**4.1 Education/awareness**

Diabetes mellitus has been termed as a disease of the affluent, so there is a gap of knowledge on diabetes in the society as well as with the healthcare providers. Food security is poor, since majority of the rural clients are dependent and either work in

**Figure 7.** *Local Acanthosis Nigricans at insulin injection site.*

seasons in a year as well as are from same families who earn annually. Thus, the food stored is limited and with inadequate distribution interfamily and within the family. At lease every client is able to feed unrefined food but is limited in terms of other sources of food like proteins, minerals, and vitamins.

The independents are either spending time outside to hang with friends with unstandardized meal or skip both meals and take insulin on trial to adjust his or her day.

Fuels may be a problem in early morning; thus, leftovers may be used if well kept. And majority do not have cooling methods to keep big share of raw foods, and the distance to the market or butchers is long (**Figure 7**).
