It took years of refining my multiple injection techniques for me to get my blood sugars down to the levels achieved in the DCCT study. It was tough, but with monitoring 8-10 times/day I was able to lower my average blood sugars and my hemoglobin A1C tests. During this period I could not get health insurance and had to save money wherever I could. I would reuse my syringes until the markings rubbed off and I would cut my strips in half. (Don’t try this now because today’s meters don’t work with cut strips.) Then for a brief period in 1989 I was part of a group health insurance plan that paid for durable medical equipment. This enabled me to afford purchasing an insulin pump.
The pump has helped me to achieve the best control I have ever had. For me, the pump gives me better control than multiple injection therapy, because it gives me more flexibility. It was always very hard for me to have a consistent schedule from day to day. With the pump I can vary the time and size of my meals, get up early or sleep in and engage in spontaneous exercise. My pump helps me match all of these events with the appropriate amount of insulin. This has made meeting the goals of tight blood sugar control much easier to achieve. But it is still very hard work.
I found Suzanne Strowig’s comment very sobering-“it was tough to maintain the tight goals the (DCCT) study required.” It is tough. (Her interview begins on page 1 of our July issue.) There are also many incredible barriers keeping PWD from taking advantage of the DCCT findings.
Some of the major barriers include: lack of health insurance; lack of trained health professionals; and lack of financial means. I was disappointed that nowhere in the media’s report of the “exciting” DCCT results were these mentioned. Less than 3% of the PWD in this country have a diabetes specialist. There are simply not enough available. PWD simply can not get a health care plan unless they are part of a group policy. Even if a PWD does have health insurance coverage, the out of pocket expenses for intensive therapy are much higher. Where does that leave someone who doesn’t have the doctor, diabetes educator, counselor and dietitian; doesn’t have access to free supplies; and doesn’t have the money? Out of luck.
Other discouraging statistics released last year by the American Diabetes Association included a NIH survey which showed that 28% of type I’s had never tested their blood glucose, and only 38% monitored at least once a day. Type 2 numbers are even worse. For type 2’s using insulin: 40% never monitored, and only 24% monitored at least once a day. For type 2’s not using insulin: 76% never tested and only 5% monitored at least once a day.
Other studies released last year show that 38% of PWD are not getting the basic eye care needed to prevent blindness, and 25% of type I’s have some type of eating disorder that makes it impossible for them to maintain proper diabetes care.
I see that a few privileged people (1,400 in the DCCT) received Cadillac treatment: intensive training, free supplies, and unlimited professional support to achieve some great results, but we have a lot of work ahead to bring this kind of care to the masses. I personally plan to assist Diabetes Health in working toward making this a reality.