World Diabetes Day 2020: Celebrating Nurses Making a Difference in the Lives of People with Diabetes

One thing that hasn’t changed in 2020 is the significance of tomorrow’s date: November 14th is internationally recognized as World Diabetes Day, a day specially reserved for diabetes awareness and advocacy.

Several weeks ago, when I realized this date was rapidly approaching, I was unenthused about it, to put it mildly. My life has been super-duper busy lately…I’ve dealt with high stress and anxiety levels, an overloaded schedule, and not enough time for self-care. So when it hit me that diabetes awareness month was just around the corner, and with that it would bring World Diabetes Day, I just felt “meh” about it. This year has been so sucky that celebrating didn’t feel right or something that I could muster up the energy to do.

However, that was before I realized that there’s a theme for this particular World Diabetes Day…promoting the role of nurses in the prevention and management of diabetes.

World Diabetes Day is tomorrow…what will you do to celebrate?

Nurses are heroes under normal circumstances. But in the context of 2020? They’re more important than ever. I read more about the reasoning behind the World Diabetes Day theme on the International Diabetes Federation website and immediately understood why nurses deserve recognition on 11/14:

Nurses currently account for over half of the global health workforce. They do outstanding work to support people living with a wide range of health concerns. People who either live with diabetes or are at risk of developing the condition need their support too.

People living with diabetes face a number of challenges, and education is vital to equip nurses with the skills to support them.

As the number of people with diabetes continues to rise across the world, the role of nurses and other health professional support staff becomes increasingly important in managing the impact of the condition.

Healthcare providers and governments must recognise the importance of investing in education and training. With the right expertise, nurses can make the difference for people affected by diabetes.

The International Diabetes Federation, 2020

So tomorrow, on World Diabetes Day 2020, I’m going to express my gratitude for all nurses, especially the ones who work specifically with people with diabetes. They deserve all the recognition and support in the world, and in a year in which the world is faced with a pandemic, the work that they do (along with other healthcare workers and essential employees) for people with and without diabetes is invaluable.

Thank you to all nurses and healthcare workers…and Happy World Diabetes Day to my fellow people living with diabetes. Wishing a wonderful day for you all filled with good blood sugars, education, and positive advocacy experiences!

A Song to Describe Diabetes Today…

On Instagram, I’m participating in the #TrueDiabeticChallenge all throughout November. Today’s post was inspired by the prompt for Day 9 of the challenge – name a song that describes diabetes today. Here’s a song that I think describes my relationship with diabetes today, even though it’s a throwback tune…

I’m a child of the 90s, so you can bet that I listened to a whooooole lot of boy bands and girl groups growing up – N*SYNC, Backstreet Boys, Spice Girls, and Destiny’s Child were just a few of them.

But of course, I loved my solo artists…especially Britney Spears.

Speaking of 90s throwbacks, doesn’t this color scheme remind you of Lisa Frank’s colorfully designed notebooks, folders, and pencils?!

Her first album, “…Baby One More Time”, was everythiiiiiiiing…oh, the NUMBER of times it was played in my house! Like most kids my age at that time, I couldn’t get enough of her bubblegum-sweet voice and catchy-as-heck lyrics/tunes. No matter what your opinion of her has been throughout her contentious career and life in the spotlight, you can’t deny her talent as a singer, dancer, and entertainer.

Brit’s been on my mind lately (I know I’m not the whole one – #FreeBritney!), so a few times throughout the workweek, I tend to listen to her music from all sorts of albums she’s put out over the years. I’m happy to report they’re still absolute BOPS today, but what’s more is that I found one that perfectly fit this prompt for me:

(You Drive Me) Crazy!

Okay, besides being an all-around excellent song with an entertaining music video (yes, that’s Melissa Joan Hart AND Adrian Grenier making cameos in it), it also tooooooooootally describes how my diabetes makes me feel these days. It drives me CRAZY!!! Let’s look at some of the lyrics…

Baby, you spin me around, oh

The earth is moving, but I can’t feel the ground

-Me when my blood sugar is low

You drive me crazy, I just can’t sleep

-Me every dang time my blood sugar interrupts my sleep

Oh, oh, oh crazy, but it feels alright

Baby, thinking of you keeps me up all night

-Definitely NOT alright because I hate when diabetes keeps me up at night and it sure as hell isn’t my “baby”

So maaaaaaybe it’s a bit of a stretch to say this song is perfect for me and my diabetes, because the way Brit sings it and how the lyrics are written, she’s enjoying being driven crazy. But not me! This is one of those songs where I could easily rewrite it and make it an eff-you diabetes anthem.

Really, though, the hook of the song captures it all: YOU DRIVE ME CRAZY.

The “you” here is YOU, DIABETES!

There Is No Insulin in Iran

This post was originally published on the T1International blog on October 27, 2020. I am reposting it here because this situation is completely, utterly horrifying and heartbreaking. As a community that collectively lives with the same chronic condition, we must come together and help Iranian people with diabetes be heard. It’s a grim reminder that the notion of “insulin for all” does not only mean that we must fight for affordable access to insulin, but we must also fight for access, period. And that simply isn’t how it should be.

To be honest, “there is no insulin” is the actual situation. Shortages of insulin are not something new in Iran, but recently there is no insulin at all. We were shocked by responses from our politicians who said, “The shortage is just for pens and we have plenty of internal production of insulin. People can replace it.” However, the types of insulin that are produced in Iran are NPH and R. Few consumers in Iran use NPH. About 70 percent of Iranian people with diabetes use insulin pens.

I myself could only find Novo Rapid insulin that was 10 times more expensive than what I normally pay – and what I paid about three weeks ago. The cost was not logical at all. We have heard many heartbreaking stories. For instance, there was a mother who did not feed her children with diabetes because they couldn’t find insulin.

We’ve made groups on social media and we are using hashtags to support each other with our own insulin, even if we are worried that we won’t have enough. In these days of quarantine, there are already a lot of people dying in Iran because of coronavirus. Now we worry that we will lose more because of the insulin shortage.

“I worry that the promise of insulin was meant to make us silent, but we have to keep speaking out.”

People have to search lots of pharmacies in their city. If they are lucky, they can find two or three pens (usually only short-acting ones). Recently, the only available type of long acting insulin pens are with insulin called “Basalin”. There is no international evidence and confirmation of safety (such as FDA approval) for this medicine.

In Iran, we just have access to glucose meters. There are no other advanced devices available, such as continuous glucose monitors or other sensors. But now, in addition to our insulin problems, we have to cope with the shortage of glucose test strips, too. How can we control our blood sugar levels without them?

As far as we can tell, it seems like our own government does not consider the current situation to be a serious issue. These days are suffocating for us. We are so unsure about everything and we don’t know exactly why this happened. When we seek an answer, we don’t get a proper one. Some say it is because of the economic sanctions imposed on Iran by the USA. Political issues should not affect something like that. People’s lives matter.

The government of Iran reacted to recent protests by saying they will distribute 600,000 pens of insulin, but they did not mention the type. Although some of us have found insulin, others are still searching pharmacies and can’t find any. I worry that the promise of insulin was meant to make us silent, but we have to keep speaking out. Thank you for helping us to be heard.

National Diabetes Awareness Month is Right Around the Corner

November is National Diabetes Awareness Month!

…And I am NOT! READY! FOR! IT! AT ALLLLLLLLLL!

I can’t be the only one in the diabetes online community who is feeling apathetic (at best) for a month that I’m normally thrilled to celebrate. After all, I love being a diabetes advocate!

But this year…the mere prospect of it just feels like it’s a little much.

National Diabetes Awareness Month 2020 is happening soon…how can this be? Aren’t we still in March 2020?!?!

It’s a little much in a year in which the world is facing a pandemic.

It’s a little much when potentially the most important U.S. presidential election in history is also happening this month.

It’s a little much when I’m dealing with a HELLUVA lot of other things in my personal life – mostly good things, but ones that happen to be highly stressful.

It’s just…when I think of it…how can I approach this National Diabetes Awareness Month with all the enthusiasm that I’ve showed it in past Novembers?

I don’t know how to answer that question right now, but I do suspect that I’ll muster up some of my advocacy spirit once I start seeing posts and prompts from the diabetes online community.

Which makes sense…after all, we turn to one another when we deal with the literal and figurative lows of life with diabetes. So it’s perfectly logical to have faith in knowing that this will be a great November with the trusty DOC supporting me.

Fighting for LGBTQ+ Justice and #insulin4all

This post was written by Quinn Leighton and it was originally published on the T1International blog on July 8, 2020. June may have been Pride Month, but it’s important every day to understand the challenges faced by the queer and trans communities on a daily basis and raise awareness. Thank you to Quinn for sharing your story, fighting for LGBTQ+ justice, and supporting efforts to make insulin available and affordable for all.

I remember stepping up to the counter to check into an appointment with a new medical provider, when the woman at the desk asked me to step to the person to her right saying to her colleague, “Can you help this…” I had to finish the sentence for her, “person. I’m a person.”

I have often felt fear and uncertainty as a person living with Type 1 Diabetes: when I wake up in the middle of the night confused, reaching for my glucose tablets because my blood sugar reads between 40-50; when my spouse is driving me to the ER because I can’t stop throwing up or get my ketones down while I’m home sick with the flu; and of course the overwhelming financial burden we face daily and monthly in order to stay alive and as healthy as possible.

All of this is assuming we don’t face additional barriers such as discrimination, bias or mistreatment the moment we walk through the front door of a pharmacy, or a provider’s office simply based on who we are and how we show up in the world. For people in the LGBTQ+ community, such as myself, this fear is real and based on lived experience. I am queer, non-binary and married. I’m also white, and acutely aware that while my experiences have filled me with anxiety and have led at times to delaying medical care, I recognize I have not experienced medical racism in the way an LGBTQ+ person of color likely has.

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“We must recognize LGBTQ+ people often do not receive the same level of treatment or care that non-LGBTQ+ do, and LGBTQ+ people of color – particularly transgender women of color – are at the highest risk of discrimination, mistreatment and fatal violence.”

Delaying care due to these fears as a queer or trans person is not uncommon in any medical setting, however if you delay care living with diabetes, it can lead to life-threatening complications or even worse. It’s imperative that LGBTQ+ people living with diabetes and other chronic illnesses have the security, affirmation and resources to access the care they need.

We also know that LGBTQ+ people, particularly transgender and non-binary people make less money, despite having the same, if not higher levels of education as their cisgender, heterosexual peers. Even with a patchwork system of employment protections across communities, states and now federally; discrimination in the workplace is still very real. Among LGBTQ+ people, cis-bisexual women and transgender people have particularly high rates of poverty at 29.4%.

Together we can work toward greater health equity, but collectively, we must recognize the disproportionately high impact of poverty, violence, prejudice, mental health issues, discrimination and fear that so many LGBTQ+ people face living with diabetes. We must recognize LGBTQ+ people often do not receive the same level of treatment or care that non-LGBTQ+ do, and LGBTQ+ people of color – particularly transgender women of color – are at the highest risk of discrimination, mistreatment and fatal violence.

Understanding these inequities is paramount in moving forward in advocacy for affordable and accessible insulin for everyone who needs it, particularly those most vulnerable to bias, mistreatment and discrimination. This includes healthcare policies protecting people with pre-existing conditions and protecting LGBTQ+ people from discrimination when accessing healthcare. Efforts to repeal or rollback protections put into place through plans such as the Affordable Care Act that seek to provide care to people who need it most, particularly during a pandemic, is simply cruel and will only result in more harm and negative health outcomes. Non-discrimination protections are critical in providing the care needed for so many LGBTQ+ people living with a pre-existing condition such as diabetes, who already face a gamut of uphill battles in other areas of daily life.

Queer and trans communities are formidable. They overcome extraordinary obstacles to gain economic self-sufficiency, put a roof over their heads, maintain their health in the best of conditions, and simply exist and live in this world. What I’ve really noticed most is the courage and resiliency to navigate these barriers while celebrating community and showing up as our true and whole selves.

I recognize structural and systemic change won’t happen easily or quickly; however, I am hopeful that the movements around us will support communities of color, particularly black and indigenous people fighting for their lives and Asian people under attack due to prejudice and misinformation surrounding the COVID-19 pandemic. I am hopeful people will elevate their support of LGBTQ+ people and those most vulnerable within our community while working to make insulin affordable so that no other person living with diabetes is forced to make life-threatening decisions. And it is my hope that this momentum of support will carry us forward toward justice.

Have You Signed the Type 1 Diabetes Access Charter?

On Wednesday afternoon, I signed a charter intended to bolster worldwide diabetes advocacy. The charter was launched by T1International and I’m sharing it here with you to encourage you to sign it, too. Here’s some more information on it, pulled directly from the T1International website:

Around the globe today, people with type 1 diabetes are dying because they cannot afford or get ahold of insulin, supplies, education and treatment.

To survive and live a full life, everyone with type 1 diabetes has the right to the following:

1. The right to insulin
Everyone should have enough affordable insulin and syringes.

2. The right to manage your blood sugar
Everyone should be able to test their blood sugar levels regularly.

3. The right to diabetes education
Everyone should be able to understand their condition, including adjusting insulin dosages and diet.

4. The right to healthcare
Everyone should have hospital care in the case of emergencies and ongoing specialist care from a professional who understands type 1 diabetes.

5. The right to live a life free from discrimination
No one should be subject to any form of discrimination or prejudice because they have type 1 diabetes.

In addition to magnifying diabetes advocacy efforts globally, the charter is also used to influence the actions of governments and organizations so that policies can be changed and the rights of people with type 1 diabetes can be prioritized.

It took me fewer than 30 seconds to sign the charter, and I put this blog post together in under 10 minutes. Join me by signing and spreading the word about it to help people living with type 1 diabetes have access to vital insulin, supplies, healthcare, education, and freedom that are necessary in order to survive and live full lives.

Do You Know How Shareholders Benefit from Insulin Price Increases?

This post was originally published on the T1International website on May 6, 2020, and was written by Rosie Collington. I am sharing it on Hugging the Cactus because to be quite frank, I never understood the many issues surrounding insulin price increases. After reading this post, I had an “aha!” moment as I finally began to understand how the profits from insulin price increases are distributed. It’s an important issue to understand: with increased awareness comes an increased drive to make change.

Patients living with type 1 diabetes have known for years that the list price of insulin in the United States has soared. They’ve paid the price – in insurance premiums, in upfront costs, and also, tragically, in some cases with their health.

But until recently, it has been difficult to prove just how much the list price of insulin has increased, and what proportion of the higher costs for patients have gone to the three main insulin manufacturers – Eli Lilly, Novo Nordisk, and Sanofi – versus other companies in the US prescription drugs supply chain, like insurance companies, pharmacies, and pharmacy benefits managers. Information about pricing negotiations is considered a trade secret, meaning that the actual data is difficult to access. Instead, researchers and patient groups have had to more or less rely on guesswork to estimate the value of price increases, or the highly selective data published by the companies themselves, which do not paint the full picture.

The lobby group representing pharmaceutical companies in the United States, PhRMA, has suggested that pharmacy benefits managers (PBMs) have been the primary beneficiaries of the sharp list price increases of many prescription medicines in recent years. The American Diabetes Association’s Insulin Access and Affordability Working Group similarly reproduced selective data released by the three insulin manufacturers on the differences between the list and net prices – the amount the manufacturer receives – of a few insulin medicines, suggesting that the additional profits accrued by the manufacturers was low relative to intermediaries like PBMs.

 

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But in March of this year, researchers at the University of Pittsburgh provided evidence that the net price of insulin medicines in the United States had also soared – by 51% between 2008-2017. This indicates that while other intermediaries had benefited from list price increases, the manufacturers had too. This may seem obvious, but having data to prove it is important.

For my research with Bill Lazonick, funded by the Institute for New Economic Thinking, it has been key to mapping how the profits from higher insulin sales revenues have been distributed. We wanted to find out whether insulin list price increases in the United States had contributed to higher research and development (R&D) investment by the companies, as they so often claim is the case. What we discovered was that as the list price of insulin has increased in the past decade, the ratio of spending on R&D relative to what the companies distributed to shareholders had actually decreased. While over the period of 10 years, the companies spent $131 billion directly on R&D, crucially we found that during the same period, the companies had distributed $122 billion to shareholders in the form of cash dividends and share buybacks.

Cash dividends are the means used by all publicly listed companies to distribute money to shareholders as a reward for holding shares. Share buybacks work quite differently – companies can buy their own shares from the market, which inflates the value of existing shares on the market. Share repurchasing can also benefit company ‘insiders’, like executives, who often receive pay in shares, because they can decide to time when they sell their shares to get the most value. This is not technically illegal, though it was once upon a time. In the last year, some lawmakers in the United States, including Bernie Sanders and Elizabeth Warren, have called for stock buybacks to be banned.

Fundamentally, the system should not have permitted shareholders to profit in this way as diabetes patients were struggling to access their life-saving prescription medicine. As coronavirus continues to spread around the world, the pharmaceutical industry is facing more scrutiny than ever before of its financing and drug development processes. By understanding how value is extracted by shareholders in the pharmaceutical industry, and what relationship this has to patient access, we can, hopefully, create a better system.

27 Acts of Kindness: Days 24 and 25

It is officially the month of May! Say what?!

This means that I’m rapidly approaching the last few days of my acts of kindness challenge…though I certainly do have some ideas on how to keep the positive vibes going in the near future.

Speaking of, I think that Wednesday’s act of kindness will definitely help me make that happen…

Wednesday, 4/29 – Act of Kindness #24: So this one’s really special to me. For months now, I’ve expressed to many people how I want to become a better diabetes advocate. Sure, I have this blog and it’s one form of raising diabetes awareness, but I want to do more. I started looking into some options on Wednesday and it brought me to the T1International website. I’ve had a vague awareness of T1International and their work for some time now – that website is where I purchased my awesome #Insulin4All sweatshirt – but I wanted to understand what they do to a greater extent.

Turns out, they have a pretty awesome mission: T1International works to support local communities by giving them the tools they need to stand up for their rights so that access to insulin and diabetes supplies becomes a reality for all.

After clicking around their website some more, I found out that they are seeking digital advocates who can help spread the word about their organization and its goals…so I decided to sign up to become a digital advocate for T1International and I couldn’t be more thrilled about it.

I’m learning more about what I will specifically be doing this weekend, but as for now, I’m just excited about the chance to advocate for a cause that I’m very passionate about, which is access to insulin for all. Because like it says on the T1International website, life with diabetes is complicated enough…nobody should have to worry about access to vital insulin, diabetes supplies, or medical care on top of it.

Travel Buddies
Water and insulin are two very important liquids that not all people have access to…and that’s not okay.

Thursday, 4/30 – Act of Kindness #25: You know what else everyone should have access to, but unfortunately, many people in the world do not? Clean water.

Access to clean drinking water is absolutely something that I take for granted…and it’s simply unfathomable to me that 785 million people – which is to say, 1 in 9 – lack access to safe water. How wild is that? Water is crucial to so many aspects of life, and there isn’t one single human on this planet that can survive without it.

So after a conversation with my mom yesterday about causes that are near and dear to our hearts, in which she reminded me that for years now she’s been hoping to build a water well in a place that it’s greatly needed, I donated to water.org. Talking with my mom and hearing the dedication in her voice made me want to do what I could to help her support a cause that means a lot to her, so I happily made the donation in her name and even got to send her an eCard notifying her of it. Hopefully, it makes her smile and reminds her that she does have the ability to get that well built one day because those closest to her will support her every step of the way.

Whether it’s insulin, water, food, shelter…there are simple basic needs that all human beings deserve to have access to, and its an injustice that they don’t. Fortunately, there are amazing organizations out there like T1International and Water.org that work tirelessly to change this, and it’s humbling to be able to support them in any capacity. I linked to their websites in this post – hover over their names above – I encourage you to check them out and consider the ways you might be able to help them, too.

 

A Problematic Post

I am not the kind of person who scrolls through social media looking for posts that will make me angry. And I’m certainly not the kind of person who likes the idea of calling someone out on their perceived wrongs via social media (or any other medium) because I think that it’s usually not constructive.

But I am the kind of person who thinks that word choice matters. So when I saw Autumn Calabrese, a celebrity fitness and nutrition expert, post the following text on Instagram, I got pretty upset. (Click photos to see them more clearly).

I’m not going to lie, I was pretty upset by this post. I’ve followed Autumn on Instagram for almost two and a half years now, ever since I subscribed to the popular Beachbody workout app. I really like her 21 Day Fix workout program because it kicks my butt every time in just 30 minutes. She comes across as a fun person who is really passionate about her job and enjoys the opportunity to help others, which is why I decided to follow her Instagram profile. Normally, I enjoy her posts because they’re filled with motivating fitness and eating tips that promote a healthier lifestyle. She definitely knows what she’s talking about when it comes to exercise and eating properly.

But after seeing this post, I think that Autumn – and people like her who are not educated in the minutiae chronic conditions like diabetes – needs to step off her soapbox.

She is using her post to say that diabetes – mind you, just generic “diabetes”, there’s no mention of any of the many types – is a lifestyle killer. She says that “the worst part about it is that you are 100% in control of if it happens to you.”

OMG. No, no, NO.

Forget that she was using the current coronavirus outbreak to promote her healthy eating plan (which in itself is a pretty weird way to advertise something) – she came after the diabetes community with this post. Now, I’ll never know what her true intent was, and I don’t care if Autumn was talking about a specific type of diabetes here. That doesn’t make a damn difference. The problem with this post is that she is perpetuating diabetes stigma and alluding to a myth that an individual has control over whether or not they get diabetes. Posts like this are the reason why there is so much confusion and misunderstanding when it comes to all types of diabetes, and I think she should be ashamed of herself for putting this on her profile.

It’s even more upsetting that she immediately got defensive when people started writing comments under her post, trying to inform and educate her. I was one of those people, and I think that I kindly and respectfully directed her to learn more by visiting beyondtype1.org so she could be better informed on all types of diabetes and maybe find out why what she wrote was harmful. Sadly, I never got a response, and her post remains on her profile, unchanged.

You can lead a horse to water, but you can’t make it drink. You can also unfollow a person on social media and write a blog post to get your feelings out there, so that’s just what I’ll do here.

 

My Take on Diabetes and Support

It’s November 20th which means that it’s Day 20 of the Happy Diabetic Challenge! Today’s prompt is “biggest supporter”. Since it’s impossible for me to identify a single person as the biggest source of support with my diabetes, I decided to write about how my thoughts on diabetes and support have changed over the years.

Emotional support is a lovely thing. It feels good to have people in your life who you feel have your back. And it’s twice as nice to have when you’re dealing with a chronic illness like diabetes.

I talk extensively about diabetes and support in the most recent episode of the podcast, Ask Me About My Type 1. (Here’s the link in case you haven’t listened to it yet.) Rather than rehash everything I said in that episode, I’m going to use this post as an opportunity to reflect how my wants and needs in terms of support for my diabetes have changed over the years.

It’s interesting (at least, it is to me) to think about how and why my desire for support has changed as I’ve grown older. My childhood was very normal despite diabetes. It was always there and it was always a thing I had to deal with, but I definitely didn’t feel compelled to talk about it as much as I do now, let alone lean on others in difficult times. Why is that?

I think it has a lot to do with getting to know myself better as I’ve aged.

HUGGING THE CACTUS - A T1D BLOG
In this post, I get all self-reflective-y on diabetes and support.

After all, they say that with age comes wisdom. And though I don’t exactly consider myself a wise old sage or anything of the sort, I do think that I’ve acquired some enlightenment about myself and the way that I process things in my adulthood.

Specifically, I realized in the last few years that diabetes has instilled in me a strong desire to feel in control of every aspect of my life…not just diabetes. When something doesn’t go according to whatever carefully thought-out plan I’ve cooked up, I get upset. And I tend to either bottle up my dismay, which is never a good thing to do, or I totally take it out on the whichever poor soul happens to be within my vicinity, which isn’t fair. Neither of those reactions is a healthy method of dealing with things, but at least I’m aware of that and I’m actively trying to improve how I cope.

I think that this example shows how important diabetes support has become to me because I’m able to lean on others in those times that all of my diabetes plans don’t work out the way I envisioned them. I’ve figured out, over time, that it’s just about the only thing that really works for me. Talking to other people with diabetes (and without diabetes) about struggles that I’ve faced makes me feel less alone. It used to be scary for me to be so vulnerable with others, but I’ve found that it’s worth it because it helps me heal, move on, and forgive/accept myself for feeling whatever I’m feeling.

Support from others is truly powerful…but above that, learning to rely on others – learning how to best support myself, really – is more than that. It’s magical and absolutely enhances the quality of my life with diabetes.