6 ms·

The cost of diabetes

30 points by djoldman 4y ago

djoldman 4y ago
Almost $1 billion per day in the United States.
- refurb 4y ago
  And it's mostly type II, not type I. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-diabetes.html https://www.cdc.gov/diabetes/data/statistics-report/diagnose... 28.7 million people in the US have diagnosis of diabetes. ~2M are type I, with the remaining 27M being type II.
lucas_membrane 4y ago
This updated cost estimate for U.S. diabetics is for 2017, not now. Insulin prices in the U.S. are up substantially since 2017. Another expensive change since then is the increasing availability of the (so-called) continuous glucose monitors, now costing around $100/week for each diabetic using one. My opinion (I use one) is that mine is well worth it, but that the monitors are unlikely to reduce the total medical cost of diabetes care for many because of all the difficulties of responding to the monitor's data with beneficial changes, which might range from immediate doses of food or medication to long-term changes in diet, exercise, lifestyle, etc.
- heisenzombie 4y ago
  Are CGMs recommended or funded for people with type 2 diabetes in the US?
  - lucas_membrane 4y ago
    Mine is paid for by Medicare, but Medicare will only pay for a CGM for type 1 diabetics who actively manage their diabetes based on the CGM data as directed by a physician. For people not covered by Medicare (almost everyone under age 65), I don't know, but I suppose it depends on their insurance company and/or employer, etc, etc, like just about everything. I talk with someone who provides services to diabetics in a low cost clinic funded as a charity for persons with very low income, and they never mention any possibility of getting CGMs for their patients. Based on my experience with a couple of different CGMs, I guess that the target market of the CGM makers includes many more type 2 diabetics than type 1, both because there are many more type 2 diabetics than type 1, and because the larger number would would yield much more profit; and I also expect that the CGM would generally work better for a type 2 diabetic than my CGMs have worked for me, because my problems with the devices have been caused by fluctuations in blood glucose levels resulting from the sometimes large doses of fast-acting insulin that I take. What is your take on this situation?
TrackerFF 4y ago
It is a horrible disease - my sister was born with Type 1, and was lucky enough to be offered a pancreas transplantation some 10 years ago. Unfortunately her body rejected it after a year or two, and she was on immune depressants ever since, while waiting for a new one. She works in fitness, and lives a very active and healthy lifestyle - but still the diabetes was progressing, slowly but surely. Those new automatic pumps turned out to be a lifesaver, and she opted to get off the immune depressants due to likelihood of other nasty stuff that those bring (cancers, infections, decreased fertility, etc.). Hopefully these pumps will work so precisely, that the damage from inconsistent insulin levels will be a thing of the past. But she obviously still needs insulin. Luckily we live in a country where that is more or less free, and always in stock. I honestly can't remember the last time she suffered from bouts of low blood sugar - which was unfortunately a very regular thing back when we were teens. Unfortunately that was not the case for my old HS gym teacher. He, too, led a very active and healthy lifestyle, but the disease progressed in a very insidious way for him. He developed a foot sore that wouldn't heal, and after some time they decided to amputate said foot from ankle. Then he had a heart-attack some months later, and was bound to the wheelchair. Which was followed by two more amputations, the other leg and one arm. He lived like that for some years before ending up blind, and doing longer stays at the hospital. Finally a massive stroke got him, and that was it. I think he spent some like 5 years from amputating the first leg, to passing away. And as you can guess, that included tons of hospital visits / stays, medication, physical therapy, becoming dependent on your friends and family, and what not. It is truly insidious, because it can completely wreck your body in so many ways, and pretty slowly too. I can't imagine having diabetes w/complications, and living underinsured (or without insurance) in a country without universal healthcare. It seems like to have a fighting chance, you need consistent insulin supply, and modern delivery systems. I shudder when I hear about poor people in the US rationing insulin, and still being dependent on those antiquated measurement/delivery devices. Seems like you're just entering a negative feedback loop, which will eventually catch up with you.
- RHSeeger 4y ago
  > and modern delivery systems. While I'd agree with most of what you say, I disagree with this. Using a syringe and manually taking insulin is perfectly workable. Personally, I have chosen to go with manual insulin injections over a pump. That being said, the invention of the CGM (continuous glucose monitor) is, in my opinion, the single best thing to happen for diabetics since the advent of synthetic insulin. Being able to know what your blood sugar is with no effort at all, and being alerted when it's high or low... is just life changing.
2Slow 4y ago
u can cure type 2 if u have it quite easy. i recomend books by jason fung, diabetes code and obesity code.
- RHSeeger 4y ago
  You can mitigate the effects of Type 2 diabetes. That's not the same thing as curing it. The effects will almost certainly re-occur if you stop the behavior you are using to mitigate it (which is generally low carbs, low calories, exercise, etc).
  - imtringued 4y ago
    You can mitigate the effects of a cookie dough induced salmonella infection. That is not the same as curing it. The effects will almost certainly re-occur if you stop the behaviour you are using to mitigate it (which is generally not eating raw cookie dough every single week). You can go for decades or even a lifetime without remission but the moment you take a bite out of that raw cookie do prepare yourself for a salmonella infection.
    - RHSeeger 4y ago
      That is so ridiculously not the same thing. The point is that Diabetes Type 2 is effectively insulin resistance; your body doesn't use insulin as well as it should (though it's more complicated than that). You can mitigate the effects of this by living a life where you don't need as much insulin (lower card, exercise, etc). But no matter what you do, your body still has a "defect" that causes it to not process (and eventually, generate) insulin as well as someone else. A better analogy would be a transplant. Just because you are on immunosuppressants to prevent your body from rejecting the new organ doesn't mean you've "cured" yourself of that rejection; you're just mitigating/preventing the impact of it.
- xedrac 4y ago
  This is a bit misleading. Yes you can reverse the metrics by which we measure diabetes. But you cannot cure the blindness it may have caused, or the leg amputation that may have been needed, etc... The earlier you begin to manage your insulin spikes, the more likely you are to succeed in "reversing" type 2 diabetes. But I think it's a little presumptuous to call it "easy". Some people have to fast for 3-5 days before their elevated insulin levels begin to drop a little. And even then, they have to do that frequently before their insulin starts to behave somewhat normally. Then when they do eat, they have to be rather careful of what they eat. Not easy, but easier than the alternative.
jnash 4y ago
You can reverse type 2 diabetes. Doctors in Australia, the UK and the US have done that for decades by recommending low carb diets.
- deleted 4y ago
  [deleted]
buscoquadnary 4y ago
My wife has type 1 the Eli Lilly executives are some of the most evil people to ever live. They keep a monopoly on the insulin market, use patents and regulatory capture of the FDA to prevent competition and hurt millions of people.
- refurb 4y ago
  Eli Lilly doesn't have a monopoly on the insulin market, there are a few big makers like Novo Nordisk and Sanofi. Generic Novolog is $57/vial at Walgreens according to GoodRx.
itsmemattchung 4y ago
Listened to a Huberman podcast episode on type 2 diabetes and intermittent fasting and in order to build intuition around my own glucose levels, I started pricking my finger with a lancet ever hour for the last few weeks (going on week 3 now) .... only to discover that I'm actually prediabetic. I wonder how many others are silently walking around, unaware of their prediabetes.
deleted 4y ago
[deleted]
RappingBoomer 4y ago
most type 2 diabetics can eliminate high blood sugar by simply eating less than 50 grams per day of carbs and exercising every day....do that and blood sugar returns to safe levels...but the establishment taught for decades that grains & carbs are the base of the food pyramid...and if we have learned anything over the last decade, it is that once the establishment settles on a particular narrative, it will defend that narrative with any and all necessary means...thus, the low carb cure for type 2 diabetes has been attacked by establishment forces and their many minions

30 points by djoldman 4y ago

djoldman 4y ago

Almost $1 billion per day in the United States.

refurb 4y ago
And it's mostly type II, not type I. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-diabetes.html https://www.cdc.gov/diabetes/data/statistics-report/diagnose... 28.7 million people in the US have diagnosis of diabetes. ~2M are type I, with the remaining 27M being type II.

lucas_membrane 4y ago

This updated cost estimate for U.S. diabetics is for 2017, not now. Insulin prices in the U.S. are up substantially since 2017. Another expensive change since then is the increasing availability of the (so-called) continuous glucose monitors, now costing around $100/week for each diabetic using one. My opinion (I use one) is that mine is well worth it, but that the monitors are unlikely to reduce the total medical cost of diabetes care for many because of all the difficulties of responding to the monitor's data with beneficial changes, which might range from immediate doses of food or medication to long-term changes in diet, exercise, lifestyle, etc.

heisenzombie 4y ago
Are CGMs recommended or funded for people with type 2 diabetes in the US?
- lucas_membrane 4y ago
  Mine is paid for by Medicare, but Medicare will only pay for a CGM for type 1 diabetics who actively manage their diabetes based on the CGM data as directed by a physician. For people not covered by Medicare (almost everyone under age 65), I don't know, but I suppose it depends on their insurance company and/or employer, etc, etc, like just about everything. I talk with someone who provides services to diabetics in a low cost clinic funded as a charity for persons with very low income, and they never mention any possibility of getting CGMs for their patients. Based on my experience with a couple of different CGMs, I guess that the target market of the CGM makers includes many more type 2 diabetics than type 1, both because there are many more type 2 diabetics than type 1, and because the larger number would would yield much more profit; and I also expect that the CGM would generally work better for a type 2 diabetic than my CGMs have worked for me, because my problems with the devices have been caused by fluctuations in blood glucose levels resulting from the sometimes large doses of fast-acting insulin that I take. What is your take on this situation?

TrackerFF 4y ago

It is a horrible disease - my sister was born with Type 1, and was lucky enough to be offered a pancreas transplantation some 10 years ago. Unfortunately her body rejected it after a year or two, and she was on immune depressants ever since, while waiting for a new one. She works in fitness, and lives a very active and healthy lifestyle - but still the diabetes was progressing, slowly but surely. Those new automatic pumps turned out to be a lifesaver, and she opted to get off the immune depressants due to likelihood of other nasty stuff that those bring (cancers, infections, decreased fertility, etc.). Hopefully these pumps will work so precisely, that the damage from inconsistent insulin levels will be a thing of the past. But she obviously still needs insulin. Luckily we live in a country where that is more or less free, and always in stock. I honestly can't remember the last time she suffered from bouts of low blood sugar - which was unfortunately a very regular thing back when we were teens. Unfortunately that was not the case for my old HS gym teacher. He, too, led a very active and healthy lifestyle, but the disease progressed in a very insidious way for him. He developed a foot sore that wouldn't heal, and after some time they decided to amputate said foot from ankle. Then he had a heart-attack some months later, and was bound to the wheelchair. Which was followed by two more amputations, the other leg and one arm. He lived like that for some years before ending up blind, and doing longer stays at the hospital. Finally a massive stroke got him, and that was it. I think he spent some like 5 years from amputating the first leg, to passing away. And as you can guess, that included tons of hospital visits / stays, medication, physical therapy, becoming dependent on your friends and family, and what not. It is truly insidious, because it can completely wreck your body in so many ways, and pretty slowly too. I can't imagine having diabetes w/complications, and living underinsured (or without insurance) in a country without universal healthcare. It seems like to have a fighting chance, you need consistent insulin supply, and modern delivery systems. I shudder when I hear about poor people in the US rationing insulin, and still being dependent on those antiquated measurement/delivery devices. Seems like you're just entering a negative feedback loop, which will eventually catch up with you.

RHSeeger 4y ago
> and modern delivery systems. While I'd agree with most of what you say, I disagree with this. Using a syringe and manually taking insulin is perfectly workable. Personally, I have chosen to go with manual insulin injections over a pump. That being said, the invention of the CGM (continuous glucose monitor) is, in my opinion, the single best thing to happen for diabetics since the advent of synthetic insulin. Being able to know what your blood sugar is with no effort at all, and being alerted when it's high or low... is just life changing.

2Slow 4y ago

u can cure type 2 if u have it quite easy. i recomend books by jason fung, diabetes code and obesity code.

RHSeeger 4y ago
You can mitigate the effects of Type 2 diabetes. That's not the same thing as curing it. The effects will almost certainly re-occur if you stop the behavior you are using to mitigate it (which is generally low carbs, low calories, exercise, etc).
- imtringued 4y ago
  You can mitigate the effects of a cookie dough induced salmonella infection. That is not the same as curing it. The effects will almost certainly re-occur if you stop the behaviour you are using to mitigate it (which is generally not eating raw cookie dough every single week). You can go for decades or even a lifetime without remission but the moment you take a bite out of that raw cookie do prepare yourself for a salmonella infection.
  - RHSeeger 4y ago
    That is so ridiculously not the same thing. The point is that Diabetes Type 2 is effectively insulin resistance; your body doesn't use insulin as well as it should (though it's more complicated than that). You can mitigate the effects of this by living a life where you don't need as much insulin (lower card, exercise, etc). But no matter what you do, your body still has a "defect" that causes it to not process (and eventually, generate) insulin as well as someone else. A better analogy would be a transplant. Just because you are on immunosuppressants to prevent your body from rejecting the new organ doesn't mean you've "cured" yourself of that rejection; you're just mitigating/preventing the impact of it.
xedrac 4y ago
This is a bit misleading. Yes you can reverse the metrics by which we measure diabetes. But you cannot cure the blindness it may have caused, or the leg amputation that may have been needed, etc... The earlier you begin to manage your insulin spikes, the more likely you are to succeed in "reversing" type 2 diabetes. But I think it's a little presumptuous to call it "easy". Some people have to fast for 3-5 days before their elevated insulin levels begin to drop a little. And even then, they have to do that frequently before their insulin starts to behave somewhat normally. Then when they do eat, they have to be rather careful of what they eat. Not easy, but easier than the alternative.

jnash 4y ago

You can reverse type 2 diabetes. Doctors in Australia, the UK and the US have done that for decades by recommending low carb diets.

deleted 4y ago
[deleted]

buscoquadnary 4y ago

My wife has type 1 the Eli Lilly executives are some of the most evil people to ever live. They keep a monopoly on the insulin market, use patents and regulatory capture of the FDA to prevent competition and hurt millions of people.

refurb 4y ago
Eli Lilly doesn't have a monopoly on the insulin market, there are a few big makers like Novo Nordisk and Sanofi. Generic Novolog is $57/vial at Walgreens according to GoodRx.

itsmemattchung 4y ago

Listened to a Huberman podcast episode on type 2 diabetes and intermittent fasting and in order to build intuition around my own glucose levels, I started pricking my finger with a lancet ever hour for the last few weeks (going on week 3 now) .... only to discover that I'm actually prediabetic. I wonder how many others are silently walking around, unaware of their prediabetes.

deleted 4y ago

[deleted]

RappingBoomer 4y ago

most type 2 diabetics can eliminate high blood sugar by simply eating less than 50 grams per day of carbs and exercising every day....do that and blood sugar returns to safe levels...but the establishment taught for decades that grains & carbs are the base of the food pyramid...and if we have learned anything over the last decade, it is that once the establishment settles on a particular narrative, it will defend that narrative with any and all necessary means...thus, the low carb cure for type 2 diabetes has been attacked by establishment forces and their many minions