Nutrition And Meal Timing For Diabetes
Eating a balanced diet is vital for people who have diabetes, so work with your doctor or dietitian to set up a menu plan. If you have type 1 diabetes, the timing of your insulin dosage is determined by activity and diet. When you eat and how much you eat are just as important as what you eat. Usually, doctors recommend three small meals and three to four snacks every day to maintain the proper balance between sugar and insulin in the blood.
A healthy balance of carbohydrates, proteins, and fats in your diet will help keep your blood glucose on target. How much of each will depend on many factors, including your weight and your personal preferences. Watching your carbohydrates — knowing how much you need and how many you are eating — is key to blood sugar control. If you are overweight, either a low-carbohydrate, low-fat/low calorie, or Mediterranean diet may help you get your weight to goal. No more than 7% of your diet should come from saturated fat, and you should try to avoid trans fats altogether.
Try to fill half your plate with nonstarchy vegetables such as:
- Whole oats oatmeal
- Whole wheat
In general, less-processed food is better. It has a lower glycemic index, which means it may have less of an effect on your blood sugar. For example, oatmeal from whole oats has a lower glycemic index than instant oatmeal.
The Only Thing Thats Changed Is The Price
In 2019, Congress heard testimony from diabetes experts and others regarding the high cost of prescription drugs.
I can help shop for the best price of insulin, connect them with a discount pharmacy, sometimes switch to a less expensive product, said Dr. Kasia J. Lipska, an endocrinologist and assistant professor at Yale School of Medicine. But these are Band-Aid solutions. What we need to do is exert pressure on drug makers to reduce those prices.
Over the past quarter century, the prices of products have increased an average of 75%. Thats a fraction compared to the huge hike for insulin. A vial of Humalog , which cost $21 in 1996, now costs as much as $400 a more than 1,800% increase.
During that time, theres been no innovation to improve Humalog, Lipska said. Its the same exact insulin hormone. The only thing thats changed is the price.
A study she worked on found that 1 in 4 rationed insulin because of the high price.
Executives for the drug makers and the pharmacy benefit managers acknowledged to Congress in 2019 that the cost of insulin had become too expensive.
Kathleen Tregoning, an executive vice president at Sanofi, testified that while the treatment of diabetes has been transformed by medical innovations, the landscape in which patients access medications has also fundamentally changed, and not for the better. We understand the anger of patients who cannot afford the insulin they need due to rising, out-of-pocket costs.
Explainer: Why Is Insulin So Expensive And Difficult To Cap
Reining in the soaring prices of insulin has thus far been elusive in Congress, although Democrats say theyll try again as part of their economic package that focuses on health and climate
Washington — Reining in the soaring prices of insulin has thus far been elusive in Congress, although Democrats say they’ll try again as part of their economic package that focuses on health and climate.
The price of the 100-year-old drug has more than tripled in the last two decades, forcing the nation’s diabetics to pay thousands of dollars a year for the life-saving medication. Democrats are considering capping the cost of that drug for at least some, although its unclear what the final proposal will look like and how many insulin users will get a price break.
Heres a look at how insulin became so expensive and why its so difficult to bring the price of the drug down.
HOW MANY PEOPLE IN THE U.S. USE INSULIN AND FOR WHAT?
Roughly 8.4 million Americans use insulin, according to the American Diabetes Association. Not everyone who has diabetes needs insulin, but for those who do, it’s an important medication. For more than 1 million of those people with type 1 diabetes, regular access to the medication is a necessity and they will die without it.
“People require insulin, its not an option and nobody should have to decide between life-sustaining medication or food and rent,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association.
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So Why The Price Change
One reason for higher pricing on these insulins are because of an annual tax on brand name pharmaceutical companies. This exempts generic drugs and was started in 2012 as part of the ACA . It originated as a $ 28 billion tax in 2012 and will grow to $40 billion in 2018 if left in place.
The drug companies Eli Lilly, Novo-Nordisk and Sanofi have Drug Savings Cards in place which allow patients who are qualified to decrease 30-day insulin supplies to $25.00 a month depending on the insulin.
Another reason for present higher costs is because brand names are coming off patent due to expiration. For example, the patent for Lantus came off patent in December, 2016. Patents for Humalog and Novolog, both rapid acting insulins, will expire soon too. These companies may keep present prices higher in anticipation of biosimilar insulins. A biosimilar insulin is made from the same protein structure and should have similar glucose lowering effects. Biosimilar insulins are subject to more stringent approval standards than small molecule regular generic drugs. Biosimilar insulins are more difficult to achieve a perfect copy than generic tablet drugs. The first biosimilar insulin called Abasaglar will be available in pen form around the end of December 2016. Everyone is interested in seeing how biosimilar insulins play out in terms of cost and effectiveness on blood sugars.
The Human Cost Of Insulin In America
This is the list of what Laura Marston has sacrificed to keep herself alive: Her car, her furniture, her apartment, her retirement fund, her dog.
At 36 years old, she has already sold all of her possessions twice to afford the insulin her body needs every day.
Insulin is not like other drugs. It’s a natural hormone that controls our blood sugar levels – too high causes vision loss, confusion, nausea, and eventually, organ failure too low leads to heart irregularities, mood swings, seizures, loss of consciousness.
For most of us, our bodies produce insulin naturally. But for Type 1 diabetics like Ms Marston, insulin comes in clear glass vials, handed over the pharmacy counter each month – if they can afford it.
One vial of the insulin Ms Marston uses now costs $275 without health insurance.
In 1923, the discoverers of insulin sold its patent for $1, hoping the low price would keep the essential treatment available to everyone who needed it.
Now, retail prices in the US are around the $300 range for all insulins from the three major brands that control the market.
Even accounting for inflation, that’s a price increase of over 1,000%.
Stories of Americans rationing insulin – and dying for it – have been making national headlines.
Ms Marston knows the feeling – like most of the diabetics I spoke to, she has experienced frightening lapses in coverage through no fault of her own.
It’s the same story for Sanofi’s Apidra and Novo Nordisk’s Novolog.
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What Are The Solutions
According to the American Diabetes Association , there are more than seven million diabetics in this country, and around 27% say that affording insulin has impacted their daily life.
Dr William Cefalu, the ADA’s chief scientific, medical and mission officer, says a lack of transparency is at the root of the issue.
“The system is dysfunctional. There are issues at each level, at each stakeholder in the insulin supply chain,” he says. “We can’t point the finger at one particular entity.”
Fixing issues with high deductibles and ensuring any discounts negotiated with insurance companies actually filter down to patients is key, he says.
Competition would be the best way to bring prices down, so why hasn’t that happened yet?
Unlike chemical drugs, which can be simply replicated, insulin is a biological material – made up of proteins synthesised through a cell line that’s unique to each formula.
But despite these fundamental differences, insulin has long been classified and regulated like a chemical drug.
In December, the FDA announced that the agency would reclassify insulin as a “biological product” by 2020, in what the FDA commissioner called a “watershed moment for insulin”.
These so-called biologics will then have an easier pathway to approval than before, promoting the development of “products that are biosimilar to, or interchangeable with” existing insulin.
For Ms Marston, it’s hard to see why insulin was ever treated like other medications.
Monthly Insulin Price As High As A Playstation 5
Catie Santos, a 28-year-old from New Orleans, grew up knowing about Type 1 diabetes because her brother was diagnosed with the disease at age 10. On her 23rd birthday, she was horrified to learn she had the same disease.
Since then, she has met people who were diagnosed in their 50s with the disease once known as juvenile diabetes.
The monthly price of her insulin, she said, ran as much as the new Sony PlayStation 5, which can carry a price tag of more than $1,000.
Santos went on her parents insurance, but that assistance ended when she turned 26. You really have to figure out this insurance thing quickly, she said. Ive known diabetics who had to take corporate jobs just to stay alive.
Some have to move back home with their parents to make it financially, she said. She is one of them.
Her most recent scare took place in the wake of Hurricane Ida, which left her family without power for three weeks. She had to cram a months worth of her insulin into the refrigerator of her aunt, who happened to have a generator.
‘Most diabetic place in America’:Here’s where it is and few know it
The high cost of insulin has prompted some Americans to head for Canada or Mexico and still others manage to get the medicine or diabetic supplies through an underground network.
Through social media, she connects people, she said. If I hear people are in need, Ill start a Twitter thread. Were not trying to profit off of people were trying to work the system that profits off of people.
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How Has The Government Impacted Insulin Prices
On July 24, 2020 former President Donald Trump signed an executive order that included language aimed at lowering insulin and other drug prices for Americans. This order became effective on January 22, 2021.
As with any legal order, the devil’s in the detail, Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. She also noted that we are, “…going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.
On June 16, 2021, under the Biden administration, the Department of Health and Human Services published in the Federal Register their plan to rescind this 2020 rule. They cited various reasons for doing so:
- It created high administrative costs for impacted health centers.
- Impacted health centers had difficulty maintaining new rules to determine patient eligibility for receiving medications at lower prices.
- The new rules led to a decrease in staff available to help with critical and emergency services.
- Covid-19 added additional stress to these impacted health centers.
On March 1, 2022 in the State of the Union Address, President Biden discussed capping insulin prices at $35 a month. He also mentioned lowering the prices of prescription medication.
How Much Money Medicare Beneficiaries Stand To Save
The Senate legislation includes notable changes that will also help Medicare beneficiaries save money on prescription drugs in other ways.
Medicare would now be able to negotiate prices on prescription drugs. Out-of-pocket spending for Medicare Part D would also be limited to $2,000 annually.
“Of all the provisions, I think that is by far the most important,” said Andrew Mulcahy, senior health economist at The RAND Corporation, of the $2,000 annual cap for Medicare beneficiaries.
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Insulin Cost And Pricing Trends
Tara O’Neill Hayes, Josee Farmer
- Diabetes cost the United States $327 billion in 2017, becoming the most expensive chronic disease in the nation.
- Insulin costs, before accounting for any rebates or discounts, comprise an estimated $48 billion of the direct costs of treating diabetes after rebates, insulin accounts for 6.3 percent of costs.
- The average list price of insulin increased 11 percent annually from 2001 to 2018, with average annual per capita insulin costs now nearing $6,000. Because patients out-of-pocket costs are typically based on list price, their expenses have risen substantially despite the decrease in net price for many of the most commonly used insulin products over the past several years.
- If the trends of the past decade continue, gross insulin costs in the United States could reach $121.2 billion in total spending by 2024, but if more recent trends of much slower price growth prevail, insulin spending could total $60.7 billion in 2024 .
The Rising Cost of Diabetes
Given the rising costs, it is worth understanding what is driving these increases. This analysis first details increases in insulin prices and offers a projection for how much insulin will cost in the coming years. It then examines what is driving these increases.
The Price of Insulin
Past Price Growth
Insulin Spending in Medicaid
Source: American Medical Association
Insulin Spending in Medicare Part D
Typical Insulin Spending per Patient
Estimating Future Costs
How Does The Uk Compare
T1International is a non-profit advocating for affordable, accessible diabetes care worldwide. Founder Elizabeth Rowley is an American who now lives in the UK.
As a T1 diabetic herself, Ms Rowley has first-hand experience navigating both health systems. She describes the US system as “convoluted”, with profits happening at all levels in between.
“People spend most of their life in fear of losing their insurance, of running out of insulin and the cost going up, or of having to stay in terrible jobs or relationships to ensure they keep their health insurance coverage,” Ms Rowley tells me. “That’s the best case scenario.
“Worst case, folks are rationing insulin which has led to many reported deaths and excruciating complications. People are buying and sharing insulin from people online they have never met, having to choose between buying food, paying rent, or taking their medicine.”
Diabetics in the US pay on average over $210 each month for insulin, according to a T1International 2016 survey, compared to less than $50 in India or nothing at all in some European countries.
“In the UK, I walked into the pharmacy, and with my medical exemption card, picked up my essential medicines. While the NHS is still overpaying for insulin, the cost it pays is miniscule compared to what people in the US must pay.”
Ms Rowley acknowledges these other systems aren’t perfect – but to her, they are still far better for patients.
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Overall Insulin Epipen Pricing Isn’t Affected
Nationally, 30 million Americans suffer from diabetes, according to the American Diabetes Association. And nearly one in 50 Americans are at risk for anaphylaxis brought on by certain foods, insect bites, medications and latex, according to a 2013 study by the Asthma and Allergy Foundation of America.
But not all of those patients require insulin or epinephrine. And most who live in extreme poverty, or less than 200% of the federal poverty level an equation that works out to $34,840 for a family of two already receive free or discounted prescription drugs, a national health policy expert said.
Karyn Schwartz, a senior fellow at the Kaiser Family Foundation, a nonpartisan nonprofit that analyzes health policy, said some patients served by the 1,400 federally backed health centers nationally, such as those with high deductibles or those who are uninsured and paying list prices for the drugs, would have benefitted from the new pricing rule.
But it’s hard to say how many, she said. It’s also difficult to speculate about how many new patients would switch care to a community health center to take advantage of the discounted insulin and EpiPen prices, she said.
Reasons For The High Cost Of Insulin
- Gavlak G.
- et al.
|Reasons for the high cost of insulin|
|Vulnerable population who is willing to pay high costs to have access to a lifesaving drug|
|Pharmacy benefit managers and other middlemen who benefit from a high list price|
|Lobbying power of insulin manufacturers|
|Possible policy level solutions|
|Value-based reimbursement and pricing, and laws and regulations governing price increases|
|Easier path for biosimilar entry, including reciprocal approval of biosimilars|
|Governmental or nongovernmental agency to oversee pricing|
|Transparency on rebates|
|Solutions that can be implemented by physicians and institutions|
|Discussion with patients about affordability|
|Awareness about sources of information on prices|
|Practice guidelines that take cost into account|
|Preference of lower-cost biosimilars in formularies|
- Hancock J.
- Lupkin S.
|1921: Discovery of insulin|
|1923: First insulin patented|
|1946: Neutral protamine Hagedorn insulin|
|1950s: Lente insulin|
|1970s: Improved purified insulins|
|1984: Recombinant human insulin|
biosimilarsgenericsN Engl J Med.
- Hancock J.
- Lupkin S.
- Hancock J.
- Lupkin S.
- Hancock J.
- Lupkin S.
- Hancock J.
- Lupkin S.
- Mazziotta J.
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