Diabetes is emerging as a growing health concern in Nepal, affecting thousands of people of all ages. Especially Type 1 diabetes, the most common in children and adolescents, is placing a tremendous load on young lives and their families. It is not only inflicting enormous financial and social burdens on the families concerned but also stealing years of healthy life and well-being from early-aged people. 

The increasing incidence of type 1 diabetes presents significant emotional and psychological challenges for paediatric patients and their families. These challenges include the initial shock of diagnosis, the demands of lifelong treatment, and the ongoing necessity for psychological resilience. Furthermore, pervasive misinformation and misunderstandings regarding the disease’s etiology exacerbate various psychosocial sequelae.

“Living with diabetes is tough for children and their parents. Children have to endure multiple daily finger pricks to check blood sugar and regular insulin shots, which can affect their school performance, playtime, and overall mental well-being,” says Dr. Santosh Pokharel, a paediatrician at AMDA Nepal Siddhartha Children and Women Hospital in Butwal.

Parents, particularly mothers, often experience emotional distress and even depression from the pressure of managing their child’s condition, adds Dr. Pokharel, who had cherished a dream a decade ago to create a clinic dedicated to treating children with diabetes. 

With proper management, individuals with diabetes can prevent complications and live a healthy, fulfilling life, even with lifelong medical costs. “Timely diagnosis, consistent treatment, proper counselling, and targeted awareness with family resilience and technological interventions can make a big difference in reducing harms of the disease,” he notes while sharing his experiences in providing proper medical care and awareness. 

Diabetes data trends

Once seen as an adult disease, diabetes in children, Type 1, has recently become common at an early age, especially in the preschool group. Various reports state, “Type 1 diabetes is a condition in which the body stops producing insulin – a hormone needed to allow sugar to enter cells to produce energy – due to destruction of insulin-producing cells in the pancreas.” People with type 1 diabetes cannot survive without insulin, which must be injected subcutaneously for life. 

There are no oral medicines so far for Type 1 diabetes, and its treatment involves regular insulin shots, a glucometer and strips for blood sugar monitoring, and periodic HbA1c tests to track the long-term status of glucose in blood, says Dr. Archana Thapa, a paediatrician at Patan Academy in Laitpur. 

Type 2 diabetes, on the other hand, is more common and is considered a health burden as a primary non-communicable disease. It usually occurs in adults but can also be seen in younger people. In type 2 diabetes, the pancreas produces insulin, but either the amount is insufficient or the body does not use it effectively (insulin resistance). Unlike Type 1, Type 2 diabetes can often be managed with lifestyle modification, oral medications, and sometimes insulin if needed.

According to a journal article entitled ‘Global type 1 diabetes prevalence, incidents and mortality estimates 2025: Results from the International Diabetes Federation Atlas, 11th edition and T1D Index version 3.0’, people living with type 1 diabetes in Nepal are roughly 19,000, with an estimated number of early mortalities due to the disease of 16,000. 

“Healthy years of life lost per person with T1D on average are 43 years. Likewise, the annual growth rate of T1D in Nepal is 6.2 per cent,” it is stated. An estimated 8 per cent of children who develop T1D are never diagnosed, which shows an undiagnosed state with an associated estimate of 3,000 children who lose their lives each year. 

Estimated years that could be restored with better care include 2.6 healthy years per person with timely diagnosis and 19.6 healthy years per person with universal access to insulin and strips, the research findings claim. 

The rise of Type 1 diabetes in Nepal, though not as rapid as Type 2, is a growing concern, Dr. Archana mentions, adding that the recorded data is much lower, ranging from 1,500 to 2,000 people. Highlighting the data gap on T1D, she argues the discrepancy can be attributed to the fact that some adults with Type 1 diabetes are treated by adult endocrinologists, making it challenging to maintain accurate data. 

Harmful misconceptions 

One of the most significant barriers is the widespread misinformation surrounding diabetes in Nepal. Dr. Pokharel notes that some families are advised by relatives and neighbours to stop insulin, leading to children becoming critically ill and requiring emergency hospitalisation. He emphasises the urgent need for public education to help people understand that insulin is not optional; it is life-saving. Even health workers, in some instances, lack proper knowledge, sometimes misdiagnosing diabetes symptoms as other conditions like pneumonia. 

The financial burden is also significant for many families. While some clinics, with support from organizations like Life for a Child, Direct Relief, AZ Foundation, and VDRC-Nepal, provide free insulin, glucometers, and other basic supplies, families still face considerable out-of-pocket costs. Sunita Chaudhari, a mother of a seven-year-old with diabetes, says she still spends around 6,000 to 7,000 Nepali rupees each month on other medical needs, food, and transportation.

The catastrophic costs of the disease are causing a substantial financial burden to the low- and middle-income families, as it requires higher expenses for frequent travel for treatment and insulin as well as other support and management costs, Dr Sushil Koirala, Country Representative of Noora Health Foundation Nepal, views, calling for the need to ensure free and easy access to insulin services from nearby hospitals. 

Dr. Subhana Thapa Karki, a senior consultant paediatrician and paediatric endocrinologist at Kanti Children’s Hospital, highlights the psychosocial impact of diabetes. She explains that adjusting to insulin regimens, dietary restrictions, and the fear of hypoglycemia can be overwhelming for the child and their family. 

Supporting young lives 

“My life has changed after 2017,” says Saksham Khadka, a seventh-grader from Tillotama Municipality in Rupandehi district, who was diagnosed with T1D.Today, he lives an everyday life by managing his health with four insulin shots daily. “I participate in many sports at my school and enjoy my life,” he says with a smile. He shared the story at a Diabetes Advocacy event organised by Vijaya Development Resource Centre (VDRC-Nepal), Gaindakot, with support from the Alexander Zverev (AZ) Foundation (a Germany-based foundation founded by tennis player Alexander Zverev in 2022 for helping children with diabetes in resource-strapped countries) last month. 

Rajan Ghimire, who was diagnosed with type 1 diabetes at a young age, is now providing psychological counselling to patients. “Sharing one’s own lived experiences helps build trust and connection, showing children that it is possible to live a healthy life with the condition,” he shares at the event. 

After listening to such change stories presented on the occasion, Minister for Health and Population Pradeep Paudel pledged to bring necessary policy actions to provide tests and treatment of T1D through all seven provinces free of cost. “The Ministry will expand its policy and programmatic interventions to ease the lives of the children and young people with diabetes,” he promised. 

Dr. Bhim Prasad Sapkota, Health Coordination Division Chief at the Ministry of Health and Population, shares the government initiatives, such as guideline draughting, to increase the accessibility of T1D care, support, and treatment through major hospitals of Nepal. 

Dr. Koirala, who has long been advocating for access to insulin and awareness for diabetes care, recommends a cohesive, government-led strategy to address Type 1 diabetes through policy-level initiatives, increased awareness campaigns in schools, and the assurance of free medical supplies. “The role of community engagement and local organisations in providing essential supplies and training, and the importance of creating a supportive environment to reduce stigmatisation, is a must,” he mentions. 

The advocates have called for establishing at least one paediatric diabetes clinic in each province in Nepal to ensure that children receive the diagnosis and care they need to survive and lead healthy lives.

Deep Narayan Sapkota, a public health professional and Executive Director at VDRC-Nepal, emphasises the government-civil society organisation (CSO) partnership for expanding diabetes education and its associated services to save the lives of children with diabetes. He urges the government to bring policy directives and guidelines to mainstream diabetes care and treatment. 

Dr. Karki also emphasises the importance of making schools diabetes-friendly environments to avert stigmatisation. At the same time, Dr. Archana sees small-scale initiatives and the emergence of trained diabetes educators as a positive step toward better management and early diagnosis of the disease. 

Dr. Pokharel, however, is focused on bringing high-end technology such as Continuous Glucose Monitoring (CGM) systems to the patients. “Such devices, which continuously monitor sugar levels without repeated finger pricking, would make a big difference for children and their families.”

The unwavering commitment of health workers, the resilience of families, and the hope of new technologies can bring Nepal closer to a future where every child with diabetes has the opportunity to thrive.

(Sapkota is a senior editor at the National News Agency.)