In the midst of COVID-19, people with diabetes struggled to get insulin

For Adam Winney, a 26-year-old with Type 1 diabetes, shopping in the early days of a pandemic was a humiliating task. Everything was sold out, except for the one kind of food he could not eat.

“The only things left were carbs, carbs, carbs,” said the Van Nuys resident. “I’ve never been fuller than in March.”

Winney’s disease has depleted his body of insulin, a hormone needed to convert sugar into carbohydrates into energy. Without it, his blood sugar can spike to dangerous levels, and can eventually lead to serious health problems such as cardiovascular disease, nerve damage and kidney failure.

But the insulin pens he trusts to keep his body in balance cost him around $ 1000 a month because his health insurance does not cover the medication. After the outbreak of coronavirus cost him his job as a receptionist at a hair salon, that benefit was beyond his reach. He went six weeks without the long-acting insulin he normally takes every day.

“I fight every morning against nausea,” he said, a sign that his body was susceptible to diabetic ketoacidosis, a state of dangerously high blood sugar levels that had landed him earlier in the hospital. “Your body just falls apart.”

COVID-19 presents a unique set of challenges for the nearly 34 million Americans like Winney who live with diabetes.

The Centers for Disease Control and Prevention says people with Type 1 diabetes are more likely to be at risk for a severe case of COVID-19. Those with Type 2 diabetes – the more severe form that begins when people lose their sensitivity to insulin – certainly have an increased risk of severe COVID-19, according to the CDC.

For example, a study of more than 7,300 COVID-19 patients in China found that those with Type 2 diabetes needed more medical care and were nearly 50% more likely to die than patients without diabetes. The risk of death was particularly high for people who had trouble controlling their blood sugar, researchers reported. Another study of more than 1,200 COVID-19 patients in the US found that the mortality rate for those with diabetes as high blood sugar was 29%, compared to 6% for those without diabetes.

“The extent to which you manage your diabetes is a risk factor,” said Dr. Daniel Drucker, a senior scientist at the Lunenfeld-Tanenbaum Research Institute at the University of Toronto. “There’s a lot you can do about it, by making sure your diabetes is optimally controlled.”

Insulin is essential to monitor blood sugar, but the expensive medicine is harder to obtain as a job disappears, along with the health insurance that comes with it.

The cost of insulin varies from patient to patient. It depends on the type of insulin they need – some take effect within 15 minutes; others last more than a day – like the dose. Some insurance plans cover more of the tab than others.

The financial strain fueling the pandemic has forced Royce Jonathan Miller of Yuba City to consider rationing the insulin he takes for Type 1 diabetes. He kept his job as an optician at Walmart, but since his father-in-law lost his job at a maintenance company that closed operations due to the pandemic, Miller has become the sole provider for the four people in his household.

Brandi DaVeiga programs the insulin pump that helps her control her Type 1 diabetes.

(Christina House / Los Angeles Times)

Miller has an insulin pump, which uses a tube to infuse a small amount of insulin under the skin so that it can be absorbed into the bloodstream. He needs to change the pieces that connect to his body every three days. Lately he has been asking himself whether this is absolutely necessary.

“I started thinking, ‘I can clean this up every two days, and hopefully it will not get infected,'” Miller said. “But I realize that if I make myself sick and get up in the hospital, that will be a bigger burden.”

A nationwide survey among 5,000 people with diabetes conducted for the American Diabetes Assn. found that one in four has rationed deliveries to cut the cost of their diabetes care since the start of the pandemic.

“Now is not the time to help these individuals manage their illness, as it may in fact be helpful to prevent them from getting serious COVID-19,” Drucker said.

People with type 2 diabetes may have even greater difficulty in giving their insulin, said Dr. Francisco Prieto, a family physician in Sacramento.

“Not everyone who has Type 2 has to take insulin,” Prieto said. “Those who do so are typically people who have had the most serious cases of diabetes or have failed all previous oral and injected treatments.” That means they may have to take even more insulin on a daily basis than Type 1 patients, he said.

Since 2019, 11 states have set limits on the amount that insurance companies can set as co-payments for insulin. Each of those states has introduced price cards, ranging from $ 25 to $ 100 per month since the outbreak of coronavirus in March.

California may soon join the list. In February, Assemblyman Adrin Nazarian (D-North Hollywood) introduced a bill that would pay insulin co-payments at $ 50 for a 30-day offer, or $ 100 per month. It went through in June with a vote of 64-4-11, but the House Health Committee has no hearing plans that could advance the bill.

Winney said a price cap would give him some rest. These days, he relies on free samples provided by one of his doctors, but that generosity cannot last.

“I see that as an incentive to finally change the insurance,” he said.

Brandi DaVeiga, who has Type 1 diabetes, lives in Lakewood.

(Christina House / Los Angeles Times)

Ensuring an affordable supply of insulin would help people with diabetes to better manage their illness, said Brandi DaVeiga, a mother living in Lakewood with Type 1 diabetes. She now has good coverage through her husband’s health insurance plan, but when she was between plans three years ago, she started skipping insulin doses to make her supply last longer. On several occasions, her blood sugar rose dangerously high, and she ended up in the emergency room.

“It’s really stressful,” she said of managing diabetes during a pandemic. “And that does not help your blood sugar.”

The fact that people with diabetes shave their insulin when they need it points to bigger problems with access to health care in this country, Drucker said.

“COVID-19 reminds us of the importance of doing everything we can in our vulnerable populations, at risk,” he said. “Let’s do everything possible to optimize their health, because that in turn may reduce the risk of having a bad outcome with this virus.”