Yet, patients’ compliance is poor, especially among the elderly and the poor, leading to amputations, kidney failures, heart attacks and blindness.

The problem, say doctors, is that patients just offer excuses and refuse to step forward to have themselves screened and manage their condition properly.

“The rural people can visit the nearest clinic for screening and if the medicine is not available there, the pharmacist from the nearest hospital will send it to the clinic for the patient to collect,” says a doctor in Sarawak.

“The government has also given access to the B40 group to go for screening at private clinics too,”

A check with the health ministry’s Pharmaceutical Services Programme (PSP) revealed that the ministry’s Drug Formulary has most of the latest insulin and drug treatment for diabetes for the specialists and medical officers to prescribe.

Doctors, however, complain that a lot of diabetic medication and insulin have been returned.

Patients, on the other hand, say they are not making excuses but face challenges that doctors cannot understand.

Diabetic patient Saraswathy Rajamanikam, 47, a part-time kitchen helper earning RM600 a month, said she needs a glucometer and glucose test strips to test her glucose level four times a day.

The meter costs more than RM100, and the strips come at RM50 for 100 pieces. Saraswathy just cannot afford them.

She was asked to go to a health clinic in Subang to have her daily tests done for free but going there four times a day is impossible for her, due to time and transport cost factors.

Separated from her husband, Saraswathy, who has only studied up to Year 3, barely has enough for her and her young son to eat. She has already put her teenage daughter in a children’s home.

Unemployed Norma Ishak, 46, meanwhile, travels from Kota Damansara to Sungai Buloh Hospital for her diabetes, asthma and hypertension check-ups and to Hospital Serdang for her heart check-up.

She, too, has limited funds. She is able to travel to Hospital Sungai Buloh, which is closer to home, but not Hospital Serdang.

“I will change the appointment date if I don’t have the money to travel there but the doctor and nurse will scold me,” said Norma.

Due to her poor heart condition after being infected with Covid-19 three months ago, her 18-year-old daughter takes care of her, cooks and manages the home.

“I was told that I was not entitled to zakat or welfare aid because I have children who can help me. But their salaries are low and were cut during the pandemic,” she said.

Her three sons are factory workers and they help pay the household bills. Her husband has growth in his liver and is unemployed.

Azman Mat Zin, 49, has not paid his electricity bills for three months. The money from his wife’s roadside food business is not enough to even feed the couple and four of their seven children who are still schooling.

He does not use a glucometer and test strips and struggles to pay for disposable insulin needles.

With the doctors and patients giving different stories, a tale with two sides to it emerges.

Malaysia’s diabetic care access is generally good but there is a need to understand why diabetic cases and complications are still high by listening to B40 patients like Saraswathy, Norma and Azman, who cannot afford transportation costs or diabetic care devices which the government does not cover.

It is estimated that 3.9 million of the adult population are diabetic. In other words, as many as one in five adults is diabetic.

Pusat Komuniti CTI CEO Margaret Loy said the NGO encountered many diabetic patients among the B40 group, some with legs amputated, while distributing food aid in Kota Damansara.

They either cannot afford to travel to hospital, buy a glucometer, test strips, needles for insulin, gauze or wheelchair, she said.

“They often have to make the hard choice between getting diabetic care and putting food on the table. We found that many deferred treatments, to their own detriment,” she said.

A diabetic woman had a wound with pus in her foot which grew to the size of a 20 sen coin due to delay in seeking treatment, and was also made more difficult during the Covid-19 pandemic lockdown.

The centre bought gauze online and lent her a wheelchair to get around and a retired nurse taught her to do her own wound dressing.

The lack of finances is not the only challenge. They also face discrimination.

A GP, for instance, declined to visit an immobile patient at home once he found out that the patient was living in a people’s housing programme (PPR) area, perceived as a high Covid-19 risk area.

Poor patients also have limited access to the more expensive latest diabetic medication.

Consultant endocrinologist Dr Alexander Tan, who used to work in a university hospital, said basic medicines are free but patients usually have to buy the more advanced medicine.

“Basic diabetic medicine lowers glucose level but patients do suffer from side effects such as low sugar. The newer medicines don’t have these side effects. They also lower weight, lower death rate, protect heart and protect kidneys but are more costly,” he said.

World Diabetes Day was commemorated on Nov 14. With the theme Access to Diabetes Care – If Not Now, When?, the International Diabetes Federation listed access to insulin, oral medicines, self-monitoring, education and psychological support and to healthy food and a safe place to exercise as fundamental components of diabetes care.

Blood glucose monitoring and insulin injecting devices are crucial for diabetes care but the B40 group cannot afford them.

The government should provide glucometers, test strips and needles for insulin pens for the B40 group while empowering them to be more self-reliant.

According to PSP, patients had returned diabetic medicine due to side effects such as hypoglycemia, weight gain and gastrointestinal discomfort besides having extra supplies, fear of insulin injections and doctors stopping the use of a medication.

To improve adherence and reduce wastage, PSP said diabetic patients are being taught about diabetes, the importance of taking their medications as prescribed and adjusting insulin doses to prevent hypoglycemia in the 390 diabetes medication adherence clinics nationwide.

However, can the government increase the provision of better medication that has fewer side effects to better control diabetes and minimise wastage?

It may be a bit expensive, but it is far better to meet people’s basic healthcare needs than reward some politicians with multimillion dollar homes and hefty pensions.