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Practice makes near perfect at bedtime

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May 28, 2016
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Complicating Factors

Last week, Lindsey railed about that portion of the diabetes community that seems to seek pity for complications that seem to arise from the deliberate neglect of that insulin-sucking monkey on our shoulders. While I agree that deliberate self-mistreatment for its own (or pity's) sake is more indicative of mental illness than anything else, I'm more likely to ask about the reasons why a person might be mistreating himself, or whether the issue is how the person's diabetes behaves despite best treatment efforts.

If one withholds insulin to lose weight, one may have diabulimia — but what if one doesn't have access to the doctors who write the scripts, or has to choose between paying for insulin and paying the rent? I've had colleagues, living with type 1 diabetes, in that position. What if the issue isn't that one has access now, but is about to lose access to a fillable prescription and it's a drug that one must be weaned away from in stages? What if the accessible doctors refuse to write scripts for sufficient insulin or oral drugs to keep the patient's diabetes in check? (We all know how many insurance companies are with test strips!) What if a pump and CGM are needed, but insurance won't cover them — or the co-payments or consumables are unrealistically expensive for that person (again, trading off against rent, gas for the car, food for the family)?

And what about access to mental health care? While it's part of many employer-subsidized medical plans, coverage tends to be sparse, and for many people, there is still a stigma attached to seeking it out. There are also a lot of gray areas (let's face it: we pretty much have to be OCD in order to properly manage diabetes!) between what is nominally "mentally healthy" and what is clinically a mental health matter.

The answers to those questions may shed light on where medical science and our social networks (virtual, real-life, and cultural) are failing us.

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