42 144. The WHO has indicated that the treatment of diabetes 343 “involves lowering blood glucose and the levels of other known risk factors that damage blood vessels.” Among the interventions that “are both cost saving and feasible in developing countries” the WHO recommends : (i) moderate blood glucose control; (ii) and blood pressure control; (iii) foot care; (iv) screening and treatment for retinopathy (which causes blindness); (v) blood lipid control (to regulate cholesterol levels); (vi) screening for early signs of diabetesrelated kidney disease.”344 The WHO has made concrete recommendations for treating this disease, which include physical activity and an appropriate diet. 345 145. The IACHR notes that at the various hearings on the incidental motions filed, doctors offered the Judge their opinions on the treatment that Ms. Chinchilla required. According to all the doctors’ statements given, that treatment involved: (i) periodic sugar control, ophthalmological monitoring, kidney monitoring, control of irrigation in lower limb, and cardiovascular checkups; (ii) verification of the times she took her medicine, help moving her, access to medical equipment and access to medicine; (iii) intramuscular insulin injections; (iv) special equipment for ketoacidosis in the event of a diabetic coma; and (v) examination by an endocrinologist.346 For her part, one of the COF nurses said that Ms. Chinchilla needed someone “very special to be with her 24 hours a day and attend to her personally, which they could not do because they had to see to the rest of the prison population.” The report of Dr. Edna Edna Erika Vaquerano Martínez, which was put forward by the petitioners and not challenged by the State, also refers to the treatment that Ms. Chinchilla should have received.347 146. In the present case, the medical examiner from the Public Prosecution Service as well as the doctor from San Juan de Dios General Hospital and the judiciary medical examiner all said that they were not familiar with the facilities of the COF, the specific medical treatment that she received at the center, and the World Health Organization, Diabetes. Fact http://www.who.int/mediacentre/factsheets/fs312/en/ sheet No. 312. September 2012. Available at: 342 World Health Organization, A Global Brief on Hypertension, World Health Day 2013, p. 24. Available at: http://apps.who.int/iris/bitstream/10665/79059/1/WHO_DCO_WHD_2013.2_eng.pdf 343 Which it has defined as a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces World Health Organization, Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916. Geneva 2003, p. 79. Available at: http://whqlibdoc.who.int/trs/who_trs_916.pdf 344 World Health Organization, Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916. Geneva 2003, p. 79. Available at: http://whqlibdoc.who.int/trs/who_trs_916.pdf 345 Among the WHO recommendations for people with diabetes are the following: (i) Practising an endurance activity at moderate or greater level of intensity (e.g. brisk walking) for one hour or more per day on most days per week; (ii) Ensuring that saturated fat intake does not exceed 10% of total energy and for high-risk groups, fat intake should be <7% of total energy; Achieving adequate intakes of NSP through regular consumption of wholegrain cereals, legumes, fruits and vegetables. A minimum daily intake of 20 g is recommended. World Health Organization, Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916. Geneva 2003, p. 77. 346 See in this connection the statements made by medical experts at the hearings of August 29, 2003 and April 21, 2004 347 According to this report, ... a person with diabetes must undergo clinical evaluation, including laboratory tests (glucose pre- and post-prandial [before and after eating]) carried out regularly, preferably fortnightly or monthly, in addition to laboratory tests to examine their urine, blood chemistry, and kidney, pancreas, liver functions, etc., since diabetes is a rapidly evolving disease that affects several of the body’s systems. ... High blood pressure ... She should have been constantly reexamined in view of the terminal occlusive arteriosclerotic disease that she had in her lower limbs, as this increased the risk of deep vein thrombosis that might cause a cardiac or pulmonary embolism. An electrocardiogram performed monthly as well as blood pressure readings every 48 hours are the indicated preventive treatments. Appendix to the petitioners brief received on April 18, 2006.