The State of Diabetes

The French author, Jean-Baptiste Alphonse Karr is credited with saying:

 plus ça change, plus c’est la même chose”

which when translated means “the more things change the more they stay the same”.  This phrase lends itself very well to describing the state of diabetes, research, treatment and prevention.  Last week was my 39th Diaversary. Today, as I write this post, I am 50 years and 13 hours old.  My world changed 6 days before my 11th birthday. For most intents and purposes, my perspective has mostly been about having diabetes, day in and day out. Like the shampoo bottles say “Lather. Rinse. Repeat.”

When I was diagnosed things were a lot simpler than they are now.  Please allow me to hit the highlights below:

Available Insulin in 1979
Short Acting Intermediate Acting Long Acting
 Regular – Beef  NPH – Beef  Lente – Beef
 Regular – Pork  NPH – Pork  Lente – Pork
 Regular – Beef/Pork  NPH – Beef/Pork  Lente – Beef/Pork

Recognize any of these? They don’t exist any longer. You can still find their cousin the rDNA biosynthetic human based insulins like Humulin or Novolin. The options were slim and there were only two major manufacturers in the game, Eli Lilly and NovoNordisk.

My parents had top of the line insurance and at that time I wasn’t concerned with the cost of the insulin. I know that even in the scope of things, the insulin was not astronomical in price.  I used “R” and “N” combined. I don’t think I used more than a bottle of each in a month. I remember, as a teen going to the pharmacy and getting my insulin, and the whole thing cost less than $20.

Iletinn2
Eli Lilly Pork insulin, NPH

Let’s fast forward to today. My Humalog Kwik pen , 30 day supply, retails for $2,086.09. My Tujeo is $916.59 for thirty days.  My  co-pay is $40 for each. I haven’t purchased needles or pen tip in several years because I inherited over 500 tips a couple of years ago, and I re-use them until they can’t be used. (Don’t shake your head. You know what I am saying.) If insulin was the ONLY medication I used, and I did not test, my monthly expenditure would be $3002.68.  I have been unemployed and had to pay out of pocket before getting assistance.

Back to 1979.  I believe that I was sent home from the hospital with a U-100, 1cc 25G 5/8″ disposable insulin syringe. There was one BIG manufacturer of insulin syringes, Becton-Dickinson (BD).  They had the insulin syringe market wrapped up. Terumo and Monoject were in the race but were happy to have the hospital syringe market.  BD had a quality syringe.  I remember having to inject at a 45° to make sure the insulin was delivered into the subcutaneous layer and not muscle. Now the needles are 30-31 Guage and so short they are referred to as ‘shorts’ or ‘nano’. No longer do you need to inject at 45°. Perpendicular all day long!

monoject-insulin-syringe-with-needle-rigid-pack-a29
Monoject Syringe and needle with rigid pack.

Part of my luggage, coming home from the hospital, included the ever popular Clinitest home chemistry set and it’s little brother the Acetest Ketone Test Kit:

testing_supplies
Clinitest Urine GLucose Test Kit and the Acetest Ketone Urine Test Kit

 

My doctor also wanted to know the volume every time I urinated. So, I also had a graduated pitcher, in the bathroom, along with my marble notebook, to document it all.  Going to the bathroom took 10 minutes sometimes! This was part and parcel for me for several years.

Eventually, The home self-blood glucose meter (SBGM) became “affordable”. I remember my parents saying that my meter was roughly $300. That is the equivalent of $770 today.  I do not think that insurance covered it at the time. I may be wrong. What did I know? I was a teenager.  What I do remember growing up was that deciding on which meter to use was never a question of coverage.  I picked a meter system and insurance paid for it.  Fast forward to today.  I know in my plan, I have the choice of any of the OneTouch meters. Period.  And even then they restrict the number of test strips I can use in a month. When I was a telephonic disease management nurse my patients used to ask me “What is the best meter I should get?”  My answer was always the same, “Let’s look and see what your plan will cover. That will be the best one for you.” A little bit of trivia for you: The “Accu-Chek” meter, by Roche, is the clinical name for requesting a blood sugar value, whether from a vein or a fingertip. “Get an Accu-Chek on Mrs. Jones.” Regardless of the meter being used. The same as when you are making a photocopy you say you are making a Xerox despite the machine being another brand.

There is been a petition and campaign circulating called “Coverage2Control”. The JDRF started the campaign which targets these three factors:

“1) keeping out-of-pocket costs for insulin and diabetes management tools predictable and reasonable, 2) giving people the freedom to choose the insulin pump that’s right for them; and 3) covering all life-saving technology, including artificial pancreas systems.”

You can read the entire message from JDRF here.

We are still taking insulin.  Now it costs a whole heck of a lot more!

We are still testing. Now the supplies cost a whole heck of a lot more!

We have a lot of products available on the market to help manage our condition. Unfortunately, the insurance industry prevents us from being able to have the choice to use the products that will work best for us, not just the products that have the highest profit margin for the insurance company. Again, to do your best it costs a whole heck of a lot more!

The more things change. The more they stay the same!

You get the picture!

 

Stay safe. Do good!

Peace+

Tim, aka The DiabetesDude

 

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