: we preach discipline to the undisciplined, while ignoring the environment that shapes their choices. True public-health reform starts not in hospitals but in supermarkets and school canteens.
Diabetes education is the cheapest medicine we have—and the least prescribed. Far too many patients leave clinics without truly understanding what diabetes is, how insulin works, or why regular monitoring matters.
Education empowers; ignorance endangers. We spend millions treating amputations, blindness, and kidney failure—yet under-invest in preventing them. A single hour with a diabetes educator can save years of suffering.
Women with diabetes often face unique hurdles—from pregnancy complications to hormonal fluctuations and mental-health burdens.
In many families, women are caregivers first and patients second, sacrificing their own health for their loved ones.
Barbados did it. Mexico did it. They taxed sugar-sweetened beverages, reduced consumption, and slowed obesity rates. It’s one of the simplest, most effective public-health interventions imaginable.
So why not here? Because politics and profits are still more powerful than prevention. A sugar tax would send a clear message: our government values citizens’ health more than corporate gain.
Our nation’s Diabetes Association has done extraordinary work filling the gaps—offering screenings, education, and hope where the system has failed. Their quiet heroism deserves recognition. But they can’t do it alone.
World Diabetes Day should be a reckoning—a time when policymakers confront the uncomfortable truth: our system fails the very people it claims to serve.
Diabetes doesn’t discriminate—but healthcare does. If we are serious about well-being, it’s time to build a system where the poor don’t pay with their lives for the privilege of being sick.
