Diabetics skimp on lifesaving care in recession

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TRENTON, New Jersey – U.S. diabetics are increasingly risking life and limb by cutting back on – or even going without – doctor visits, insulin, medicines and blood-sugar testing as they lose income and health insurance in the recession, an Associat

TRENTON, New Jersey – U.S. diabetics are increasingly risking life and limb by cutting back on – or even going without – doctor visits, insulin, medicines and blood-sugar testing as they lose income and health insurance in the recession, an Associated Press analysis has found.

Doctors have seen a drop in regular appointments with diabetic patients if they come back at all. Patients more often seek tax-subsidized or charity care. And they end up in emergency rooms more often, patients and physicians said in interviews.

Sales of top-selling drugs and other products used to treat and monitor the disease have dropped since the economic crisis accelerated last fall, the AP analysis found. There are even signs that some patients are choosing less expensive insulin injections over pricier pills to save money.

Meanwhile, the number of people with the disease keeps growing – another 1.6 million Americans were diagnosed in 2007 alone.

People with other health problems also are cutting back on care amid the recession, but diabetics who don’t closely monitor and control the chronic disease risk particularly dire complications: amputations, vision loss, stroke – even death.

Patients’ frugality comes at a tremendous cost to the already-strained health care system. The typical monthly bill to treat diabetes runs $350 to $900 for those without insurance, a price tag that’s risen as newer, more expensive medicines have hit the market. Emergency care and a short hospitalization can easily top $10,000, and long-term complications can cost far more.

M. Eileen Collins, 48, of Indianapolis, tried to scrimp on her medication last fall after her husband lost his job and with it, their insurance. Without money for insulin, test supplies and other medicines, she asked for free samples and also got a few drugs through $4-a-month generic programs. But she stopped taking most of her drugs and cut her insulin doses in half to stretch her budget.

“I truly did not think I was putting my life in danger,” Collins said. “I thought if I was just real careful with what I ate … I’d be all right.”

By late November, Collins was vomiting blood and rushed to a hospital. Doctors diagnosed her as malnourished, anemic and in diabetic ketoacidosis, a life-threatening condition caused by lack of insulin and sky-high blood sugar. She spent a week in the hospital.

Her story is hardly unique.

Dr. Steven Edelman, a University of California, San Diego endocrinologist who runs a free clinic staffed by medical students, has seen a 30 percent surge the past six months in patients seeking free diabetes medicines and supplies, which the clinic has to ration. Many had been solidly middle class, but the recession took their jobs, insurance and even some homes.

“A third to a half of these people haven’t been taking their meds at all,” said Edelman, who also founded the advocacy group Taking Control of Your Diabetes.

Diabetes occurs when the body doesn’t make enough insulin or doesn’t efficiently use the hormone, which helps turn sugar from food into energy. The disease can be kept under control by monitoring blood sugar as well as exercising, improved diet, medications, testing and regular checkups.

Uncontrolled diabetes can cause fatigue, blurry vision, excessive urination, gum problems, infections and wounds that don’t heal. Damage to the kidneys, liver, heart and eyes follow. Often, much of that damage isn’t apparent until a stroke or heart attack strikes.

Sales of diabetes testing supplies and drugs indicate how many Americans have moved beyond scrimping and are cutting vital expenses. Several doctors said they began noticing a shift in August or September when the financial markets melted down and layoffs accelerated.

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Copyright 2009 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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