Redirecting Guilt into Action: A Post by Elizabeth Roosevelt

This post was written by Elizabeth Roosevelt and it originally appeared on the T1International blog on July 16, 2021. I wanted to share it here today because Elizabeth did a beautiful job of summing up similar sentiments that I’ve personally experienced regarding insulin affordability and access. Thank you for sharing, Elizabeth, and know that many others feel the same way as you!

“We can discuss our technology, diabetes and Covid-19, our experiences with insulin affordability; anything you would like,” Beth, who oversees and organizes the T1International Digital Advocates, echoes through the Zoom during our Digital Advocate meet and greet.

A little embarrassed, I think to myself, “please, not our experiences with insulin affordability.”

As someone living with type one diabetes for fourteen years and a Digital Advocate for T1International since August 2020, it sounds like a conflict of interest that I wouldn’t want to share my experiences accessing insulin – a drug that saves my life each day. After all, this is a major goal of T1International: to advocate for global access to insulin.

It sounds like I shouldn’t be an advocate.

“This prompted me to seek organizations like T1International where I could not only learn more about healthcare inequalities that impact my own community but also fight for change.”

In reality, I’m just a little nervous. I am nineteen years old, was diagnosed with type one diabetes at age five, and have always lived in the United States. Growing up, I had no idea where my insulin came from, but I knew it would be there, delivered to my front door in an unassuming cardboard box with a few neon biohazard labels slapped on the top.

Every time I opened the refrigerator to grab insulin for a pump site change, a few vials of Novolog would be perfectly lined up on the top shelf. Each time I swung the cabinet open to reach for a new infusion set, the supplies were there, waiting for me. When packing for vacation, I never thought twice about having enough supplies back-stocked in my house to take with me.

When I wanted to switch from the Medtronic pump to the OmniPod, the thought that the OmniPod might be more expensive never crossed my mind. Money didn’t grow on trees, but my parents always made it happen. And for that I am eternally grateful and blessed.

So, if the other advocates started sharing their experiences with insulin affordability on that Zoom, I’m not sure what I would’ve said. That I’ve never had an issue with it? That I didn’t know insulin affordability was a pressing problem in the United States until a few years ago, when Instagram posts by Senator Bernie Sanders and diabetes influencers began to pop up on my feed, explaining that Big Pharma was killing Americans, especially those with diabetes? It was only when our country’s flawed healthcare system made headlines that I noticed I seemed to be in a position many American diabetics were not.

This ignited a spark in me. It didn’t seem fair that just because I was born into a family that could afford private insurance to cover my diabetes costs I could do just about anything a person without diabetes could do. I could study and work to the best of my ability because a high blood sugar wasn’t slowing down my mind. This prompted me to seek organizations like T1International where I could not only learn more about healthcare inequalities that impact my own community but also fight for change.

Because I’ve had access to technology that allows me to sleep through the night and insulin delivered to my doorstep, I sometimes feel like less of a person with diabetes (PWD) and guilty of my privilege. While all people with type one struggle with the condition in some shape or form, I find myself invalidating my challenges because I tell myself I have it much easier. And in many ways, I do. I’ve grown up as a privileged white person in an affluent neighborhood, sheltered from the reality that very few people have access to insulin as I do, especially under the heavy, capitalist-driven policies of the United States.

However, I’ve learned that having it easier than others is not something to be embarrassed about nor does it make me less of a PWD. Instead, it is a responsibility.

It’s crucial that those of us who have access to insulin use our platform and privilege to fight for our community and for the people with diabetes who are solely focused on surviving. We must serve as the voice for the people with diabetes who can’t use their own because they’re bogged down working three jobs and choosing between putting food on the table for their family or insulin.

Maybe this fighting takes the form of educating our friends, family members, and colleagues about the disparities in insulin access through discussion or educational posts on social media. Or maybe, it’s collecting near-empty insulin vials and diabetes supplies in your community to help provide short term relief to struggling diabetics. Or perhaps, it’s calling the offices of or requesting meetings with your districts congressional representatives to urge their support of regulating legislation.

Whichever way our fighting takes shape, we must redirect the guilt we feel over our privilege into a heightened sense of advocacy, into change, into a fire that spurs our movement forward and pushes the established healthcare system towards equality.

#insulin4all truly means for all, and until all those who need insulin have access to it, our work isn’t done.

From Patient to Medical Student: My Journey with Diabetes Treatment – A Post by Konstantina Taki

This post was written by Konstantina Taki and it was originally published on the T1International blog on June 8, 2021. I’m sharing it here today because the journey from patient to medical student as person with diabetes has always personally fascinated me. Despite my interest in medicine, I’ve never actively pursued it as a career (and probably never will), but I appreciated learning about Konstantina’s experience. Thank you, Konstantina, for sharing your perspective!

Having lived with type 1 diabetes for more than 12 years, I have experienced different aspects of the condition. First of all, as a patient, I approach diabetes from a personal view. I can also understand how the condition affects parents of children with diabetes. It’s something new, demanding and difficult to handle. The last five years, as a medical student in Greece, I have seen diabetes from yet another more practical and scientific perspective.

The world of medicine is a marvellous, enormous one. It is a multifaceted science. When I started studying medicine back in 2016, I had a completely romantic approach. I was convinced that the core of medicine is the purpose of making people’s lives better. I believed that healthcare systems were patient-centered and every decision or strategy was made in order to ensure that people’s lives were safe and to improve their health. It was a challenge for me to realise that even in such a human-centered domain, there are motives and decisions which aren’t really altruistic. Instead they are often led by powerful companies.

“Inequality in treatment of people with diabetes should come to an end.” – Konstantina Taki

Over the course of time, I had to face the fact that pharmaceutical companies influence healthcare systems in such a way that healthcare professionals almost have no control. For example, a lot of medical research is funded by the pharmaceutical industry, or ‘Big Pharma’. So how can we ensure that the outcome of research is unbiased? The vast majority of medical seminars and conferences are also sponsored by Big Pharma. This means that organisations who want to support medicine without pharmaceutical industry support struggle in terms of fundraising. Healthcare systems, and the people leading them, tend to lose their purpose of saving people’s lives and improving the health of patients. Instead, they take advantage of people’s health to make profits.

Type 1 diabetes is a non-preventable chronic illness, and its successful management depends on insulin. Without insulin, a person with diabetes is in danger. Insulin belongs to the category of essential medications. I believe pharmaceutical companies take advantage and exploit this situation. Unfortunately, many patients, including those with diabetes, deal with the effects of Big Pharma’s politics and strategies. Having read articles, and later discovering T1International, I saw the process of how the profits of pharmaceuticals cause the loss of human lives. In 2021, people with diabetes still die of their inability to access the only drug that keeps them alive: insulin.

Your money or your life. This is a dilemma that seems to have deep roots in medical society. I am lucky, and I feel safe due to the fact that in Greece this phenomenon doesn’t occur as much as abroad. However, I did experience this dilemma personally in my Endocrinology appointment. In the examination room, there was my doctor, a nurse and a sales manager from a pharmaceutical company with diabetes products. The whole appointment was led by the sales manager. She was focusing on the weak points of my blood sugar throughout the session. Her aim was to convince me to start using a continuous glucose monitor (CGM), which at the time wasn’t distributed for free in Greece. Once I understood that she was trying to get me to use and pay for the product, I tried to focus on my diabetes management without discussing the CGM. The doctor was indifferent. She didn’t seem to be bothered by the sales manager. I ended up arguing with them and then I left the room.

Access to healthcare is an unquestioned human right for every person, which includes the need for medication and technology. Given the fact that the production and distribution of medication diabetes technology can provide extreme amounts of profits to companies, people with low or even no income are therefore excluded from healthcare systems. So who is being served by healthcare systems? Patients or profits? And how could all those profit-maximizing strategies come to an end or at least decrease?

Being able to approach diabetes as a patient but also as a medical student, and hopefully as a medical doctor in a few years, I have mixed feelings. I undoubtedly want to see a change. From a humanitarian view, I strongly believe that no human life is inferior when it comes to health and medicine. People should be treated equally, without discrimination or undue pressure. If there is one thing that medicine has taught me is how vulnerable we are when our health is at risk. In addition, I acknowledge that my awareness for this phenomenon is a result of the realisation of the catastrophic effects my life would have if I had no access to insulin. Companies should not hold patients hostage – but it happens every day.

The reason I appreciate T1International so deeply is its scope to change this condition through raising awareness and advocacy. Inequality in treatment of people with diabetes should come to an end. Health care systems globally must turn into patient centered systems. It is a difficult and slow process but nothing is unachievable. #insulin4all isn’t just a trend. It is a need, a vision, and hopefully one day it will become a reality.

People with Diabetes are Good at Minimizing

I attended a Massachusetts #insulin4all meeting recently that got me thinking about how good people with diabetes tend to be at minimizing.

I speak for myself, and some other people with diabetes I know, when I say that we’re really good at making it seem like it’s not a big deal. We manage a 24/7, 365 chronic condition like it’s not the full-time job that it is. I have family and friends who occasionally pick up on this and marvel at my ability to be present in a myriad of social situations while discreetly watching my blood sugar levels or calculating insulin dosages. I rarely act like diabetes is as serious as it is and that’s because I’ve become an expert at making it seem like small potatoes in my life.

And I’m not just good at minimizing my diabetes – I’m also highly proficient in minimizing the fact that it has forced me to make difficult decisions in my life, particularly when it comes to financial choices.

Over the years, I’ve become excellent at downplaying the impact of diabetes on many aspects of my life.

During this #insulin4all meeting, I was conversing with other chapter members about whether or not we, as individuals, have struggled to afford insulin. And a lot of us confessed that we’ve been pretty lucky and have never really had to resort to making truly difficult choices when it comes to affording insulin or other diabetes supplies. Despite that, we feel passionately about those who struggle to gain access because we understand how high the stakes are – it’s literally a matter of life or death.

But just because we’re able to (for the most part) afford insulin, that doesn’t mean that we haven’t had to make certain choices that we might not have had to make if we didn’t have diabetes.

For example, when it comes to my career, I’d never consider a job that doesn’t offer solid health insurance plans. Even if my strongest desire was to be a freelance writer, I wouldn’t go through with it because I know that it would be challenging to figure out my health insurance. And I know that the minute I run out of FSA dollars each year, I start thinking about setting money aside just to cover the costs of my diabetes supplies…which means that instead of buying some new clothes or planning a weekend getaway, I sometimes have to sacrifice those luxuries in favor of ensuring I have enough money to cover my fixed expenses as well as my diabetes medications.

When I think about it, of course I realize that it’s not fair, but haven’t really considered it before because this is just how it is. I’m used to it. And so are many other members of my #insulin4all chapter. We’re all accustomed to having to make certain choices about our lifestyles or spending habits that minimize the larger issue of insulin affordability. We’re used to it, even accepting of it, but that doesn’t make it right and it certainly underscores the terrifying fact that too many people simply can’t afford insulin and have to make much tougher decisions in order to get it.

It’s time to become a little less good about minimizing and better at vocalizing – not just the seriousness of diabetes, but also the dire nature of insulin affordability and access that affects millions around the world.

Underrepresented Communities and Navigating the System – A Post by Alzahrra Almajid

This was originally published on the T1International blog on June 8, 2021 and it is written by Alzahrra Almajid. I decided to share it on Hugging the Cactus because it is my goal to understand the challenges faced by the BIPOC community and learn what can be done to help. Alzahrra’s experience is a massive wake-up call that we still have a long way to go when it comes to advocating for marginalized groups. Thank you to Alzahrra for sharing her story.

I was diagnosed with type 1 diabetes when I was 8 years old. Having parents who were immigrants from Iraq and people of color was especially hard in navigating diabetes. My mom dealt with a lot of demeaning comments from healthcare providers because she was not taken seriously. In the initial months after diagnosis, her ability to care for me and help manage this new disease was often questioned. It felt like they thought she was too incompetent to understand how diabetes is treated. I remember how disrespected and vulnerable I felt because of the tone doctors spoke to us with.

When I was about eleven years old, I was hospitalized for having a high fever and diabetic keto-acidosis (DKA). On the second day of my stay at the hospital, a nurse asked me if I was purposely not giving myself insulin because it “did not make sense” that my blood sugars were still elevated. I was stunned by how demeaning that comment was. I felt so belittled in that moment that it has stuck with me all these years. Why would I want to feel that way? How could I fake it if the nurses were the ones administering my insulin at the hospital? It turned out I had an infection that was causing the high blood sugars and fever so no, I was not purposely not giving myself insulin. After that day, I started to notice how different my life was compared to other diabetics I met.

Alzahrra noticed her experience with diabetes was very different compared to that of other people with diabetes she has met.

There was not much awareness about type one diabetes in my community so it was difficult for me and my mom to find resources about what treatments were out there. We were not aware of what an insulin pump was or what a continuous glucose monitor (CGM) was. We had no idea that they even existed until I began to research diabetes on my own when I was about eleven years old. Only after I mentioned insulin pumps to my doctor, did we start discussing them as a viable option. When I learned about CGMs later on, I wanted one so bad because I was certain it would help my elevated A1cs. However, after hearing how much it cost, I knew that it was nearly impossible to get it.

Seven years after my diagnosis my brother was also diagnosed with type 1 diabetes which made the already bad financial burden worse. Although all people with diabetes struggle with how expensive diabetes can be, immigrants and people of color often do not have access to quality health insurance (or any access) so they are less likely to benefit from advanced diabetes technology. As I got older I began to understand how difficult it is to navigate a system that makes it harder for people in underrepresented communities to get adequate care.

I knew from early on that I wanted to advocate for marginalized groups. Being a person with type 1 diabetes is already mentally draining and expensive. When you add the challenges of navigating through racial or ethnic disparities, diabetes becomes agonizing. Black, Indigenous, and People of Color (BIPOC) deserve to have representation in the diabetes community and have their concerns addressed. They deserve the same level of care and access to resources that their white counterparts have. I chose to become a Communities of Color Lead for the Illinois #insulin4all Chapters because I want to influence positive change by making sure BIPOC are not left out of the conversation.

T1International Launches “100 Years: From Gift to Greed” Campaign

The following is a post that was featured on the T1International blog on May 17, 2021. I’m sharing it here today because I want to help spread the word about the Gift to Greed campaign. Learn more about it by reading on (and visiting the links at the end of this piece)…

On Monday, May 17th – 100 years after Banting, Best and Macleod begin their first experiment trying to extract insulin in Toronto – T1International and its advocates around the world launch their year-long campaign. 100 Years: From Gift to Greed will tell the story of insulin’s discovery and how it went from being a gift to the world to a profit machine for the pharmaceutical industry. The campaign will be led by a combination of social media education and a variety of actions.

“A gift to the world has become a tool for price gouging patients all over the world.” – Elizabeth Pfiester, Founder and Executive Director of T1International

Insulin is as essential as oxygen for all patients with type 1 diabetes and many with type 2 or other forms of insulin-dependent diabetes. Globally, insulin rationing is common, and half of those in need of insulin cannot afford or access it. For every two people alive with type 1 diabetes, there is a third who did not survive. The production and distribution of insulin is dominated by three companies – Eli Lilly, Novo Nordisk, and Sanofi – who control more than 90% of the global market.

In the early 1920s in Toronto, Canadian physician and scientist Frederick Banting began working on an idea in the laboratories of J.R.R. McLeod to isolate and extract insulin. Medical student Charles Best and chemist James Collip worked with Banting to test, purify and refine insulin for clinical trials in humans.

After vowing that insulin would not be something to profit on, the discoverers sold their patent for $1 CAD each and eventually passed the rights to the pharmaceutical company Eli Lilly and Co. so that it could be mass produced and widely available. Banting famously said, ‘’Insulin does not belong to me, it belongs to the world.’’

While this incredible advancement was intended as a gift from the discoverers, Eli Lilly and the two other major insulin producers, Sanofi and Novo Nordisk, have turned insulin into profit machines, assisting in bringing in billions of dollars in profit every year. By 1923, insulin was the highest-selling product in Eli Lilly’s history, and profits from it accounted for over half of the company’s revenue. As we know, the prices have continued to skyrocket ever since. Since 1996, the list price of insulin has increased by over 1200% in the United States. Eli Lilly’s Humalog insulin increased in price by 585% between 2001 and 2015 alone.

T1International’s Founder and Executive Director, Elizabeth Pfiester, said, ‘‘A gift to the world has become a tool for price gouging patients all over the world. The greed of the pharmaceutical industry is keeping insulin out of the hands of millions. This greed leads to the loss of countless lives and dampens the dream of Banting and his colleagues, which was to make insulin a gift to the world. It is outrageous that this is the reality, and T1International will continue to speak out until the pharmaceutical industry is held accountable.’’

T1International advocates will be speaking out and educating the community about the story of insulin and how to get involved in T1International and the global #insulin4all movement. The aim is to put an end to the reality that far too many people die or suffer grave physical, mental, and emotional health consequences due to pharmaceutical greed.

Visit the campaign page and read more at: t1international.com/100years

Questions about T1International and this campaign should be directed to press@t1international.com.

Type 1 Diabetes, Disability and the Role of Legislation in Advocacy – A Post by Pramita Jasuja

This is a post by Pramita Jasuja that was originally published on the T1International blog on April 9, 2021. I am sharing it here today because I thought it was an interesting take on how type 1 diabetes is (or in this case, is not) recognized in another country. Thank you to Pramita for sharing her story and explaining the importance of legislation in advocating for people with diabetes.

Every new type 1 diabetes (T1D) diagnosis can be intimidating, both for the person and the family members. Many people with T1D are told they should be able to live a “normal” life and that they can do everything that a person without diabetes can do.

As a newly diagnosed child with blood sugar levels of over 570mg/dl, all that was on my mind was T1D. But a year post-diagnosis, when daily needles became the new normal, I was told by my family that I was completely fine and that there “was no need to tell anyone” about my medical condition. “I am normal” was stuck in my mind and I took it very seriously. So much so, when my endocrinologist asked me as the “patient” to sit near her chair, I replied: “I am not a Patient.” Both my parents and the endo smiled.

It’s been 7 years since that incident and I now reflect on my statement, especially over the word “normal”. Calling yourself “disabled” can have negative connotations attached to it. People often refrain from using that word, as if living with a disability is abnormal. Though if we do this, we deny a part of us. When it comes to legalities, the word “disability” is significant. Disability legislation considers people living with disabilities as subjects who possess rights capable of claiming that they have a disability – not those simply given charitable treatment. This was spelled out in the UN Convention on the Rights of People with Disabilities (CRPD), the human rights convention that hit the highest number of signatories.

I live in India. It’s one of the countries that has ratified this convention, but it’s also a country where myths and stigma overtake the real issues. A report by WHO found that in low-income countries where superstitions surrounding diabetes are common, the fatality rate is high. India is no exception. Due to a lack of proper health care facilities and a lack of national registry exclusively for T1Ds, children in the country are facing late diagnosis and even death. Considering the level of poverty in the country, blood test strips and continuous glucose monitors (CGMS) should be subsidized. Unfortunately, that is not the case. People with T1D are rationing them, which makes diabetes management challenging. Plus high blood sugar levels and/or ketones hinder the ability to perform “normal” day to day activities.

Insulin is like water. Someone with T1D can not live without it, but medical insurance in India does not cover it, and not every type of insulin is subsidized. So for those with T1D and financial struggles, there are the worries about the price of life-giving insulin and medical supplies.

After considering these facts, let’s look at the definition of “person with a disability” under the Rights of People with Disabilities Act (RPWD) 2016 that was enacted after India ratified CRPWD: “a person with long term physical, mental, intellectual, or sensory impairment which, in interaction with barriers, hinders his full and effective participation in society equally with others.”

“When it comes to legalities, the word “disability” is significant. Disability legislation considers people living with disabilities as subjects who possess rights capable of claiming that they have a disability – not those simply given charitable treatment.”

The sad part, however, is that T1D is not considered a disability under this Act, even though the current problems faced by people with T1D in India do “hinder (their) full and effective participation in society equally with others”. I’m arguing that you can not tell every T1D to live “normally” when the condition doesn’t always allow for it. The community is suffering silently and legislative action is being denied.

It is through the recognition of injustices and assertion of our rights that we can ensure equal opportunities. T1D advocacy is emerging in India and as a collective we are highlighting these issues. Change is happening. In 2020 in Kerala High Court, a public interest litigation was filed over the issue of including T1D in the list of disabilities and creating a national registry for people with T1D. This step is important. Recognition of T1D as a “disability” would obligate the government to fulfill what is laid down in the Act, for example providing affordable and accessible health care, ensuring the implementation of non-discrimination clauses and creating special faculties at educational institutions.

Seven years after that endo visit incident, even though I will never be able to deny that I am a patient, what I can do is advocate for patient rights. At a macro level this means standing up for the community. Recognition under the legislation of people with diabetes as those with disabilities is the first step, a chapter in the book of advocacy in my country of India.

Insulin is a Right for Incarcerated People with Diabetes – A Post by Elana Megerian

This article was written by Elana Megerian and it was originally published on March 24, 2021 on the T1International blog. I’m re-posting it here today because, quite frankly, I found it disturbing. I had no idea that safely navigating encounters with law enforcement was a problem for the diabetes community. I can also admit that I made assumptions based on the headline of this article, but decided to stick with it only to discover that my assumptions were wrong and that the criminalization of diabetes symptoms is a real issue. If you have any doubts about this article, I encourage you to read the full piece so you can understand what’s going on and the steps that should be taken to address it.

When widespread Black Lives Matter protests erupted in the summer of 2020, the diabetes online community began crowdsourcing ideas about how to safely participate. Concerns grew in response to an incident in which police confiscated the supply bag of a protestor with type 1 diabetes, despite her consenting to a search and communicating her need for glucose.

A viral video of the encounter revealed another pressing need of the diabetes community: how to safely navigate encounters with law enforcement. This led me down a rabbit hole that heightened my alarm as I found story after story of police and prisons withholding insulin.

In 2013, footage from Rikers showed Carlos Mercado repeatedly vomiting, fainting, and displaying signs of severe illness in the presence of corrections officers. At age 45, he died after having his insulin withheld for 15 hours.

In 2014, William Joel Dixon was found dead in his cell after his insulin was withheld for seven days. Records show that his blood sugar was only checked once during that week. He was 28 years old.

In 2015, Michael Robinson died after being put in solitary confinement in response to his pleas for insulin. He was 33.

In 2016, Morgan Angerbauer’s death in an Arkansas jail cell was caught on video. Records show that she had been calling out for help, but was ignored. She received no insulin for 23 hours, and her requests for blood glucose checks had been denied. She was only 20 years old.

In all these situations, staff were aware that the victims required insulin to live. In all the cases, insulin was withheld long enough to induce diabetic ketoacidosis, a potentially fatal complication that usually occurs in people with type 1 diabetes who do not have regular access to insulin. It is a torturous and almostly completely preventable cause of death, yet it is far too common in US prisons. Since 2008, at least 12 such deaths related to withholding insulin have occurred in the state of Georgia alone.

Insulin is a Right for Incarcerated People with Diabetes
“#insulin4all is more than a hashtag: It is a rallying call to everyone impacted by insulin inaccessibility, and a mournful cry for all who have lost their lives while insulin remains clearly in view, but cruelly out of reach.”

Diabetes symptoms have also often been criminalized. In August 2020, Max Johnson, a black man with type 1 diabetes who was having a seizure due to hypoglycemia, was dosed with ketamine by police and Emergency Medical Services (EMS) after his girlfriend called them for help. The same drug that killed Elijah McClain, ketamine was reportedly delivered to Johnson at such a high dose that it rendered him unable to breathe and led to a two-day stay in the ICU. The American Diabetes Association has documented many other cases in which people were denied insulin, or had their diabetes symptoms treated like criminal behavior by police.

Having insulin withheld or having diabetes symptoms criminalized is obviously seriously dangerous, especially for Black Americans who are both more likely to have diabetes and more likely to have violent encounters with police.

These instances flagrantly defy the 8th and 14th amendments of the United States, which protect the right to adequate medical care for incarcerated people as well as those in police custody. Since the law is unequivocal, it is distressing that violations are commonly committed by the very individuals and systems meant to enforce it.

One factor perpetuating this is the lack of recourse for victims and their families. It’s hard to successfully bring a case against the police or a prison. Even if such a case is won, it doesn’t bring back a lost life, reverse damage from chronic hyperglycemia, or ease the trauma of being brutalized by those called in to help you through a medical crisis.

So what can be done? Standards of ethical behavior need to be raised for police, EMS, and corrections officers. Given how common the condition is among incarcerated individuals, anyone working with this population should be educated about diabetes, its basic management, and the signs of acute crisis. Deaths due to subpar medical care aren’t rare occurrences. Chronic illnesses are the leading cause of death in US prisons and are probably frequently covered up.

This disproportionately impacts Black Americans, who have higher rates of incarcerationdiabetes, and diabetes-related complications compared to their white counterparts. Diabetes is too often a death sentence in the prison setting. Advocacy for prison reform is urgent.

It is time to recognize that incarcerated people with diabetes are particularly vulnerable to insulin insecurity. #insulin4all is more than a hashtag: It is a rallying call to everyone impacted by insulin inaccessibility, and a mournful cry for all who have lost their lives while insulin remains clearly in view, but cruelly out of reach. It’s a demand for justice for everyone who needs insulin to survive, including incarcerated people with diabetes. We must find ways to meaningfully include and involve this population in our activism.

Insulin Access Issues Affect People From All Walks of Life – A Post by Laura Nally, MD

This post originally appeared on the T1International blog on March 16, 2020. I wanted to share it here today because it’s a stark reminder that insulin access issues affect all kinds of people: those who do and do not have health insurance, stable jobs, and so forth. Thank you to Dr. Laura Nally for sharing her story about what happened when she went without insulin for a mere four hours, illustrating the serious nature of access to insulin for all.

In 1990, when I was 6 years old, I was diagnosed with insulin dependent type 1 diabetes. In 1996, I could purchase 1 vial of insulin for about $20 without insurance. Today, a vial of the same insulin that I have taken for 24 years costs somewhere between $250 and $400 in the United States. There is no logical or scientific reason for this. To put things in perspective, in Canada, the same insulin costs about 1/10th of the price.

I am a physician and I have health insurance. However, just because I have health insurance does not mean that I can always access affordable insulin when I need it. Recently, at my cousin’s wedding, my insulin pump became disconnected from my body. It had probably become disconnected when I went to the bathroom 2 hours earlier. It was an accident, and this sometimes happens when you sweat a lot. This honest mistake led to a serious medical problem.

I called my doctor immediately to get a prescription sent to the nearest pharmacy. When I went to the pharmacy, I wasn’t due for a refill, so I paid $369 out of pocket for 1 vial of insulin. I didn’t have a choice. I took a large dose of insulin immediately. Unfortunately, it can take up to 3 hours for insulin to work, and in the meantime, I became very sick.

Four hours after I had become disconnected from my insulin pump, I was vomiting on the bathroom floor at the wedding and falling asleep between vomiting episodes. I was confused, my thoughts were clouded, and I could not take care of myself. All of this happened after going just 4 HOURS without insulin!

Why was I so sick? I was starting to develop diabetic ketoacidosis, a life-threatening condition that prevented me from being able to think clearly. I see patients with diabetic ketoacidosis in the hospital frequently; they may be disoriented, confused, combative, sleepy, and even comatose. Even though I was able to recognize the early signs and symptoms, I still became extremely sick within 4 hours. It took me 12 hours to fully recover from this episode. My family woke me up to check my blood sugars, drink water, and take insulin every 2-3 hours overnight.

I am lucky because I knew what to do to treat this condition and that my family was able to help me.

did not have time to call insulin manufacturers and ask for support.

did not have time to figure out how to get a coupon for my insulin online, like many have proposed is a solution.

did not have time to learn how to use Wal-Mart brand insulins, which act completely differently than the rapid acting insulins that I currently take. THIS WOULD HAVE BEEN FAR TOO DANGEROUS.

did not have time to worry about how much I could afford to spend on insulin.

We don’t have time to argue over this issue. We need affordable insulin now. It’s a matter of life and death.

Diabetes does not selectively affect individuals who can afford insulin and have health insurance; it affects people coming from all walks of life, regardless of socioeconomic status.

Many people cannot relate to what it would be like to have your life depend on whether or not you can afford or access a medication. In all forms of type 1 diabetes and some forms of type 2 diabetes, you may be able to survive without insulin for as long as you can survive without water, which could be a few days or up to 1 week. Most people need a minimum of 3-4 vials of insulin per month. If we estimate that 1 vial of insulin can costs $300 without insurance, that would mean out of pocket insulin costs were $900-1200 each month for insulin.

What if a 1 month supply of water cost $900-$1200? Could you survive? For how long? What if you could only receive water once per month, and the amount depended on how much water your doctor thought you needed. What if the doctor didn’t estimate your water needs correctly?

What if there were restrictions on how much water you could receive in a given month by the company that supplies the water? Let’s say you ran out of water too soon and became extremely thirsty, but when you try to get more, you’re turned away because the water you were given last month should have lasted you longer. You will have to wait until next week to get your water. But can you survive until then?

What if the company you get your water from decided to verify that you REALLY need that much water, like insurance companies do with prior authorizations. They will contact your doctor to submit extra paperwork and if the larger supply of water is approved, you will know within 2-3 days. What do you do until then?

Diabetes does not selectively affect individuals who can afford insulin and have health insurance; it affects people coming from all walks of life, regardless of socioeconomic status. It affects our children, our parents and grandparents, our brothers and sisters, our friends and coworkers. No one who is in urgent need of insulin should be turned away from the pharmacy without insulin or the diabetes supplies that they need.

3 Things I Want the World to Know About Insulin

This post was originally published on Hugging the Cactus on March 13, 2020…coincidentally, the first day of the pandemic that I started to work from home. I decided to repost it today because even though so much has changed in the last 365 days, the fact that so many people know so little about insulin remains the same. I think that if the world knew these 3 things about insulin, then it would go a long way in understanding how it is vital to most types of diabetes care and treatment, and people might finally realize that something must be done about insulin accessibly and affordability.

See that tiny glass vial in the below image? Can you believe that the contents of it are extremely precious?

Can you believe that, at approximately $9,400 per gallon, insulin is ranked as the sixth most expensive liquid in the world?

It’s kind of crazy, right? But besides knowing that insulin is priced outrageously, there’s actually a few other things that I think the world should know about insulin.

Ethan Zohn_ A Survivor Contestant Who Inspires-2
Did you know that insulin is the sixth most expensive liquid in the world?
  1. Not all insulin is created equal. Just like diabetes, insulin exists in various forms. Besides liquid insulin, there’s also inhaled insulin (Afrezza). And some people with diabetes may even take oral medications that are designed to help increase the effectiveness of insulin that they either receive via injection or produce on their own. There’s brand-name insulin produced by several drug manufacturers (the big three being Eli Lilly, Novo Nordisk, and Sanofi) as well as generic versions of the drug…but that doesn’t mean that generic insulin works just the same as brand-name insulin for all people with diabetes. Insulin is complicated and different types work better for different people.
  2. Insulin is incredibly sensitive. Take one look at the vial in the above photo and tell me that the insulin inside it is safe at all times. Nope, it sure isn’t! Besides the packaging being super fragile, people who rely on insulin must also be careful to keep it at the proper temperature at all times. All it takes is dropping the vial once or leaving it in an unstable environment for the insulin to be rendered useless, potentially wasting a few hundred dollars. It’s as volatile as it sounds.’
  3. Taking too much or too little insulin is dangerous and life-threatening. For some people, there can literally be a life-or-death difference between one unit of insulin. Too much can cause blood sugar to plummet and a person can experience severe hypoglycemia that may result in shock. Too little insulin has the opposite effect: A person will experience hyperglycemia that can have ranging consequences, some that are minimal/temporary, others that are very serious. That’s why precision is so important when dosing for insulin; on top of that, nobody wants to waste a single drop of the stuff because it is so expensive. But this is what many people with diabetes need in order to survive.

So when you see the hashtag #Insulin4All or hear someone talking about how overpriced it is, you’ll know some of the basic characteristics about insulin that make it invaluable to people with diabetes. Perhaps you’ll be inspired to join the fight to make insulin affordable and available to all – as it should’ve been to begin with.

Dexcom G6: Available to Who? A Post by Tracy Ramey

This post was originally published on the T1International blog on February 17, 2021. I wanted to post it here on Hugging the Cactus because it was incredibly well-written and eye-opening. Thank you to Tracy Ramey for sharing her perspective and prompting me to really think about diabetes technology and who it is available to you. I couldn’t agree more with your closing thoughts. Read on to learn about Tracy’s thoughts on the Dexcom G6, its availability, and the problems with the commercial that aired during Super Bowl LV.

Celebrity. Celebrity in a filter. Technology. Sleek. Celebrity showcasing a device that many people with diabetes can’t afford and telling said people with diabetes that they should get with the times. That’s it. That’s the entire commercial for Dexcom G6, a continuous glucose monitor (CGM), that aired during Super Bowl LV Sunday. To the world outside of the diabetes community, it presents an easy solution to the problem of diabetes management, a quick aside they can tell that person with diabetes they know in the office on Monday.

“Hey I saw Nick Jonas in that commercial. He said you don’t have to prick your finger anymore! Ya know, he doesn’t even look like he has diabetes.”

As a mother of a child that has type 1 diabetes, managing this condition is always on my mind. I am my child’s “pancreas momager,” if you will. For the past three years I have endured well meaning people giving advice, offering empty platitudes, and not understanding the tightrope we walk as a family attempting to raise a well rounded human that is growing physically and emotionally while course correcting a disease that is never the same day to day. I hear often how diabetes is manageable, an understanding that is as true as it is nuanced. Managing diabetes is not a one size fits all leather jacket. Said person with diabetes will assuredly be giving Diabetes Splainin’ Danny an immense amount of side eye.

With this ad, Dexcom and Nick Jonas had an immense opportunity to truly advocate for all insulin dependent people on the world’s stage. Instead of dispelling hurtful myths such as diabetes being caused by eating too much sugar, or insulin being “so cheap, it’s like water”, they created new ones like people with diabetes do not need to prick their fingers. The ad conveyed that there is an easy solution to diabetes management, which is a huge blow to everyone that has been fighting with insurance companies, pharmaceutical companies and device companies just to get basic insulin and other vital supplies covered, including glucose monitors.

Dexcom’s ad conveyed that there is an easy solution to diabetes management, which is a huge blow to everyone that has been fighting with insurance companies, pharmaceutical companies and device companies just to get basic insulin and other vital supplies covered, including glucose monitors.

Most people with diabetes know about Dexcom and the other major continuous CGM company, FreeStyle Libre by Abbott. Assuredly, if they don’t have one of these devices, in most cases it’s not for lack of understanding – it’s due to high cost. For many uninsured or underinsured insulin dependent people who are already struggling to afford their insulin, the Dexcom (with an initial out-of-pocket price tag for receiver, transmitter, and pack of 3 sensors that exceeds $1,000) is technology that remains out of reach. The ad boldly proclaimed “It looks like the future, but it’s available now.” Available to who? I know people that have had to plead with their insurer to keep their Dexcom if coverage changes occur. Many can’t get it covered in the first place, even though being able to have CGM technology is a gamechanger in the life of people living with diabetes. IT affords a level of control that is hard to think of giving up once you experience it.

But again, we must ask: who is this available to? This technology requires a prescription, and we know that Black and Brown communities are being offered access at much lower rates than their white peers. I am a Black woman with a family history of type 2 that puts me at greater risk of developing it. Interestingly, despite having several family members with type 2 diabetes, my child with type 1 is the first person that has CGM technology, and that was because I pushed for it.

You know what I’m getting at. The elephant in the room is medical racism and implicit bias. When cries for justice rang out for Ahmaud Arbery, George Floyd, and Breonna Taylor, many companies found themselves scrambling to make sure they appeared to sympathize with Black people and the systemic disregard for our lives. But here we are, almost a year into the pandemic, with a January 8th, 2021 headline from Endocrine.org that reads “Black people with type 1 diabetes, COVID-19 are four times more likely to be hospitalized for diabetic ketoacidosis.”

Companies that make a profit off of medical devices as life altering as Dexcom owe it to their consumers to look at the data and adjust to get their technology onto the bodies that need it most. Instead of addressing how they are going to provide a solution to inequities that black, Indigenous and people of color (BIPOC) face – especially Black patients – in comparison to their white peers, Dexcom paid $5 million plus for a Super Bowl ad that ignores barriers to access completely. This is chump change when, according to Yahoo!Finance, they earned $1.93 billion in 2020.

Dexcom offers a life saving product that I am fortunate enough to be able to use for my child because of my health insurance. I am acutely aware that many who look like us and need it the most don’t have access to CGMs like Dexcom’s G6. The Black and Brown people that are experiencing medical systemic racism deserve better. All insulin dependent people deserve better than a 30 second ad that wags it’s finger at all of us silly Billy gumdrops that are still pricking our fingers. Don’t spit on me and tell me it’s raining.