I have been a doctor for 30 years. To this day, I learned more about the treatment of diabetic ketoacidosis (DKA) from the nurses on the DKA unit at Grady Hospital in Atlanta during my years as a medical student than from anyone else. Diabetic ketoacidosis, once a leading cause of death for type 1 patients, is now is so very treatable in the right hands and with the correct amounts of insulin and fluids.
I remember vividly a patient in the emergency room telling me that the nurses on the 7th floor of Grady knew more about diabetes than any doctor in the hospital, and the patient was correct. These nurses were trained and knew type 1 diabetes inside and out. They checked glucose levels every hour. They didn’t need ketone levels to know if a patient was making excessive ketones, they could smell it from the breath of their patients.
The way the nurses who stood vigil at the bedside of these patients with type 1 diabetes, and learned the subtleties of diabetes that the doctors overlooked, was fascinating to me. The precision of the team in the diabetes observation unit at Grady Hospital was exquisite—in a time long before home glucose monitors, insulin pumps and sensors.
I was so proud of myself back in 1996, when I met with Congresswoman Elisabeth Furse and Congressmen Newt Gingrich and George Nethercutt to convince them that the US needed a Congressional Diabetes Caucus. They agreed (two of the three have children with type 1 diabetes). Now the Diabetes Congressional Caucus has more members (both Democrats and Republicans) than any Caucus in the House and Senate.
The newly formed Diabetes Congressional Caucus, even asked me what I thought was needed next, and I helped craft the legislation for Medicare to fund glucose meters and insulin pumps to patients. This required meetings with the Congressional Budget Office and for me to testify before Congress and be grilled by Subcommittee on Health of the US House of Representatives on April 22, 1997. The bill passed and private insurers then took Medicare’s lead to reimburse for glucose meters, strips and insulin pumps, which had been limited prior to the Medicare legislation.
This is 2015 and there has actually been a rise by 40% in the number of patients hospitalized for DKA over the past decade.
Why hasn’t having glucose meters helped? Patients are in DKA, not because of an infection, as typically seen, but because patients have been unable to afford their insulin. Patients are coming in and telling me they are in the “donut” hole with their insurance and begging me for samples of insulin. Was my memory eluding me. Did patients come in with DKA decades ago because they couldn’t afford their insulin?
I just called the local pharmacy and asked how much a vial of glargine and lispro insulin would cost if I had no insurance. The answer was $310 for the glargine (Lantus) and $243 for the lispro (Humalog) with the pen insulins being more expensive.
I am thrilled that new legislation has been enacted to so that patients with pre-existing conditions, like diabetes, are no longer denied health insurance. This was a critical issue for so many of my patients. Despite new opportunities to get affordable health insurance, many of these new plans limit reimbursement for costly medicines like insulin. What would happen to patients who couldn’t get insulin samples from my office who are hospitalized for DKA?
We live in a complicated healthcare environment. I dream of a world without diabetes…it will make the healthcare system a little easier. We at Perle are doing everything possible to see this dream become a reality.