Bridging the Gap - Health Equity for all

For Folks with Type 1 Diabetes, Insulin is a Literal Lifesaver

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10 Nov 2023, 1:00 pm

When you think about what’s behind diabetes, your mind probably turns to poor diets, being overweight, and a lack of exercise compounding over time. That’s true for type 2 diabetes (T2D), which makes up 90%–95% of diabetes cases, but type 1 diabetes (T1D) is a different beast altogether. Speaking more broadly, diabetes is a condition that gets in the way of your body’s ability to produce enough insulin or prevents cells from using the insulin in your body. Your cells need glucose, a type of sugar, to function. Without insulin — a hormone made in the pancreas — that energy source can’t move from your bloodstream into the cells. T2D is by far the most common, but T1D has a small but significant share of the diabetes population. Both types affect the body’s ability to produce and use insulin, and both can be managed with support. <figure><img alt="3D medical animation still of type 1 diabetes | Source: Scientific Animations, Inc." class="img-responsive img-fluid mx-auto d-block" src="https://cdn.storymd.com/optimized/JdPGZmfjo3/thumbnail.jpg" /> <figcaption>Type 1 Diabetes. Source: Scientific Animations, Inc.</figcaption> </figure> <h2>What’s behind both types?</h2> Despite how similar their names are, they’re different diseases with unique causes. Whereas T2D develops over the course of many years and is connected to lifestyle factors, T1D involves the triggering of a damaging autoimmune reaction. It tends to develop early in life. What causes this damaging autoimmune response to take hold is a mystery, but genes and environmental factors are suspected. For example, a prolonged viral infection may be able to trigger it. Many people with T1D also have family members who have it, but this isn’t always the case. During the autoimmune response, your immune system attacks cells in the pancreas that make insulin, mistaking them for foreign invaders. More specifically, it destroys insulin-producing beta cells, and this impacts your body’s ability to produce insulin. <figure><img alt="Type 1 diabetes (autoimmune attack) | Source: Scientific Animations, Inc." class="img-responsive img-fluid mx-auto d-block" src="https://cdn.storymd.com/optimized/pqDvxmhPoa/thumbnail.jpg" /> <figcaption>Autoimmune Attack in Type 1 Diabetes. Source: Scientific Animations, Inc.</figcaption> </figure> T2D, on the other hand, is a metabolic disorder. In these patients, the pancreas continues to produce insulin but is unable to use it effectively (or the body has developed a resistance to it). <h2>What happens when you run out of insulin?</h2> Nothing sets apart T1D from T2D like the need for insulin. While perhaps only 10%–20% of adult T2D patients use insulin to control blood sugar levels, everyone with T1D must take insulin every day to survive. Without it, they’ll die from hyperglycemia in days or weeks. The risk without insulin is that the patient will quickly succumb to diabetic ketoacidosis (DKA, a combination of high blood sugar, dehydration, shock, and exhaustion). DKA develops when your body lacks the insulin to allow blood sugar into cells for use as energy, so instead, your liver breaks down fat for fuel. A byproduct of this process is an acid called ketone, which can rapidly build up to dangerous levels. Ketones build up in the bloodstream and leak into the urine. They make the blood too acidic, triggering DKA. <figure><img alt="Ketoacidosis | Source: TheVisualMD" class="img-responsive img-fluid mx-auto d-block" height="467" src="https://cdn.storymd.com/optimized/Nq4906t7AK/thumbnail.jpg" width="640" /> <figcaption>Ketoacidosis. Source: TheVisualMD</figcaption> </figure> DKA tends to build up slowly, and the first signs are usually feeling very thirsty and urinating a lot more. These signs usually appear when the blood glucose level has risen above 300 mg/dl for roughly 4 hours. Some people feel ill immediately, while others carry on in only a vague state of discomfort for days before things turn sour. More severe symptoms will then show if it is untreated: <ul> <li>Fast, deep breathing</li> <li>Fruity-smelling breath</li> <li>Headache</li> <li>Dry skin </li> <li>Flushed face</li> <li>Muscle stiffness </li> <li>Fatigue</li> <li>Nausea/vomiting</li> <li>Stomach pain</li> </ul> DKA is a medical emergency that must be treated immediately. Without it, DKA will lead to death. Hospitalizations due to DKA are on the rise in the US. DKA aside, regularly experiencing high blood glucose over time can trigger serious complications in T1D patients. These include: <ul> <li>Heart disease</li> <li>Eye problems</li> <li>Dental disease</li> <li>Stroke</li> <li>Kidney disease</li> <li>Nerve damage</li> <li>Depression</li> <li>Sleep apnea</li> </ul> <figure><img alt="Complications of Diabetes mellitus | Source: Scientific Animations, Inc." class="img-responsive" src="https://cdn.storymd.com/optimized/Wdxxagced2/thumbnail.jpg" /> <figcaption>Complications of Diabetes: Eye Problems, Kidney Disease, and Nerve Damage. Source: Scientific Animations, Inc.</figcaption> </figure> These complications can be prevented or delayed by staying on top of blood glucose, blood pressure, and cholesterol, as well as being diligent with self-care. Self-care with T1D means a multipronged approach. First is following a diabetes meal plan that features less refined carbs and processed meats and more whole grains and lean meat. Next is being physically active and keeping a close eye on blood glucose. It’s a lot of work living with T1D, but your healthcare team can come up with a care plan optimized for your situation. <h2>Playing the role of your own pancreas</h2> T1D is a rather unique disease in that you live with something akin to organ failure which you must compensate for. The pancreas is a vital organ, and the responsibility falls on the patient to make up for the loss of functionality. Although it sounds dangerous on the face of it, people with T1D can eat sugary stuff like a cupcake. The key is knowing how much insulin they need to cover that food, since managing T1D is all about balancing the ratio of sugar intake and insulin. <figure><img alt="Monitoring Glucose - Know Your Blood Sugar Numbers: Use Them to Manage Your Diabetes | Source: TheVisualMD" class="img-responsive img-fluid mx-auto d-block" src="https://cdn.storymd.com/optimized/Oo5llMfDAK/thumbnail.jpg" /> <figcaption>Monitoring Glucose - Know Your Blood Sugar Numbers. Source: TheVisualMD</figcaption> </figure> Doing the thinking and acting on behalf of your pancreas is hard work. People with T1D check their blood sugar several times a day to make sure things are in balance versus their insulin intake. You can still eat and live normally for the most part, it just requires accountability in adjusting your insulin appropriately. Depression has a strong overlap with diabetes. Significant depressive symptoms affect roughly 1 in 4 adults with diabetes (T1D or T2D), which is unsurprising given the burden of managing a demanding chronic disease. <h2>What if you can’t afford insulin?</h2> Tragically, one of the main reasons why a lot of people enter a state of DKA is due to affordability and access to this life-saving hormone. Insulin in the US is outrageously expensive: it is 7–10 times more expensive compared with comparable countries. In 1996, a vial of insulin cost $21; now, that same vial costs up to $250, yet it only costs $2–$4 to produce. As a tight resource for people unable to afford insulin, patients have turned to rationing their supply. Multiple deaths have been reported, mostly among young people with T1D who were unable to afford their insulin. Being able to get some but not enough insulin still has complications. This cohort has to risk DKA, kidney failure, blindness, heart attacks, and strokes. It’s a grim picture for people struggling to survive, yet as many as 1 in 4 are forced to ration insulin. The roots of and solutions to this crisis are a separate conversation, but for anyone struggling to obtain insulin, there are some short-term options to consider. <ul> <li>Emergency rooms. If you are out of insulin and desperately need some, go to an ER. You can’t be denied service in a life-threatening situation if you don’t have insurance or the ability to pay. This is guaranteed under the Emergency Medical Treatment and Active Labor Act.</li> <li>ReliOn insulin from Walmart. This is a cheaper version of insulin available at Walmart. ReliOn Novolog works the same as Novo’s brand name insulin but is more affordable. Prices are $72.88 per vial and $85.88 for a pack of five prefilled insulin pens.</li> <li>Pharmaceutical assistance programs. These cost-saving programs by insulin manufacturers are designed to help people afford insulin. Eli Lily, Novo Nordisk, and Sanofi each have their own offering, and you’ll need to meet the income requirements to qualify.</li> <li>State copay caps. Some states offer copay caps on insulin for people with certain insurance plans, so there’s only so much you end up paying each month. 25 states (plus the District of Columbia) have capped insulin copayments for state-regulated commercial health insurance plans. In some states, the provision counts for state employee health plans too.</li> <li>Pharmacy emergency refills. Certain states have laws mandating refills of insulin at your local pharmacy in emergencies. You will have to research your state’s laws as the restrictions and requirements differ.</li> <li>Coupon sites. These free sites are tools that help to ensure you’re always getting the best price for your insulin, reducing costs significantly. Coupons can be presented at pharmacies via your smartphone or by printing them out. There are also discount cards you can use during each prescription pickup. Blink Health, Good Rx, Inside Rx, and SingleCare are all examples of coupon sites.</li> <li>Community Health Centers. These institutions often have sliding-scale options for affordable insulin.</li> </ul> <h2>More on Type 1 Diabetes</h2><ul><li><a href="https://soulivity.storymd.com/journal/bmp8k6ri6j-type-1-diabetes" target="_blank">Type 1 Diabetes: Symptoms, Causes, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/jaq9l76t4w-managing-diabetes" target="_blank">Managing and Living With Diabetes</a></li><li><a href="https://soulivity.storymd.com/journal/j3ybpdq0aw-insulin" target="_blank">Using Insulin to Manage Blood Sugar</a></li></ul>

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