It’s a potentially life-threatening condition that requires near-constant management. Such management has been aided by the advent of new insulins, as well as other drugs and technologies. At the same time, doctors and patients have to manage rising prices.
This is the story of two men reaching a turning point in their care. And a caring doctor going to bat for her patients.
Subbulaxmi Trikudanathan, M.D., got into medicine because she wanted to do something meaningful with her life. Her fascination with the endocrine system and her family’s history of diabetes led her to work at the UW Medicine Diabetes Care Center. What she didn’t expect, though, were the roadblocks. Here’s her take on it.
Some of my patients tell me, “I want to ration my insulin because it’s expensive.” It’s alarming, but not surprising. The Journal of the American Medical Association did a study in 2016, and they found that insulin costs more than tripled between 2002 and 2013.
This is a problem. About half the patients in my practice have commercial insurance, and the others are split between Medicare and Medicaid (or state plans). What patients pay out of pocket can vary a great deal, and it’s the kind of situation that hits poor people the hardest. And even when a patient does have an insurance plan, the plans don’t always cover the things we want to prescribe: various kinds of insulin, or aids like insulin pumps and glucose monitors. We hear “no” a fair amount.
When that happens, we’ll often make a special case to the insurer to prove that the patient really needs a medication or a monitor. Or my colleagues and I will call up a drug company — some of them have patient advocacy programs — to see if we can get a better price. We’re also fortunate to have a charity care budget, and sometimes we can get some funds.
All patients should receive good care, irrespective of their social or economic status. What I believe, very strongly, is that the right thing should be done for the patients.
Joel Wheat was diagnosed with type 1 diabetes before he was 10. Wheat is now 30 and a father. And a few years ago, he started to feel like he was drowning.
The first diagnosis: his aunt. I remember that day like it was yesterday. My aunt was watching me and my cousin, and it was extremely hot. I was drinking a tremendous amount of Kool-Aid — drinking and going to the bathroom, drinking and going to the bathroom. My aunt told my dad, and my dad took me straight to the ER.
What it was like. I had great care at Seattle Children’s, but it got too expensive to travel to Seattle every three months, so we found a doctor closer by in Olympia. Then I got a bit older. I still took insulin, but from my late teens to early twenties, I wasn’t seeing a doctor.
Then there was the day… I started visiting this clinic, and when they didn’t know what to do, they pulled a diabetes book out of a bag they kept around. My girlfriend (now my wife) could see this wasn’t working, so she did some research and found UW Medicine. When we met Dr. Trikudanathan and her team for the first time, they broke everything down for us. It was a relief.
The turning point. I started having these low-sugar blackouts. It felt like I was drowning, and I’d fall asleep for an hour — sometimes while I was taking care of my daughter. When I woke up, I couldn’t remember the last two hours. Dr. Trikudanathan thought I should get a continuous glucose monitor because it would warn me if my blood sugar was falling. At first, my insurance company wouldn’t pay for it.
The intervention. My wife crunched the numbers, and Dr. Trikudanathan compiled all my stats and hospital records, and we put in a special appeal to my insurance company. When they called to tell me they’d approved the monitor, I was so happy that I forgot to tell them where to mail it!
Paix Irigon spends every working day with kids. Irigon is a 42-year-old preschool director. Multiple medical challenges — including type 2 diabetes, high blood pressure and allergies — make it necessary to leave the classroom to visit Dr. Trikudanathan every three to six months.
The first diagnosis: his eye doctor. I was at the optometrist’s office about six years ago, and I was thirsty and kept getting up to use the bathroom. The optometrist told me, “You should call someone right now.” So I called the hospital. My sugar levels were super high, and I got my first dose of insulin that day.
What it was like. You start thinking about your mortality, for sure. I’m taking insulin and other medication to lower my A1C (blood glucose). I work out at the gym. I don’t eat as much as I’d like, and I really miss rice, and bread and pasta.
The turning point. I was on a three-month, reduced-cost special for a drug to lower my A1C. After the coupon deal was over, the cost went up to about $680 a month. So I stopped taking it.
The intervention. Dr. Trikudanathan put me on another drug to replace the first one — and the same thing happened. Now we’re on the third drug. Dr. Trikudanathan is wonderful. Some doctors just tell you what to do, but she’ll talk to you about different ways to treat your diabetes.
Final words? I work, my wife works. We’re in a better situation than a lot of people, financially. I know companies have development costs, but I think it’s wrong to jack up the prices like that. You’re talking about people’s lives and their health.
