Being Diabetic in America

I don’t know where to start this post. I don’t know if this post should be a post, or a poem. I’m angry and my thoughts are swirling around in the hurricane of my mind.

Being diabetic, for me, means two types of insulin, pen needles, test strips, a glucometer, and juice boxes on standby. It means counting carbs and calculating my insulin dose based on a pre-set ratio and the state of my blood sugar prior to said carbs. Sometimes it means waking up in a cold sweat, confused, stumbling into the kitchen to eat until the horrible low blood sugar feeling leaves me. It means I’ll most likely wake up the next morning with high blood sugar that I’ll do my best to knock back down with insulin. Sometimes I over-correct, and go low (and when you give a mouse a cookie…you know the rest). I know exercise should be part of my routine, but I have a nagging fear that I’ll be out jogging and pass out on the side of the road.

Being diabetic means stress. Because diabetes doesn’t play by the rules. Being diabetic during a pandemic like COVID-19 means even more stress. Because the rules seem to be ever-changing, and because I’ve read I’m four times more likely to die if I get it. Four times.

COVID-19 isn’t why I’m angry tonight, but it’s a part of it, because being diabetic (in America) also means needing access to affordable insulin, and supplies.  Access means having a job that offers really good health insurance (i.e. insurance with a high monthly premium), being independently wealthy, being on Medicaid, or living close enough to Canada to drive across the border to buy it there, where it’s affordable.

I have a job that offers really good health insurance, but that’s not the plan I picked. The really good health insurance was too expensive. I picked the high deductible plan, and decided I would get my insulin in Canada.

Niagara Falls photo op.

In February 2020, before COVID-19 hit Upstate NY, where I live, I took a day trip to Niagara Falls, Canada, with my two children, ages 7 and 11, and for $380 American dollars ($503 Canadian), I purchased a 3-month supply of both of my insulins (Tresiba and Humalog pens), and enough pen-needles to last me just as long. No insurance needed. No prescription needed, either. I called ahead and the pharmacist had everything ready for me. I didn’t need test strips because I had saved up quite the supply of those the year before by being a “bad diabetic” and not testing my blood sugar very often. At that time I was also self-employed and fortunate enough to be on Medicaid.

My receipt (prices in Canadian dollars).

I happily paid that $380, because this same pile of life (pictured below) would have cost me close to $1800 in America, with my high deductible health insurance plan. $380 vs. $1800, for the exact same pile. All I had to do was cross the border. I had plans to return to that same pharmacy in Niagara Falls this month, before my supplies ran out – but that was before COVID-19 hit.

A 3-month supply of insulin and pen needles.

Today I realized I only had enough Tresiba, my long-acting insulin, for another two days, at best. With a long weekend ahead, I called my doctor’s after hours number and had the on-call doctor call in a prescription to my local pharmacy, just for the Tresiba. She called in a 3-month supply.  When I pick it up tomorrow, in America, I’ll pay $484.32. In Canada, I paid $102 ($135 Canadian).

A vial of insulin costs between $3 and $6 to make.  In America, the retail price of a vial of insulin is $340. In Canada, it’s $30. You can get a vial of insulin over the counter at Walmart, in America, for $25, or so it’s been “mansplained” or even “womansplained” to me, but this is a dangerous, outdated product.

The pharmaceutical companies charge what they want in America, because they can. They’re playing a dangerous game that is costing diabetics their lives. Pay or die.

In 2019, the overall compensation of David Ricks, CEO of Eli Lilly, was over $21 million

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