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Hey Friends,
This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.
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 You keep using that word. I don't think it means what you think it means. You guys. Healthcare News lost its freaking mind last week about Medtronic’s “Artificial Pancreas” getting FDA approval. It’s always exciting when a new device or device enhancement becomes available to people with diabetes because it usually means that if I can get my hands on said device, I’ll have better blood sugar results. But I’m concerned that the “breaking news” media reports have caused people to believe that there’s finally a solution that will relieve diabetics of our constant daily struggle to keep our blood sugar in target range. So, no. Medtronic’s new 670G insulin delivery system (“artificial pancreas”) is no such device. If you look closely at the FDA’s announcement, you’ll notice that the FDA has not called Medtronic’s new device an “artificial pancreas.” In fact, if you look at Medtronic’s announcement, you’ll notice that Medtronic, the creator of this device, doesn’t even call it an “artificial pancreas.” Also, the Medtronic Minimed 670G is approved for type 1 diabetics only (1.25 million people in the U.S.), not type 2 diabetics (27.9 million people in the U.S.) So let’s all hold our damned horses and chill the heck out, here. You might be wondering whether the new Minimed 670G insulin pump/CGM system is even worth getting excited about? You bet! In fact, the new 670G system has new features that other pumps don’t have, and two of these features are what make the 670G different (and more automated) than other insulin delivery systems. The two features the 670G has that other systems don’t have:
For some very basic details on insulin delivery systems and the 670G, take a look at the table below.  Based on what I’ve read about the Medtronic 670G and based on what I know about insulin delivery systems and how they work (since I’ve been using them for 16 years) Here’s my quick assessment:
My verdict? If you are a type 1 diabetic using the Medtronic 670G system, you are still going to have to work just as hard to manage your blood sugar as you always have, but, if the new Medtronic sensor is more accurate than Medtronic’s previous sensors, there’s a non-zero chance you’ll get slightly better blood sugar results from your efforts if you use this system. And a better result, no matter how slight, can make a world of difference for some. As for me, I'm going to continue to use my old Medtronic pump along with my Dexcom sensor, even though the two devices don't interact with each other. If diabetics using the 670G start raving about the painlessness and accuracy of the new Medtronic sensor, then maybe I'll give the 670G system a try. And if you are using the 670G, I invite you to add your opinion in the comments section below. For now, because I've been scarred (emotionally and physically) by Medtronic's prior sensors, I just can't give up my Dexcom (which, thus far, has been a far superior CGM) anytime soon. Hell yes, insulin prices are skyrocketing. And the trajectory is so much steeper than we thought. Last week's news made a really amazing effort to shed light on the insane costs of being diabetic, and, as a result of last week's reports, a bunch of change.org petitions to lower insulin prices popped up and got passed around on Facebook and other social media.
Which is awesome. It’s really nice to see people caring about insulin prices. The JAMA study's data from which the news reports got their numbers is entirely correct and you should definitely read it if you get an opportunity (It's a study about type 2 diabetics. It didn't include type 1s). But I am concerned that the news reports have not clearly explained the meaning of JAMA's figures in a way that is relevant to the diabetics who actually take insulin (and their loved ones). So I'd like to set the record straight and help clarify the figures. Why? Well, I figure if you're gonna be pissed off on behalf of the diabetic(s) you love, I want you to be pissed off based on a more clear interpretation of the data. The actual average price of insulin per insulin-dependent type 2 diabetic in 2013 was $2661.52, not $736.09, as many believe based on last week's news reports. Wait, WHAT? Why am I saying the average yearly price of insulin in 2013 was $2661.52 and all the other news articles are saying it was $736.09? Let me explain. This JAMA study tells us that insulin cost an average of $736.09 per type 2 diabetic per year in 2013, This average cost is distributed across ALL diabetics, whether they’re taking insulin or not! But, only 29.2% of Type 2 diabetics actually take insulin. Do you know what this means? It means that 29.2% of type 2 diabetics are absorbing 100% of the insulin cost. Look, if you're an insulin-dependent type 2 diabetic with a kick-ass health plan, your insurance company might absorb a good portion of this cost on your behalf. But, if you don't have a health plan, or if you have a high deductible before drug coverage kicks in, or if you pay a high coinsurance percentage, or if you're stuck in the donut hole, you might become desperate enough to start thinking about other less healthful options, such as rationing insulin by skipping doses (yes, this is actually happening, and it really shouldn't be) or using the cheaper but less effective insulins. So sure, the study had numbers in it. And the numbers were correct. But the study didn't calculate the values that are most relevant to people who are going broke thanks to their insulin bill (which wasn't the purpose of the study anyway, so don't be mad at the researchers. They didn't do anything wrong). So, here’s what’s actually relevant to us: The average cost of insulin for an insulin-dependent type 2 diabetic increased from $742.14 in 2002 to $2661.52 in 2013. And guess what else. Prices have increased a LOT since 2013. Based on the published cash prices for insulin on GoodRX.com and using the JAMA study’s average figures for yearly insulin consumption in mL, an insulin-dependent diabetic on analog insulin (the good stuff that actually works) can expect their “average” insulin costs in 2016 to be anywhere between $2662 and $5459 or more per year. If you don't have a good health plan to cover these costs, you are screwed. Here’s some extra math, for those of you who like math: The JAMA study indicates that in 2002, the average price of insulin was $4.34 per mL, and that in 2013, the average price of insulin was $12.92 per mL. The study also indicates that in 2002, insulin-dependent type 2 diabetics took an average of 171mL per year and in 2013, insulin-dependent type 2 diabetics took an average of 206 mL per year. So, if you care about a diabetic, and if you've been getting all pissed off about the price of insulin increasing but you haven't yet fully grasped how ridiculous the price increases are, just do the math yourself using the figures above, and then join me in my full blown rage, or cry, or shout expletives, or call someone and cry, or whatever. And, if you haven't done so yet, go sign one of those change.org petitions! Because for pete's sake, we 'betics can't afford these disgusting insulin price shenanigans. During one of our recent BootCamp for Betics Webinars, we discussed the accuracy of nutrition labels, and how they can sometimes be incorrect. A participant asked how we are supposed to know if a specific nutrition label is wrong, and whether there are standards in place to ensure nutrition label accuracy. I found some answers. I wouldn't necessarily qualify them as "good news" answers but here they are:
Companies have a handful of acceptable methods they can use to figure out what should go on a nutrition label. One way to do it is to send the food product to a lab for analysis. Any food that is fried, coated or salted needs to have their nutrition information determined by a lab because of its complexity. But, this is time consuming and expensive because the labs have to follow strict FDA procedures. But, if a food isn’t fried, coated or salted, there’s another option. A company can instead use a “nutritional database” to figure out what to put on their food label. This means that the company can go on the internet and pick one of the online nutrition websites, and enter the ingredients for their food item, and use those internet results to generate their nutrition label. The FDA does not regulate nutrition labels on a proactive basis. The FDA has guidelines, to be sure, but the FDA does not (and could not possibly) verify whether every single nutrition label ever printed is correct. If there’s a complaint about a product, the FDA can investigate and issue a recall of a product, but that typically only happens if there are reports/complaints about a product. The FDA also allows a margin of error of 20% either way. So if the item in question has either 20% more or 20% less of a nutrient/substance than is indicated on its label, that is considered acceptable. So a product labeled 100 carbs per serving could actually have 80 carbs or 120 carbs and still be considered accurately labeled. A random audit in the 1990s discovered that 90% of food labels were within this acceptable 20% margin of error, and 10% were not. So, the short answer to the question posed during the webinar is: A nutrition label is 90% likely to be up to 20% wrong and 10% likely to be worse than 20% wrong. |
AuthorHi, I’m Kara. I’ve been type 1 diabetic since 1986. I’ve been attending diabetes camp since 1987. I’ve been a camper, a counselor, a staff director and training director at diabetes camps for the last 30 years. I have a regular day job as a technology consultant, and even though I like my day job, diabetes is my true passion. My late maternal grandmother had diabetes, and died from complications related thereto. Both of my grandfathers have diabetes, and so do my dad and my uncle. My little brother is hyperinsulinemic, which means that his pancreas is already overproducing insulin to counteract his body's insulin resistance. I hate diabetes! But guess what. Diabetics aren't doomed. There is a way to have diabetes and still live a long and healthful life, but, at times, it can be hard as hell. Like, really, really, insanely hard. But I’ve finally figured out how to lower my blood sugars and keep my A1C at a reasonable level. And it's not easy, and sometimes I screw up, but my method is totally workable for anyone who wants to fix their blood sugar, including you. And I want to share what I’ve learned with you, so that you can be healthy and feel better, too. Archives
May 2018
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