Diabetes by Some Numbers

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This is where my mind wanders when you leave me on hold for too long.

While I was on hold for the umpteenth time with Minimed (those Continuous Glucose Monitoring sensors? A real pain in the tummy to install), I was struck by one of the features of the newly released Minimed Revel insulin pump that the recorded hold message touted: a one-to-one carb ratio for very insulin-resistant diabetics. The carbohydrate ratio is a setting on the pump that approximates how many units of insulin are required to compensate for a given number of carbohydrates. So, my ratio runs about 18-to-1; for every 18 grams of carbohydrates I eat, I need to take about a unit of insulin to keep my blood sugar at the same level at which I started. A one-to-one ratio implies that for every gram of carbohydrates the user eats, he must bolus one unit of insulin to maintain blood glucose levels.

Now, one unit of insulin is 1/100 of a milliliter, and the little vials of insulin that the pharmacy distributes have 10 milliliters of insulin each, for a total of 1,000 units of insulin per bottle.

Meanwhile, the average American gets about 50% of his daily calories from carbohydrates. So, if our diabetic patient is eating the recommended 2,000 calories a day, and 50% of those are carbs, that’s about 250 grams of carbohydrates per day. At one unit of insulin for each carb, that’s at least one bottle of insulin every four days (and that’s assuming our diabetic is never high and doesn’t require a basal rate of insulin at all).

One bottle of the Humalog or Novalog insulin used in pumps is about $60, assuming it is at least partially covered by insurance. $60 per four days comes out to about  $450 per month and just short of $5,500 per year. Just for insulin! Presumably, if our diabetic is looking at the Minimed Revel for its one-to-one carb ratio, he’s also got to pay for the pump (about $5,000, less whatever portion his insurance covers), plus infusion sets and insulin cartridges, plus test strips and meters, plus copays on doctor visits and lab-work, plus insurance premiums… and to top it all off, with the CGM, I’m going through about one triple-A battery per week.

And I’ve been on hold for over forty minutes twice this week.

No wonder everyone is up in arms about healthcare costs. Having a chronic disease is expensive.

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