Diabetes Care in LOS

[Liamog]

Anyone living in Thailand or visiting regulalry have experience of diabetes care there.

I am medicated at the moment for type 2 and not insulin dependent which is working fine for now. It's possible I will need insulin in the future. I need to see my Dr here for assessemnt about every 3 months.

If I was to stay in Thailand for a while (2 years or more) how good is my diabetes care likely to be? How would I access professional monitoring and medication? And how much would it cost me.

I believe healthcare is quite good? Anyone have any experience/ knowledge of diabetes care or other healthcare in LOS that they could share?

I posted this in the TingTong forum and got some useful info. One of the posters suggested I post it here.

Many thanks

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Relax, its the same as everywhere else. My suggestion is that you see a doctor in the hospital clinics rather than the ones that are in the clinics in the street or a pharmasist. They think they know everything but the staff in the hospitals seem to be much better.
As far an expense, if your insurance doesa not cover it, it is still very inexpensive. If your insurance covers it, you better check if you need to land in your home country periodically and how often as mine is trying to drop me after I have been away for 6 months.

[thonglor55]

Some of the comments I make are dietary:
* As I'm sure you're aware, jasmine rice (ie. the variety eaten in Thailand) rates very poorly on the Glycemic Index ie. in some cases over 100 and is acknowledged as the rice variety with the highest sugar content. One of my diabetic friends here describes it as "pure poison". To be eaten sparingly if at all
* If there's one written Thai word you need to be able to recognise it's the word for "sugar"; while Thai food does have ingredients' labeling it's mostly in Thai (odd, that??) and if you are an obsessive reader of the sugar etc. content of the packaged food you eat it's part of the (very small) Thai vocabulary you'll need
* My Australian friend who is diabetic came here a few years ago and thought he'd be able to get the slow release version of the Metformin that is, I'm told, one of the principal Type 2 diabetes drugs. That was not the case so he had to take his medication throughout the day; one side effect of taking Metformin that way was an increased tendency to diarrhea (with knock-on effects for his sex life). ER/XR versions may be available now, you'll have to ask
* BNH has a good diabetes clinic so I'm told, and doubtless other hospitals do too but it pays to ask around
* Many packaged fruit juices sold in Thailand have a very high sugar content; never ask for any sort of fruit juice in a restaurant

[Liamog]

As far an expense, if your insurance doesa not cover it, it is still very inexpensive. If your insurance covers it, you better check if you need to land in your home country periodically and how often as mine is trying to drop me after I have been away for 6 months.

Thanks justme. I had presumed any insurance I took out wouldn't cover it as a pre-exisitng condition? Will some of the health insurance plans there cover regular meds etc or just treatments arising from complications? I'm in the UK but will be moving to Thailand next year - will need to do some research on the insurance.

[Liamog]

Thanks for the info thonglor.

As I'm sure you're aware, jasmine rice (ie. the variety eaten in Thailand) rates very poorly on the Glycemic Index ie. in some cases over 100 and is acknowledged as the rice variety with the highest sugar content. One of my diabetic friends here describes it as "pure poison". To be eaten sparingly if at all

* My Australian friend who is diabetic came here a few years ago and thought he'd be able to get the slow release version of the Metformin that is, I'm told, one of the principal Type 2 diabetes drugs. That was not the case so he had to take his medication throughout the day; one side effect of taking Metformin that way was an increased tendency to diarrhea (with knock-on effects for his sex life). ER/XR versions may be available now, you'll have to ask.

I didn't know that about jasmine rice. As I'm also mildly gluten intolerant I was sort of planning rice to be my staple carb. Noodles it is!

I can't take Metformin so am on a combination of Glylacide and Pioglitazone. I need to check these out with a pharmacy before I go as as I think they are newer and more expensive than Metformin.

Thanks for the info.

As far an expense, if your insurance doesa not cover it, it is still very inexpensive. If your insurance covers it, you better check if you need to land in your home country periodically and how often as mine is trying to drop me after I have been away for 6 months.

Thanks justme. I had presumed any insurance I took out wouldn't cover it as a pre-exisitng condition? Will some of the health insurance plans there cover regular meds etc or just treatments arising from complications? I'm in the UK but will be moving to Thailand next year - will need to do some research on the insurance.

well unfortunately I am trying to cover that bridge now and dont have ALL the answers and especially for the UK as opposed to USA.
I can only tell you that my diabeties led to kidney failure and dialysis. The insurance compamny just wrote a letter and said that since I knew kidney failure was imminent, they wont cover the dialysis after the 6 months has been reached and I am long past that. Jusrt a way to get out of paying. We are trying to see if I go hime for X amount of time and return, will the clock start again? No answer yet. They have also stopped paying for meds which we are fighting as the meds I am taking were the same ones before I left USA. Odd because everything is cheaper here and one would "think" that they would be happy that I was where they did not have to pay as much as in the USA. No, they want to pay as little as possible. At this moment, they say that they will only pay for "emergencies".
Check your policy throughly and ask all these questions of your insurance company before stepping off the ledge.

the BEST pharmacy for all this stuff is FASCINO on North Pattaya Road.

Given that the best long term treatment for your kidney failure is a transplant, you should begin discussing with your doctor whether you are a suitable candidate for a pancreas transplant at the same time. If he won't entertain the notion find one who will. A pancreas transplant will cure your diabetes and make the longterm survival of both you and the transplanted kidney more likely. Given your interaction with the Thai medical establishment you will know better then I if any of this is a viable option in Thailand.

Transplants are illegal in Thailand unless they are a blood relative, or spouse. Transplant cases are throughly investigated to insure that it is not a marraige or adoption of convienience. If a transplant were decided upon any time in the future, many recommend China or India at a cost of between 30 and 50 thousand US dollars. Thats to get one pretty quick. My understanding is that the ones in China are not well investigated as to the donors background as long as they are an exact match but India is much tighter in regulating them.
Now, several things the person above forgot to mention..... diabeties patients are EXTREMELY suseptable to infections!! First, it takes a diabetic about 4 - 6 times longer to heal than the average person. Once you get a transplant, you will probably stay on steroids 6 months to a year and maybe much longer so that this valuable new gift of life does not get rejected by your body. Steroids cause the immune system to greatly decline and thus your body is open to serious infection. If your body's immune system is down or near down and you get an infection, well if they cant get control of it, it is syonara life.
I have investigated this at great length and it is the opinion of many fine surgeons at Bumrungrad International Hospital that the risk of infection is too great a risk compared to dieting right, watching your sugar levels and watching your meds carefully so that the diabeties does not progress. If it does progress to the point of kidney failure, there is also dialysis which while cumbersome and a pain in the ass as well as a discomfort, it doesnt have near the same costs and risks as transplant.
PS Transplants are not covered under most insurance policies or at lest the ones that are done outside your home country.
Alot to think about and research. My suggestion would be to see a Nephrologist (not just an MD but a KIDNEY SPECIALIST before leaving your home country and get their expert opinion. Not one on the SGF board. Also throughly check all these variables with a specialist at your insurance company and if they will cover you, get it in WRITING!

[Beachlover]

Unkie... Based on that, I assume Thailand doesn't have a public waiting list for kidney transplants? Not that it would be open to foreigners anyway. Unless you want to do something dodgy, you will probably need to either go back to the US and get on their waiting list (if possible) or stay in Thailand where you want to live and be reliant on dialysis.

There's a thread about it here: http://www.thaivisa.com/forum/topic/417 ... ransplant/

I've heard most kidney transplant patients develop diabetes after the transplant anyway, as a side effect of the drugs they need to take.

[Sen Yai]

Transplants are illegal in Thailand unless they are a blood relative, or spouse. ............My understanding is that the ones in China are not well investigated as to the donors background as long as they are an exact match but India is much tighter in regulating them.

Read this desperately sad article before considering a transplant in China.

This is probably why transplants are illegal in Thailand except between close family.