Providing Diabetes Care, Insulin, in Ukraine

Sylvia Kehlenbrink, MD; Mark Harmel, MPH


April 01, 2022

This transcript has been edited for clarity.

Just 1 month after the onset of the crisis in Ukraine, about one quarter of the population has been forcibly displaced, with almost 4 million Ukrainians having fled their country and another 6.5 million Ukrainians currently forcibly displaced within Ukraine.

And there's a large part of the Ukrainian population that is currently inaccessible due to ongoing fighting insecurity and the Russian occupation.

One of the main public health concerns and challenges in the humanitarian response right now is ensuring the continuity of life-preserving medications and medical care for people with chronic diseases and noncommunicable diseases, which have been the leading cause of premature death in Ukraine and globally.

This is especially true for diabetes because type 1 diabetes is probably the most immediately life-threatening noncommunicable disease. In the absence of insulin, it is rapidly fatal.

According to the International Diabetes Federation, there are about 2.3 million people with diabetes in Ukraine, which is about 7.1% of the population. Individuals who have left Ukraine as refugees in neighboring countries are accessing fully functional healthcare systems. Those systems are currently being strained and overwhelmed, but we hear they are still able to manage this large influx of refugees and provide care.

However, those who are currently internally displaced within Ukraine and unable to leave due to the occupation or ongoing insecurity face uncertainty. Not only are their lives at risk due to the ongoing war, but hospitals are being targeted by airstrikes, supply chains are being disrupted, and critical infrastructure is being destroyed, leading to critical shortages in medical supplies. And of course, this is particularly concerning for the delivery of insulin to the people of Ukraine who need it for survival.

We in the humanitarian response hear right now that the logistics of getting the medications from warehouses from neighboring countries into Ukraine and distributed to the people has been the greatest challenge. The international community has donated large quantities of medications and supplies, but the challenge really is distributing them.

These challenges are true for providing care in any humanitarian crisis. People need continued access to their life-preserving medications, diagnostic supplies, and care. Nonetheless, despite the very large burden of diabetes, globally the provision of diabetes care in humanitarian crises has largely been neglected and has not been very well coordinated so far. We need to address that gap and find solutions.

An alliance of over 40 organizations called the International Alliance for Diabetes Action (IADA) has formed to address four key thematic areas in providing diabetes care in a humanitarian crises. The first is providing clinical and operational guidance. The second is ensuring access to essential medications and diagnostic supplies. The third area is improving policy, financing, and advocacy around this issue. And finally, the fourth is improving data and research in providing diabetes care in humanitarian crises.

IADA recently hosted a roundtable with over 34 organizations involved in the humanitarian response in Ukraine to understand the current processes in coordinating care on the ground, the needs in medications and supplies, and the role each organization should play to avoid duplication, and to clarify lines of communication and where critical gaps and shortages are in their response.

While the Ministry of Health and the health cluster with the World Health Organization are coordinating the larger response, help from a variety of sectors is needed to provide this care. We recently developed an insulin switching guide, which is needed because there are about 31 different insulins on the formulary in Ukraine.

How do you switch someone from one insulin to another safely in this context? There's a link to these switching guides that have been translated into Ukrainian and Polish in different languages from the surrounding regions. That's just one example of how we're developing more resources for people living with diabetes.

How do you manage diabetes without access to food? How do you manage, in the freezing cold outside, to avoid freezing insulin? How do you manage if you don't have access to insulin for a few days or for a long period of time? We welcome your involvement.


  • International Alliance for Diabetes Action: Resources for the crisis in Ukraine and donations can be made to any of the partner organizations of IADA.

  • For donations to support people living with diabetes in Ukraine, the International Diabetes Federation Europe created a helpful site called Connect Solidarity with resources and links.

  • Insulin switching documents developed by the American Diabetes Association and Diabetes Disaster Response Coalition, among others.

  • Donate insulin and diagnostic supplies to be shipped to Ukraine through Insulin for Life. The site has instructions on how to send the supplies within the US.

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