First, my mouth gets dry. I get thirsty. I drink. I urinate. Repeat. 

Sometimes my forearms get tight. It feels like my muscles are stretched to their limits, ready to snap through the skin. I try to pick things up, even small things like my phone. I can’t. 

If it stays elevated long enough or goes high enough, I start to feel nauseous and exhausted. Around this point, I usually get annoyed. The pamphlets have always said that aggravation is itself a symptom of high blood sugar, but in the moment it just feels like a logical reaction to the situation. Why won’t it go down? I’ve already given the insulin, why do I still feel like shit? Everything becomes irritating. I know, I know – it’ll drop and the world will start spinning again. My life goes on.  

One time it didn’t. My pump failed and it neglected to tell me. Insulin that I thought was travelling through a cannula in my thigh into my bloodstream to move the buildup of glucose into my cells was actually just pooling on the surface of my skin. It was the middle of the night and I didn’t notice, and I was just a kid. Without insulin for an extended period, my blood sugar went dangerously high and stayed elevated for hours. I woke up vomiting, the first of 14 times that morning. 

Diabetic ketoacidosis occurs when cells break down fat rather than glucose to generate energy, a process that releases acid into the blood. It’s life-threatening. I returned to my bed after two weeks in intensive care. 

Kids in school like to joke around and ask fun hypothetical questions, like what would you do to survive the apocalypse? I never gave these questions much thought (I wasn’t particularly fun). What was the point? Surely the apocalypse means no insulin. I’d be dead anyway. 

It turns out that the apocalypse advances in stages. And for the diabetic children of Gaza, who have already survived over two and a half years of systematic annihilation, the insulin phase of the apocalypse is now in full effect. 

Earlier this week, Dr. Ahmed al-Farra, head of paediatrics and obstetrics at Nasser Medical Complex in Khan Younis, reported that the Ministry of Health has had no supply of NovoRapid fast acting insulin pens – the kind of insulin you keep with you at all times to use to lower your blood sugar over the course of a day, before eating or drinking, or when your blood sugar level spikes because you’re ill or just for no discernable reason at all – for six months. 

There are also no new blood sugar test strips or meters. You use these to find out how much glucose is in your blood at any given moment. First, you put the test strep into the meter. The screen on the meter lights up and says it’s ready. You prick your finger with a lancet and put a drop of blood on the test strip. The meter counts down and spits out a number. That number, combined with five million other factors, like whether you’re exercising, whether you have been exercising or will be exercising, whether you’re eating and what exactly you’re eating, whether you’re drinking, whether you’re sick, whether you’re stressed or scared (which can both impact blood sugar), whether you do or don’t have access to low blood sugar supplies, and whether that number on the screen is on the way up or down, inform your decision to either do nothing, to give insulin in order to lower the number, or to consume glucose in order to raise it, and by how much to do either of the latter two. In non-genocide contexts, you do this around ten times a day. 

Meters need to be replaced. They break if they’re dropped. They’re extremely sensitive to light and heat. They’re small, so they’re easy to lose. Test strips can only be used once. Once that drop of blood is on them, they’re done. No new meters or test strips mean that eventually, diabetics won’t be able to monitor their blood sugar at all. They’ll feel it go up and down inside them as they oscillate from shaking to vomiting, but they won’t know what exactly it is. If they can’t know, they can’t make the right decisions. If they stay high, acid will trickle into their blood. Eventually, they will die.   

Also on Tuesday, Al Jazeera’s Moath al-Kahlout published a video report on the dire situation for diabetic children in Gaza City. He features 10-year-old Amir, whose reliance on expired test strips and insulin means that the numbers on his meter may be inaccurate and his insulin ineffective. His mother, Umm Amir, goes to the pharmacy every day to try to find new supplies. They’re either not there or far too expensive, having surged to exorbitant prices after Israel’s shelling began in October 2023. They have to ration. 

In the video, Umm Amir pricks her son’s finger (one of the only two times per day they can afford to do so) and drops the blood on the expired test strip. The camera shows us the result: 498 (that’s in mg/dl, not the standard UK units of mmol/L, which would convert the number to about 27; “normal” for a type 1 diabetic is considered to be roughly 80-180 in mg/dl or 4-10 mmol/L). 

Even accounting for a margin of error, there’s no reason to doubt that the true number is dangerously high. And as someone who has been 498 before, let me tell you with absolute certainty: Amir is not ok. He, and the thousands of others rationing their insulin, are at risk of ketoacidosis in the short term and life-changing complications from extended hyperglycemia in the long term. 

According to Dr. Al-Farra, there are about 2,500 children with diabetes in Gaza. As a result of Israel’s inhumane blockade of essential medical supplies, many have been admitted to hospital in order to receive their insulin intravenously. That is, to rely on the health system that Israeli forces have systematically dismantled in one of their central acts of genocide. 

The supplies, of course, are all just sitting there, held in trucks stopped at Israeli-controlled crossings. It’s not just diabetics who are suffering. Israel is withholding medication for cancer, blood pressure, thyroid conditions, and much more. 

It should be noted that this blockade began – and continues – during a so-called “ceasefire”, in which life in Gaza is now theoretically administered by Donald Trump and Tony Blair’s “Board of Peace”. That is the same UN-sanctioned Board of Peace which is reportedly granting itself complete legal immunity and the right to seize any and all “public” property in Gaza for its own purposes. 

It is also the same Board of Peace that posted on X on Wednesday: “UNRWA has no place in the new Gaza. We are turning the page on the complex of perpetual aid dependency & conflict” one day after the UK Foreign Office pledged  £23 million to support UNRWA’s humanitarian services in Gaza. 

What exactly is our leaderless government’s plan at this crucial moment? Will the next prime minister do anything differently than Starmer? Will he remain surrounded by the same complicit cabinet? Will he, or anyone, act with any urgency to save these children? Will the government finally condemn Israel as a monstrous perpetrator of genocide and exert real pressure on it to abide by the ceasefire, return stolen land, and open the crossings? Will the UK place an actual arms embargo on Israel, rather than lying about it? Will it end the trade deal? Will it prosecute British citizens who committed war crimes in Gaza? 

As Vashti contributing writer Hamza Yusuf posted this week, “Yeah I know Andy Burnham doesn’t wear a tie, likes buses to run on time and detests the London elite, but any chance we can find out what he thinks about Israel’s genocide in Gaza and how he’ll pursue accountability?” 

We’re all waiting, Andy. What are you going to do?▼