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Vanman04 t1_j1eagz1 wrote

Reply to comment by nancyapple in Despite improvements in insulin formulations and delivery over the last 30 years, diabetes control has not improved among US adults, and disparities for minority and uninsured adults worsens by Ordinarymangodoctor

Seems cost is playing the biggest part.

"Several factors may have contributed to the lack of improvement in glycemic control. First, the rising cost of insulin is likely leading to medication nonadherence.17 Approximately one-third of US adults using insulin report either rationing, dose skipping, or delaying prescription refills to save money.18 Second, only a small proportion of practitioners may be starting or intensifying insulin therapy in a timely manner.19 Third, acceptability of insulin remains low among patients, leading to reluctance to begin or continue using insulin therapy as recommended.20"

It also explains that Mexican Americans are driving a large part of the bad results which again likely points to access to newer tech.

Last but not least this report seems to end right at the beginning of when closed loop systems started to come online. The new tech in insulin pumps is pretty amazing but the cost to use them is pretty insane.

My son is type one. He uses an insulin pump that is connected to a continuous glucose monitor. His pump has the ability to monitor his glucose level and deliver or stop insulin as needed. The results are nothing short of amazing. That said it is expensive as hell.

The pump itself cost 6k with insurance our cost was closer to $300 but then you need supplies for it which run somewhere in the neighborhood of $90 per month. On top of that you need the supplies for the continuous glucose monitor that adds another $90 -160 per months after insurance. Add insulin for another $30 per month after insurance. This is with pretty decent insurance.

Without insurance it becomes completely unworkable unless you are high income. There are a ton of people still using shots and pricking their fingers which causes all kinds of issues with control.

I feel like the title sort of obscures the reality. It's not that the tech is not good enough to improve outcomes it is much more that the barrier to to getting that tech in peoples hands is too high.

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muinamir t1_j1ef60n wrote

Anecdotally I know of so many people who have struggled to afford their insulin and meds. I wish we'd stop trying to pin this solely on diet and realize we're shutting people out from the treatment they need.

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TheConboy22 t1_j1fu6ze wrote

I am one of those somebodies. Type 1. This condition has made me a slave of the corporations. Without their life giving insurance premiums I’d have moved away from them a long time ago. My meds are stupid expensive…

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Reep1611 t1_j1h3gaq wrote

If you are a somewhat capable worker, especially if you learned a craft, you might want to learn German and think about moving here. Our current Gouvernement is updated and codifying new laws regarding immigration, so it will be mich easier to live and work here and enjoy all the benefits like our very good healthcare.

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nowlistenhereboy t1_j1fzxkm wrote

> I wish we'd stop trying to pin this solely on diet

You can perfectly manage your glucose levels by meticulously testing and administering yourself extra insulin to cover but all of that extra insulin is not without its own cost to your body. Having all of that extra exogenous insulin creates its own set of side effects because insulin does a lot more in your body than just allow glucose into cells. Insulin facilitates growth of adipose tissue and can lead to hypertension, atherosclerosis/heart disease among other things.

Getting exercise and reducing your caloric intake to more closely match your caloric expenditure is the MAIN thing EVERYONE should be doing.

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RigilNebula t1_j1gbn9f wrote

>Having all of that extra exogenous insulin

For type 1 diabetics, all insulin is exogenous. It's not "extra", it's simply insulin.

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nowlistenhereboy t1_j1gkn7d wrote

That totally depends on how much they eat. If they eat enough to the point they are administering more insulin than their body would normally produce if they did not have diabetes, then it's absolutely excess insulin.

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drugihparrukava t1_j1gmvj6 wrote

We (type 1's) don't take insulin just for food. We can fast and need insulin because we don't produce it. Several hours if you're pumping, or a days/a few days if you're MDI, of no basal,(background insulin) and we're in DKA. Nothing to do with food.

It's a never ending balance of working out levels, as we have over 42 known factors that we do calculations for. Getting it exactly right isn't even possible with existing closed loop pumps.

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nowlistenhereboy t1_j1gnd4n wrote

Yea, not getting it absolutely perfect is not what I'm talking about. What I'm saying is that you can potentially eat a very large amount of calories, cover it with a bunch of insulin, and your sugar will appear to be fine. But all the negative effects of that over consumption and excessive insulin will manifest in the same way it would affect a type 2 or even someone who doesn't have diabetes.

This issue is way more pertinent to type 2 diabetics. But even a type 1 could develop insulin resistance in this way as well as the negative side effects of hyperinsulinemia.

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drugihparrukava t1_j1gof55 wrote

Hyperinsulinemia is when the pancreas releases large amounts of insulin so that doesn't happen in a T1 body. Insulin resistance can occur in T1 for several reasons, but it's not the same as hyperinsulinemia which is one of the possible causes of T2. So we generally use the term IR which can happen temporarily in a type 1 (due to one's period, ovulation, or many other hormonal changes, illness, scarring causing bad sites etc) or from having T1 for decades on its own can cause some resistance.

If a T1 does choose to eat large amounts of calories, of course that's not healthy for anyone, diabetes or not. But no the glucose (or "sugar will appear to be fine") isn't necessarily the case. It's a struggle to work out boluses and we dose differently for carbs, proteins and for many other reasons.

TLDR: yes no one should be eating excessive quantities anyway with that I agree. T1, however, and insulin dosing is very complicated and not caused by diet.

​

Just an FYi if anyone's interested; it's understandable if you don't live with T1D to know just how much of a mental load this disease is. We have an additional 180 decisions to be made per day while acting as our own pancreas 24 hours per day. This is a rather simple chart of the 42 factors that affect blood glucose, and not all are listed here either: https://diatribe.org/42-factors-affect-blood-glucose-surprising-update

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RigilNebula t1_j1j0v05 wrote

The things that you're saying are just the consequences of overeating in general though. If a non diabetic eats too much food, they'll see a growth of adipose tissue, and this can lead to hypertension and heart disease.

Unlike non-diabetics, if a type 1 diabetic overeats without taking 'exogenous' insulin, they will not gain weight, and there's no risk of a growth of adipose tissue. (There are, however, significant other risks, including death.) However, if they take insulin for the food they ate, they'll see the risk of weight gain and excess fat that non diabetics would see from overeating.

So you may be arguing that there are health risks to overeating. And this is true, but it's not specific to type 1 diabetics.

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Dolphintorpedo t1_j1eobvn wrote

Well tons of people are dieting themselves into type 2 diabetes so maybe it's fair to talk about dieting out of it as well. Why talk about a cure of the symptoms and not the source cause?

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meeseek_and_destroy t1_j1eqmyp wrote

The people I know rationing their insulin are type one. So no diet can fix it as they were born that way.

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2alpha4betacells t1_j1i1aik wrote

I still use shots just because I hate wearing the pump (falls off, reinserting sucks, I’ve accidentally had in torn out many times)

Hate inserting CGMs too, but now I have one that is implanted under my skin and only needs to be reinserted (by a doctor) every 6 months

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