I’m infuriated about the price some folks have to pay for their life-saving insulin. Big Pharma knows it’s a major PR problem for them. Scott Benner is the father of a T1 diabetic girl, Arden. He attended Novo Nordisk’s recent PR conference in Indianapolis.
“If you think that you have a commonsense idea that fixes the problem – I promise that you don’t. The issue of insulin pricing, in my estimation, is a microcosmos of every political stalemate that I’ve ever considered. On the surface it feels like someone just needs to do the “right thing”. Problem is, there are too many ‘someones’ and they all hold a different version of what doing the ‘right thing’ means. – no magic wand.”
Source: Novo Nordisk Summit — Arden’s Day and The Juicebox Podcast
I tried to leave a comment at Scott’s blog but couldn’t get it to work. So here it is:
I suspect Sarah P (an earlier commenter) is on the right track.
How much does Novo Nordisk sell their insulin for in socialized systems like Britain’s National Health Service? I bet it’s a lot lower than the retail price in the U.S. And yet they are quite likely making a decent profit on sales in the U.K.
On the other hand, if the U.S. market is subsidizing markedly lower drug prices in other countries, that needs to change.
Many drugs are dramatically cheaper outside the U.S. Look up hepatitis C treatment and rattlesnake anti-venom, for example. But I can’t cross the border into Mexico, buy those drugs, then return to the States and sell them here at a lower price. That’s illegal. Big Pharma would never allow that law to be changed.
How much of this is socioeconomic vs genetic vs physiologic?
“Diabetes during pregnancy may put offspring at a higher risk for incident type 2 diabetes later in life, an analysis of indigenous and non-indigenous Canadians found.
Overall, those who had been exposed to type 2 diabetes and gestational diabetes in utero had a higher risk for developing type 2 diabetes before the age of 30 compared with those who had no exposure to diabetes (3.19 versus 0.80 versus 0.26 cases per 1,000 person-years, respectively, P<0.001), according to Brandy Wicklow, MD, MSc, of the University of Manitoba in Winnipeg, and colleagues.”
Source: Diabetes Exposure in Womb Tied to Later-Life T2D | Medpage Today
Good news from Sysy Morales at Diabetes Daily:
“Did you know that Walmart sells Novolin Regular human insulin and Novolin N insulin (commonly known as NPH) for approximately $20 a vial? In most states, you don’t even need a prescription.
These older insulins were what people with diabetes relied on during the 1980s and 1990s before new insulin came along like Humalog, Novolog, Levemir, and Lantus. The activity profiles of R and NPH were combined in patients with type 1 diabetes so that there would be peaks and valleys throughout the day. A peak of insulin action would cover breakfast, lunch, and dinner. Snacks may also be needed at various times to avoid hypoglycemia. Patients were generally injecting both R and NPH in the morning before breakfast and then again before dinner, but of course, there were various schedules provided to patients. Meals on these two insulin types were kept somewhat consistent regarding the quantity of food and carbohydrate intake as well as mealtimes.”
Source: You Can Get Cheap Insulin at Walmart Without an RX in Some States
Finger-pricking four times a day gets old real quick!
The U.S. Food and Drug Administration has issued new guidelines for manufacturers of home glucose monitoring devices. The old standard was that the glucose reading of the device had to be within 20% of the actual or true value compared to a medical lab-grade machine.
For example, if the device read 165 mg/dl, the true value could be anywhere from 132 to 198 mg/dl.
Under the new +/- 15% rule, the true number should be between 140 and 190 mg/dl.
I bet you thought your device was more accurate than that.
From the FDA to device manufacturers:
“Blood glucose test results are used by people with diabetes to make critical decisions about their treatment; therefore, it is important that the results are accurate so that nutritional and drug dosing errors are better avoided. Your studies should demonstrate that your SMBG [self-monitoring of blood glucose] is sufficient for this purpose by showing that 95% of all SMBG results in this study are within +/- 15% of the comparator results across the entire claimed measuring range of the device and that 99% of all SMBG results are within +/- 20% of the comparator results across the entire claimed measuring range of the device.”
Low-carb vs standard “diabetic diet”:
The most significant fact to emerge is that those who follow the advice of Dr [David] Unwin are so often successful.
In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice:
(1) Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg, waist circumference fell by 15 cm, blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but in common with prior observations for low-carbohydrate diets a significant improvement would have been anticipated.From the perspective of the practice, there has been a huge saving in the expenditure on drugs used for the treatment of diabetes. The actual figure is about £38,000 per year against the regional average, which represents the lowest spend per 1000 patients in any of the 19 surgeries in the surrounding Southport (UK) and Formby area for which information was available. This saving should be seen against the extra costs of the Norwood Surgery diabetes intervention at just under £9,000 per year.
(2) There has also been an improvement in the obesity prevalence as determined by BMI. This has dropped from 9.4% before the initiative commenced to 8.4%. The National Health Survey for England shows that for adults there has been a steady increase in the prevalence of obesity in England between 2010 and 2015 (Table 1).
Source: 305. A Comparison between the approaches to Type 2 Diabetes (T2D) by Dr David Unwin and Diabetes UK | Verners Views
RTWT for diet details.
Diabetes Self-Management has good article to consider if you’re still in the workforce. To whet your appetite:
“Diabetes influences what jobs are best to work. Here are some things to think about:
• Regular schedules are best. Dr. Alan Glaseroff, a physician with Type 1 diabetes, says “Try to avoid shift rotation. It throws off your insulin, food, and exercise schedule.”
• Stressful jobs aren’t good, as stress raises blood sugar levels. In addition to emotional stress, stress can include physical hardship such as working in extreme cold or extreme heat.
• It’s important to be aware what kind of health insurance, if any, a job provides.• It is also important to know if breaks are allowed. Managing diabetes requires occasional breaks for checking blood sugar, eating, or take medication. A warehouse worker told me, “At my job, you get one paid break in nine hours. Most people skip the unpaid break and just keep working. My diabetes has been out of control since I started.”
• Larger companies might be better, because they are covered by worker-protection laws. The Americans with Disabilities Act (ADA) requires employers with over 15 workers to provide “reasonable accommodation” for disabilities, including diabetes.The Family Medical Leave Act (FMLA) assures that workers get unpaid time off for health needs such as doctor appointments and self-management training, but it only applies to companies with 50 or more employees within 70 miles of your place of work. According to San Francisco–based employee rights attorney Alan Adelman, jobs with union membership may provide an extra layer of protection.
Under the ADA, no employer of any size is allowed to discriminate against you, though small ones are not required to accommodate special needs.”
Source: Diabetes In the Workplace – Diabetes Self-Management
Ginger Vieira has a short and sweet article at Healthline on the new proposed diabetes classification system you may have heard about. I’ll be surprised if the proposal gains any traction. If it does lead to helpful clinical management changes, we won’t see them for at least 5–10 years. A snippet:
Today there are four common types of diabetes: type 1 and type 2, latent autoimmune diabetes in adults (LADA), and gestational. And these classifications are plagued by an enormous amount of confusion, misconceptions, and even misdiagnosis between the types.
To complicate things further, a new study published in The Lancet Diabetes & Endocrinology is suggesting people with type 2 diabetes should be categorized into an additional four subgroups.
“This is the first step towards personalized treatment of diabetes,” said Leif Groop, a doctor and professor in the diabetes and endocrinology department at Lund University of Sweden.
Source: Are There Really Five Subgroups of Diabetes?