Diabetics Skimp On Care During Recession

Patients Skipping Insulin, Doctor Visits and Blood-Sugar Testing As They Lose Income And Health Insurance

(AP)  Diabetics are increasingly risking life and limb by cutting back on - or even going without - doctor visits, insulin, medicines and blood-sugar testing as they lose income and health insurance in the recession, an Associated Press analysis has found.

Doctors have seen a drop in regular appointments with diabetic patients, if they come back at all. Patients more often seek tax-subsidized or charity care. And they end up in emergency rooms more often, patients and physicians said in interviews.

Sales of top-selling drugs and other products used to treat and monitor the disease have dropped since the economic crisis accelerated last fall, the AP analysis found. There are even signs that some patients are choosing less-expensive insulin injections over pricier pills to save money.

Meanwhile, the number of people with the disease keeps growing - another 1.6 million Americans were diagnosed in 2007 alone.

People with other health problems also are cutting back on care amid the recession, but diabetics who don't closely monitor and control the chronic disease risk particularly dire complications: amputations, vision loss, stroke - even death.

Patients' frugality comes at a tremendous cost to the already-strained health care system. The typical monthly bill to treat diabetes runs $350 to $900 for those without insurance, a price tag that's risen as newer, more expensive medicines have hit the market. Emergency care and a short hospitalization can easily top $10,000, and long-term complications can cost far more.

M. Eileen Collins, 48, of Indianapolis, tried to scrimp on her medication last fall after her husband lost his job and with it their insurance. Without money for insulin, test supplies and other medicines, she asked for free samples and also got a few drugs through $4-a-month generic programs. But she stopped taking most of her drugs and cut her insulin doses in half to stretch her budget.

"I truly did not think I was putting my life in danger," Collins said. "I thought if I was just real careful with what I ate ... I'd be all right."

By Thanksgiving eve, Collins was vomiting blood and rushed to a hospital. Doctors diagnosed her as malnourished, anemic and in diabetic ketoacidosis, a life-threatening condition caused by lack of insulin and sky-high blood sugar. She spent a week in the hospital.

Her story is hardly unique.

Dr. Steven Edelman, a University of California, San Diego endocrinologist who runs a free clinic staffed by medical students, has seen a 30 percent surge the past six months in patients seeking free diabetes medicines and supplies, which the clinic has to ration. Many had been solidly middle class, but the recession took their jobs, insurance and even some homes.

"A third to a half of these people haven't been taking their meds at all," said Edelman, who also founded the advocacy group Taking Control of Your Diabetes.

Diabetes occurs when the body doesn't make enough insulin or doesn't efficiently use the hormone, which helps turn sugar from food into energy. The disease can be kept under control by monitoring blood sugar as well as exercising, improved diet, medications, testing and regular checkups.

Uncontrolled diabetes can cause fatigue, blurry vision, excessive urination, gum problems, infections and wounds that don't heal. Damage to the kidneys, liver, heart and eyes follow. Often, much of that damage isn't apparent until a stroke or heart attack strikes.

Sales of diabetes testing supplies and drugs indicate how many Americans have moved beyond scrimping and are cutting vital expenses. Several doctors said they began noticing a shift in August or September, when the financial markets melted down and layoffs accelerated.

Sales have dipped for pricey brand-name diabetes pills, blood glucose monitors and even test strips, based on industry sales figures and interviews with the top two makers of testing supplies. The strips generally cost $1 or more each; patients using insulin are supposed to test at least two to four times a day to be sure their blood sugar is in a safe range.

Most diabetics typically can control the disease for a few years with diet, exercise and pills available as cheap generics. But eventually, those pills stop working well, and patients switch to more advanced - and more expensive - medicines.

Sales of the most widely used pill, $4-a-month metformin, are up 7 percent since June, according to the AP analysis of figures from health data firm IMS Health Inc. Brand-name versions of the same drug, costing 10 times as much, are down 9 percent, on average, since then.

By February, sales for nearly every other category of diabetes pills and insulins were down from a year earlier, most by double digits, IMS figures show. The only exceptions were a heavily promoted new type of diabetes pill, Januvia, and advanced insulins that tightly control blood sugar levels.

The sales declines come even as the number of diabetes cases grows, fueled by the rise in obesity. According to the American Diabetes Association, more than 24 million Americans have diabetes.

Even as sales of expensive pills have fallen, sales of advanced insulin injections are up 9 percent since summer. That could mean some patients would rather face a needle to save money, according to Brian Lasky, a research analyst at IMS Health.

"By December, people were making decisions in terms of, 'Do I fill this prescription or ... buy Christmas presents for my kids?"' Lasky added.

Johnson & Johnson, a maker of top-selling OneTouch blood sugar meters, testing strips and insulin pumps, reported a 2 percent fourth-quarter drop in U.S. sales for the category compared with the same period a year earlier, a large drop considering quarterly sales up to then had been rising at around 10 percent.

"We're seeing some signs that consumers and patients are becoming more frugal," J&J Chief Executive Bill Weldon told analysts in January.

Getting patients to stick to their treatment has long been tough. But rising unemployment has made things worse.

At a family clinic in impoverished Newark, N.J., so many patients simply stopped showing up after losing health insurance that doctors posted notices asking clients with financial troubles to speak up so staff can try to help.

"Sometimes you don't see (diabetes) patients for several months," said Dr. Cynthia Paige, medical director of the New Jersey Family Practice Center. They "don't understand what a nightmare uncontrolled diabetes is and how it's ravaging your body," she said.

April Bumpus, 31, of Woodstock, Ga., was laid off from her job in medical sales last spring while recovering from surgery, and her health insurance was canceled. By September, she had to switch from two advanced insulins that tightly controlled her blood sugar to cheaper, older ones that cause surges and drops. The advanced insulin would have cost $360 a month, the older insulin only $100.

"It makes you really feel like you have the flu" at least once a week, said Bumpus, who's more worried about the long-term consequences. "That does scare me. I can have a heart attack, I can have a stroke, I can go blind."

Emergency rooms increasingly are treating diabetics who haven't been taking medicines, according to doctors at several hospitals nationwide and the professional group for ER doctors. Many of the patients have blood sugar so high they are hospitalized for days. Free clinics also are getting a surge of diabetes patients desperate for help.

"There's an increase in just overall consequences of diabetes: losing a foot, losing a kidney, bad eyesight. At least six people come to mind over the last six months ... most because of the recession," said Dr. Nicholas Vasquez, who works in one of the country's biggest ERs, at St. Joseph's Hospital in Phoenix.

Vasquez and his colleagues view the desperate patients in their ER as harbingers of what's to come if the recession deepens.

"What we're seeing mostly is the first steps of people not taking care of their diabetes and starting to have consequences," he said.

[brownawella]

I must say the comments about weight are quite irritating. As a Type I diabetic I am not overweight and have not been.

Stop overgeneralizing that all diabetics are overweight. Yes being overweight can lead to Type 2 diabetes.

In addition, there is nothing I could have done to prevent my Type 1 diabetes so stop blaming all diabetics for their condition.

[jonesjep]

"Diabetics Skimp on Care During Recession"

No they dont.

People have gotten to the point that they feel entitled for medicine and health care. After all they are free RIGHT!!! No medicines have to be developed RIGHT!!! Pharmaceutical companies and all of their millions of workers should work for free RIGHT!!! Doctors and nurses do not have to go to college RIGHT!!! If they did it would be free RIGHT!!! Hospitals are free to build RIGHT!!! The workers who lay the bricks and put up the steel work for free RIGHT!!!

I am not even going to comment on anyones weight. I will comment on the china cabinet in the background. How about sell those things? After all what is more important, and therefore should be more valuable, stuff or her life?

[element51]

rf35......After reading your post I gave a second thought to mrs_neves post and I think you may be on to something. If you are right, she is doing a great job of poking fun at the fundies since they do indeed have some outrageous ideas. It actually is close to impossible for me to believe that anyone in their right mind could make such a statement in a serious manner. Some people have odd senses of humor and perhaps she is one of those people. When you are a diabetic and you read something that says God has put a curse on you because you are a "sinner" it produces a strong reaction. So I will choose to believe that she is just poking the hornets nest to see how many of us will take the bait. If I am wrong I truly feel pity for her since her life must be very miserable.

[rf35]

I feel it necessary to educate some of the people here on the concept of the troll. The person posting as mrs_neves is an example of one species that I find very entertaining. She (or he) does not really believe what she is posting. Rather, the point is to get a rise out of others on the site, to get them to attack her posts while she enjoys a good chuckle. I find her posts to be a humorous parody of fundi Christian attitudes. Taken in the proper context, mrs_neves is actually quite funny. In fact, she is not very subtle, as trolls go. Many would prefer to be somewhat less obviously outrageous in order to appear serious and thereby generate even more attacks. She might not even be a true troll, rather someone simply trying to show the silliness of fundamental Christian extremists and their attitudes towards most everything in life.

[Dr_Vaquero]

Recession is causing diabetic patients drop their medication and filling up ER units. But I think the truth is even before the crush in the economy started people already ignored to care about diabetes. The cost of complicated diabetes consequences in hospital is rising day by day. Diabetes is a serious problem to economy. That´s the reason why, with the intervention of the Public Health, we have come to know that PREVENTION is the key to stop this rising hits the sky.

Economy strategies must follow this objective, prevention; thereby we can avoid the deadly consequences of Diabetes. It isn´t new the issues of diabetics skimp on care since we have long history on fighting vision loss, diabetic foot, and heart and kidney failure. I do practices in a general hospital in Mexico where patients come back over and over as them can´t afford medication. They might begin with simple symptoms such as a terrible thirst, hunger, weakness, drowsiness. After they went through blindness, foot injures systemic infections, lung problems and more. The final and horrible consequences are heart stroke, brain stroke which ends in incapacity, limb amputation, and eternal dialysis for kidney failure. Unfortunately we have seen this process step by step from the very beginning to the last stages due to the insufficiency of the patient´s budget.

Mexico has miss achieved the universal health service, which means, Government supposed to bring health service to all people living in the country, but not only are people dying from treatable illness but also avoidable ones.

Diabetes can be prevented. All human beings must concern about it and start changing lifestyles. Diabetes is the first cause of death in the US and Mexico and each one of us has a vaccine we have only to decide when to use it.

[rwsmith29456]

People on insulin tend to gain weight. A person who doesn't have diabetes has a fairly constant blood sugar level while in diabetics on insulin, blood sugar can fluctuate widely. Insulin makes you want to eat because when sugar is lower you need food and when it is higher you have less energy. Fighting this tendency is a constant battle for many diabetics.

[rwsmith29456]

Even with decent insurance, diabetes is EXPENSIVE. You have to constantly buy supplies and drugs that the supply and drug companies know that you HAVE to have and charge you accordingly. Even if you use one of the 'discount' supply houses it's going to cost you a small fortune to stay healthy. I'm not surprised at all that tight economic times would reduce the level of care that a person has to give themselves.

[TerpsichoreGal]

mrs_neves - My 19 month old nephew has type one diabetes. His father was diagnosed with type one diabetes at the age of 11. My brother-in-law is very conscientious of his disease, eats very well, and is a long distance runner having just completed his 8th marathon. mrs_neves , diabetes is not a pestilence from God and there is no sin that at 19 month old child could do that any loving God would punish with diabetes. Yes, the lifestyle choices of people can cause some to get type-two diabetes but only an uneducated and unsophisticated person would actually believe that God did this to them for sinning (gluttony). They did it to themselves. It is hard to believe that there are still people out there whose thinking is so un-evolved. We no longer live in the dark ages and as an educated people we understand the cause of disease and illness. I recommend a good college level course in pathophysiology; perhaps this will help you to become more enlightened and more compassionate. Your sick denomination of hateful Christianity is giving the rest of us a bad name.

[CALpumper]

"Diabetes occurs when the body doesn't make enough insulin or doesn't efficiently use the hormone, which helps turn sugar from food into energy. The disease can be kept under control by monitoring blood sugar as well as exercising, improved diet, medications, testing and regular checkups."

I have been living with T1 for 24 years.
If you (CBS News) are going to write about Diabetes, Please, I beg of you, make sure you note Which Type you are writing about!!!!!!!!!

The above is medically termed Type 2 Diabetes.
In Type 1 the body does not produce any insulin at all.
There are many other types too.
This disease is such an epidemic and is So misunderstood, don't do the PWD community a disservice by lumping each Type into one category.

[whatever567]

It hacks me off that everyone thinks you have to be obess to be a diabetic

my husband has diabetes from Viet Nam and Agent Orange Exposure
remember a lot of the baby boomers served in Viet Nam some may not even know that because they were exposed to Agent Orange it made them more susectible to diabetes type II.
the other thing is my husband was not heavy when he was diagnosed with diabetes

GIVE US ALL A BREAK people you dont have to be fat to be a diabetic
my friends mom is thin as a rail and she is a diabetic