We need to get better DM nomenclature. Right now there’s type 1, type 1.5 (LADA), type 2, type 3 (proposed), CFR DM, Hemochrome DM, glucagonoma DM, MODY, gestational DM, and a host of other even more niche types.
Also diabetes insipidus, which has nothing to do with blood sugar.
Sounds like a particularly mean Harry Potter style hex.
The base program, yes. Medicare Extra Help, which is income-related and will sometimes pay for things regular Medicare doesn’t, goes through the states. In NY it’s administered through the county. (Cite: that’s who I had to deal with to get it.)
Great, a hex to make one pee endlessly.
Ummmm, no.
We can start with the fact that my diabetes specialist somehow managed to graduate (elementary school) without any advanced math skills. She normally applies conversions backwards, but being aware of her issue, I check the math. Twice.
Then figure in the new insulin’s are not only concentrated (2X, 3X, or 5X) and are good for anyware from 12 hours to 30+ hours, and if your on dialysis, any rational response curve goes out the window, and dosing devolves to an arcane art, not a science.
Yes, I’m getting my Borg blood sugar sensor this week. Waking up with a BS of 63 is getting old.
Not from Big Pharma, but there is a group of Type-1’s that have hacked the new constant metering blood sugar meters and a particular older insulin pump together to form a crude artificial pancreas.
I’m sure the FDA is making the sign of the cross.
To clarify the mystery of dosing a little bit…
Insulin is dosed on units. As long as you are using the same general type of insulin - and by that I mean rapid acting. long acting, mixed, etc. - a unit is a unit is a unit.
Put another way, 10 units of Novolog = 10 units of Humalog = 10 units of Admelog.
10 units of Lantus = 10 units of Levemir = 10 units of Basaglar.
So, if you are merely switching brands from brand A to similar-acting brand B, the dose is unchanged.
But if you are switching from a medium-acting to a rapid-acting, or a long-acting to an ultra long acting, yeah, you have to know how to convert the dose.
mmm
Just to add that the older insulins have to be taken at least twice daily and are less forgiving in terms of control. That means that rather than checking sugars one to two times daily, patients have to check their sugars at least 3x a day. Every time they check a patient has to pay for test strips and lancets which are not cheap. Strips can cost upwards of 50 cents each and even a box of 100 lancets is $15 at Walmart. Also even if you are only paying $25 for a vial of insulin, if you take 100 units a day, you will need 3 vials a month, plus at least 60 syringes which with cost another $10-20. My cat’s insulin cost $80 and an additional $45 for needles every 3 weeks and she was on about a tenth the dose of a usual human (although I did use then pens for her because it was easier and I could hit up the drug reps for samples for her as well as for the human patients). There are so many new good medications available for diabetes and it frustrates me that I cannot use them. Medicare is particularly bad because the government will not let the pharmaceutic companies give discounts to Medicare patients and older patients are the ones more likely to have trouble with insulin.
This seems to contradict what a previous poster said about Medicare and insulin.
Let me clarify what I was talking about. First of all, when we talk about type 2 diabetes, there are a lot of medications that improve the body’s use of insulin and may prolong pancreatic life. However, many of these are very expensive. Because there is competition, the drug companies subsidize copayments. If, for example, a medication costs them $10 to produce they may then sell it for $400. They contract with the insurance companies who agree to pay $200 and charge a 40% copay of $80. So, the insurance company pays $120 and the patient pays $80. When there is more than one medication in a class, the companies want patients to use their medication. They usually have coupons that subsidize the copayments, so that, for example, they will pay up to $120 per month of the patient’s copayment after the first $5. They still receive $125 for the medication ($120 + $5) and make a profit, and the patient feels like they got a great deal and only pays $5. However, the government has decreed that these coupons cannot be used for any federally subsidized insurances (medicare, medicaid and sometimes federal employee-which is a big deal here in the DC area).
Medicare itself does not cover medications at all. You need to buy a Medicare part D plan to cover medications or be part of a Medicare Advantage (HMO) plan. Many patients cannot afford any part D plan or buy the cheapest one which has poor medication coverage.They are then stuck paying whatever their part D insurance allows.
For those Medicare patients who are truly indigent, they can get Medicaid as their supplements which will cover Part D and medications. For those whose incomes meet certain limits, they can get assistance under the Low Income Subsidy program LIS which does have income limitationsincome limitations-pdf. That is where the $8.50 comes in.
Let’s also not forget about the infamous “donut hole”. This year, Part D plans will cover their usual amounts up to a total cost (not out of pocket) of $3820. After that, they are in “the hole” which in previous years meant that they paid 100% for medications. However, this year they pay only 25% for brand-name medications and 37% for generic medications until total costs reach $5100 after which they pay 5% for all medications. Confused yet? donut hole.
If you do not qualify under LIS and meet other criteria, sometimes the drug companies have compassionate use program that will send you free medication.
Now imagine you are an elderly person who is not computer literate trying to navigate this. (Also now see why as a primary care physician I am at the office until midnight every night dealing with this. There is a reason I know all of the programs and all of the prices-because I am dealing with them constantly).
And isn’t it terrible that physicians need to know that sort of stuff in order to serve their patients? I applaud your work on their behalf, but it should never have been necessary. There’s so much actual medical knowledge to keep up with . . .
PSA for anyone in the U.S. having a hard time paying for prescription drugs, either with or without insurance: check out Goodrx.com (there’s even a smartphone app). It gives you the prices of every drug I have ever checked at the several pharmacies neatest to you with their own electronic coupons.
Sometimes there isn’t much of a discount over sticker price (usually that’s the case with brand-name drugs still under patent), but sometimes the discounts are substantial, on the order of 80% or even more. This info came in mighty handy when my MIL was visiting from overseas and needed meds unexpectedly (she never signed up for Medicare Part B because you can’t use it outside the U.S. anyway).
Or one I am more familiar with: Advair. The last time I had to buy a disk and hadn’t met my deductible yet, it was over $350. (Of course the disk I bought in Cyprus was 1/10 the price, but that’s a rant for another day.)
I’m fairly certain there are telephone numbers that people can call to get explanations about all of this.
Is this a joke?
No it’s not. Since I know for a fact that there are places that exist that explain this information.
Diabetics should suck it up, we need to do some studies about reparations!
My grandmother was for about the last 10 years of her life. Before she went into a nursing home, all she owned was the furniture and other contents of a 1BR apartment, and her only income was Social Security.
Type 1 diabetes may also be a viral disease, whether directly, or that the virus does something to the immune system to destroy those beta cells.
Both types, but especially Type 2, have many subtypes, and we really don’t know what causes any of them.
About 15 years ago, I visited the Banting Museum in London, Ontario, which has a torch in the front yard that was lit by the Queen Mother when the museum was dedicated in the late 1980s. That torch will be extinguished when diabetes is cured; unfortunately, that’s going to be a while.
Yup. And you can call six numbers and get six different answers.
Then there’s the ever-popular circle: Agency A: Sorry, we can’t answer that particular question, you need to talk to agency B. Agency B: sorry, we can’t answer that particular question, you need to talk to agency C. Agency C: sorry, we can’t answer that particular question, you need to talk to agency A . . . .
So? Is dying better than waiting on the phone?
At some point you guys will get tired of killing each other off via guns, mercenary medicine, imposed poverty and McDonald’s. When you do, the civilized world is ready to embrace you.