Wearing an over-sized sweater and with her head covered with a grey-checked woollen shawl, Kunzang Dema patiently sits at the corner of a ground floor of the national referral hospital in Thimphu.
It is 5:20 am and still dark outside. Nine other diabetic patients like the 55-year-old Kunzang Dema wait patiently for the lab to open.
Kunzang Dema knits to kill time. Some browse their smartphones, others would talk with each other.
“I was diagnosed with diabetes two years ago. Since then, I have been visiting the hospital for a regular check-up once every month,” she said.
All patients diagnosed with or suspected of having diabetes are required to give two glucose tests during their routine check-up, one before meals and another two hours after a meal.
Kunzang Dema said she prefers to come early morning because she gets the blood test done as soon as the lab opens at 7am.
After the first glucose test, Kuenzang Dema and her two friends eat their packed breakfast and wait to give the postprandial plasma glucose test.
“I usually come around 5:30am but today I am late. The cold weather makes one lazy,” said Ugyen Tshering, a man in late 70s with a wrinkled face and a wide smile.”
Ugyen Tshering, also a diabetic patient comes for his routine check-up once every three months.
“It seems people came as early as 5am because there are already about 10 prescriptions stacked before mine,” he added.
He said in the past, patients have to stand in a queue for hours to get a token number and when the lab opens, people rush to give the test. “If people wait for their turn then there won’t be any issue. But it’s the people who ruin the system.”
However, he said there has been a good change in the system. “Now, whoever comes first gets to give the test first. We can sit and wait for our turn.”
Those who come after 7am are provided with a token number. They are called for the test after the ‘prescription patients’ as the patients who come before 7am are called by the patients there. “I think that’s fair enough, “he said.
Ugyen Tshering said diabetes was rare when he was young. Now many people, irrespective of age, are affected by the disease.
After the test, the patients collect their test results the next day and visit the lifestyle disease clinic at the hospital every Tuesday and Thursday where they are assessed for complications and co-morbidities such as hypertension.
On an average, the clinic gets about 80 diabetic patients on Tuesdays and Thursdays. A nurse at the clinic said that during summer, the clinic gets over 100 diabetic patients.
“This could be because, during winter, most diabetic patients who are old go on pilgrimage and to warmer places,” she said.
The patients are also advised about dietary control and lifestyle modifications, oral hypoglycemic drugs or insulin depending on their sugar levels.
Diabetes is a growing health challenge in Bhutan. To address the problem, the health ministry started a National Diabetes Control Programme in 1996 and diabetes clinics were set up in all dzongkhag hospitals.
The number of diabetic cases has increased from 4,097 cases in 2012 to 12,120 cases in 2016, according to the annual health bulletin. The prevalence of diabetes in Bhutan is estimated at 6.4 percent.
Diabetes can lead to complications including heart attack, stroke, kidney failure, leg amputation, vision loss, nerve damage, and fetal death and other complications in pregnancy.
Health officials said early diagnosis and prompt care to achieve glucose control have been shown to reduce the risk of complications and improve the quality of life.
“Eating healthy, exercising regularly, avoiding smoking and eating doma, and controlling blood pressure and lipids are important measures to preventing the onset of diabetes,” the officials said.