What does “insists I am involved” mean? Do they take attendance? Does the group report to your insurance company on whether or not you attended?
And just by looking at this thread, you can see how varied the prices are - depending on 1) whether you have insurance or not 2) what kind of insurance you have 3) how well you know the (often very complex) rules governing your insurance in order to get the most out of your plan 4) whether there are any outside programs or discounts available depending on how much money you make, who makes the insulin you need, or where you buy your insulin. This has been true for a long time for a lot of drugs and procedures and I am continually gobsmacked that so many of us have put up with this sort of bullshit for so long. I am sure a lot of the reason is how fragmented our health care system is - there are so many variables there is no way to compare plans or prices in any meaningful way and I’m pretty sure our ‘system,’ such as it is, is pretty happy with keeping things that way.
I can’t speak for Beck, but if you were talking about my insurance group, the answer would be ‘hell, yes.’ It’s the insurance company that insists on it, because patients with chronic diseases cost them money that they’d rather keep for themselves. Anything they can do to attempt to lower their costs, they’ll do.
It’s disgusting.
I’ll never forget the first time I ever rang up insulin. I was a 16-year-old Target cashier in 1980, and even though I was years away from deciding I wanted to be a pharmacist, I did know what that substance in the box with the $6.28 price tag was, and called the pharmacy because I just didn’t believe it. I thought something like that would be, like, $300 or something.
And now it is.
:mad:
It would have been one of the old animal-sourced (beef or pork) insulins, which aren’t sold in this country any more, and Target closed its pharmacies not long afterwards. They reopened them in the early 1990s when the company went nationwide.
Cut to 1987, when I was volunteering in a hospital pharmacy while making up my mind about going back to school, and when I saw Humulin, I asked if they took pancreases out of dead people and extracted the insulin, because I knew that was how they got human growth hormone (ETA from donated pituitary glands). The whole E. coli genetic engineering thing was explained to me, and I thought that was pretty cool.
See the end of my post that you quoted. I’d already addressed that.
Also, what Broomstick said. It isn’t always free or easy to consult a doctor. It should be; but it isn’t.
Anyone more advanced than a rookie Medical assistant knows insulin dosing, you don’t need a dedicated doctor to help you. Insulin dosing is not an arcane formula only pharmacists and endocrinologists can understand.
In Spain you can in fact ask your pharmacist for assistance with dosage, when would be the best time to take a specific medication, interactions, etc.* Would that be possible in the US or is it one of those “I’m not touching that with a ten-foot-pole to avoid suits” things?
- Showing off: in several regions, the e-prescription system allows the pharmacist to substitute a scrip for another and to write notes to the doctors. This will normally be for very straightforward stuff such as “scrip for 500, gave 2x250 instead” or “generic instead of brand-name,” but it can be more complicated when the pharmacist recognizes an interaction or allergy the doctor appears to have missed.
yes the high prices are really bad. I am type I and found that low carb diet helps me a lot to keep numbers down. I don’t do Keto diet but I am close to that.
Or very poor follow up. Yes.
If you don’t have insurance AND money in the US you’re shit out of luck unless you are actively dying. Then you go to the ER - but the ER doesn’t do follow-up.
So… one possible scenario is that a person doesn’t know they have diabetes. They get sick enough to wind up in the ER. The ER figures out they’re diabetic. They’ll give them insulin and whatever else is needed to get them out of “actively dying” then tell them to follow up with a doctor. If they don’t have a regular doctor then the ER will make a referral… but that still leaves the problem of how to pay for that appointment and the subsequent medications, and that’s without considering potential problems with transportation or getting time off work or whatever.
Yes, US pharmacists can help with that sort of thing but the differences between the old-style insulins and the newer ones are considerable. Also, diabetics are variable. Not everyone responds the same way to the same insulin.
It is true that treating diabetes is not rocket-science in a sense - in Shaghai in WWII a English teacher taught herself how to make insulin sufficiently well to keep herself and 400 other people alive - but there’s “adequate to preserve life” and then there’s “optimizing results”. Big Pharma pushes the new drugs/delivery systems/etc. with the argument of convenience and optimization… none of which is any good if the patient can’t access such care.
There are certain substitutions pharmacists are comfortable making. There are others they are not. I could see pharmacists happily giving instructions for something specifically asked for by a doctor in a prescription but being less comfortable doing so when substituting old-style insulin for one of the newer ones with much different frequency, duration, etc. Could it be done? Yes. Should it be done with someone with limited knowledge/access to patient history and diagnosis? Um… maybe not. Unless it’s an emergency.
They can do that in the US, too. There are a very few drugs where absolutely NO substitutions or alternations can be made in the prescription, but most of the time what you describe is permissible. As far as drug interactions or allergies, US pharmacists not only are allowed to report it they have a duty to inform the doctor and the legal right to refuse to dispense something they believe could harm the patient.
When we went through an uninsured period my spouse’s meds got to be quite varied. The docs and pharmacists would put together free samples of something so a pill bottle might have three different colors of capsules in it, as an example. We still had to make choices - we kept him on the diabetes medications but dropped the statins until we get coverage again. He did wind up rationing the diabetes meds for a short time, but as he was Type II diabetes that was less hazardous for him than for someone Type I. It’s not good for Type II diabetic to, say, skip meds for a bit but they can still function. For someone Type I that could be lethal.
That’s something to keep in mind - although the problem is pressing for someone Type I, people with Type II diabetes are also suffering. Some Type II folks also need insulin, either daily or from time to time (there were a couple occasions my spouse’s blood sugar went berserk and he temporarily needed insulin until the problem was resolved.) While short term deprivation is less of a problem for Type II’s, long term they, too, can get damaged kidneys, destroyed eyesight, nerve damage, amputations, and early death.
I’m on Medicare, and also pay for supplemental insurance (which has gone up in price). I need to take 300 units of insulin every day, a combination of Humulin N and R. I already have stage 3 kidney disease, plus vision problems and nerve damage.
I will vote for any candidate who will make this more affordable.
I’m waiting for doctors to be able to create a new pancreas and kidneys out of my own stem cells… or print them with a 3D printer. According to my nephrologist, that may be possible in 10-15 years, if I live that long.
We see a lot of commercials for drugs to cure hepatitis C and for preventing HIV infections. Mrs. L.A., RN, often comments how great it is that these drugs are available. We also see a lot of commercials about ‘lowering your A1C’. There was another thread where I wondered why no one has come up with stem cell or gene therapy to cure diabetes. The Hep C and anti-HIV drugs are enormously expensive. I’m guessing stem cell/gene therapy would be as costly as hell too. But people would pay it. I have the idea that the health industry isn’t so much interested in curing diseases (in spite of the Hep C treatment), but in merely treating diseases without curing them for as long as possible.
I hope your nephrologist is right about growing new pancreases, and that other chronic diseases such as heart disease, cancers, and such can be similarly cured. But I have the feeling that there won’t be much interest until the calculus is done to maximise profits. There are plenty of people, so it doesn’t matter if a few thousand or a few million die. The important thing is money.
A problem with growing a new pancreas for someone with Type I diabetes is that Type I is considered an auto-immune disease (at least in most cases). Even if you could 3D print a new pancreas if you just plop it into the recipient’s body their immune system will destroy the new one, too.
For people whose pancreas was damaged/destroyed by something else - injury, perhaps - it would work. Presumably. But not for people whose immune systems are on a search-and-destroy mission. Well, suppose you could administer immune suppressants, but then they have to pay for those…
I do believe there are people in medicine who genuinely want to cure disease and fix problems permanently. I also believe there are some greedy assholes who want to make money and don’t care who they hurt.
Huh, well I learned something new today. Insurance companies take attendance at support group meetings.
What’s the difference between Type I and Type II?
Type I usually begins in childhood. The body’s immune cells attack the pancreas so it doesn’t produce insulin. Type II diabetics usually get it when they’re adults. The pancreas either doesn’t produce enough insulin, or the body cells can’t utilize it properly.
You are thinking of Medicaid (for the poor), not Medicare (for the elderly and disabled). Medicare is administered exclusively at the federal level.
**Type I **means little or no insulin is produced in the body. It is believed to usually be an auto-immune disorder although severe injury or surgical removal of a diseased pancreas (such as with pancreatic cancer) can also induce the disease. If you have this and you don’t get insulin you will die. Extreme low calorie diets and/or fasting can buy a little time, but if you go that route it’s a race between death by rising blood sugar or death by starvation.
In **Type II **diabetes the pancreas still produces some insulin, but either it’s not enough or there are adequate amounts of insulin but the body’s cells have become resistant to it and it doesn’t work as well as it should. It is possible to have both of those problems at the same time. Many, if not most, Type II diabetics do not require insulin except in unusual circumstances but the older and individual diabetic gets/the longer they’ve had the disease the more likely they are to start requiring some form of insulin to keep their condition under control. In other words, this can get worse with time.
Type II diabetics have a potential advantage in that exercise, proper diet, and weight loss can either reduce the amount of medication they require, or in some instances go into a sort of remission where they don’t require daily medicine… but regular monitoring is very much suggested. The only hitch is that keeping to a rigorous diet and losing weight are very hard, especially if you have additional problems you have to deal with (like poverty, or a heart condition that limits the exercise you can do). And for a substantial portion of Type II diabetics even the best dietary control and exercise regimen still won’t eliminate the need for some medication to keep their blood sugar under control and prevent long term damage.
Medications for Type II diabetics start with drugs that either increase natural insulin production, increase the sensitivity of body cells to insulin so it and sugar are better utilized, or both. Medications for Type I start with insulin because if the pancreas ain’t producing at all there is no point in trying stimulate it.
It is also possible to qualify for both of those programs at the same time.
That used to be the party line, but it’s gotten fuzzy over time.
Morbidly obese kids can certainly get Type II as kids. Plenty of adults have spontaneously developed Type I. which is why they are no longer referred to as “juvenile diabetes” and “adult-onset diabetes” as much as they used to be.