A Lifetime of Learning: Sandy's story of diabetes management
Date: 1/16/2014
Living with the ups and downs of diabetes

Diabetes is no stranger to Sandy of Hamilton. Diagnosed at the age of five with type 1, Sandy has spent a lifetime living with the disease. Still, sometimes even an expert like Sandy needs a little help. 
An Introduction to Diabetes
Diabetes begins with the pancreas, a small organ located in the abdomen next to the stomach. For such a small organ, the pancreas has some big jobs. One of the functions of the pancreas is to regulate blood sugar. This is called the endocrine function, and it aids in the creation and release of the hormone insulin. 
“Your body has millions of cells which are kept locked. Sugar belongs inside those cells. Insulin is the key that lets in the sugar,” explains Trish Patsaros, APN-C, BC-ADM.
There are two types of diabetes: 
Type 1 - absolute insulin deficiency; the pancreas does not produce insulin
Type 2 - the body is either not making enough insulin, or the insulin produced is not working efficiently
Although diabetes is manageable, it can be a daunting to do so. It requires a constant, life-long commitment. 
The Cost of Diabetes
Managing diabetes has been a part of life the past 45 years for Sandy. 
“I’m what they call a ‘brittle’ diabetic, which means my sugars will drop or go up very quickly,” she explains.
Like many diabetics who have had to deal with the ups and downs of the disease, Sandy came to rely on an insulin pump to help regulate her blood sugar levels.
“The pump is great because it gives me insulin constantly. And it will adjust insulin based on the food I’m eating. I just enter my blood sugars and carbohydrates,” she says. 
When she found herself without health insurance, however, Sandy also found herself struggling to pay for the needed supplies to continue using the pump. 
“There is a lot of expense involved with managing diabetes,” explains Trish Patsaros, APN-C, BC-ADM. 
“For example, these patients need to test regularly and one single strip to test blood sugar costs up to $1. For someone like Sandy who needs to test 5, 6, 7 times a day, plus add in the cost of the pump and supplies—it can really add up,” says.
The impact of these expenses can go deeper than financial strain. For a patient who is not properly managing diabetes, the disease can be very dangerous. 
In a study released by the American Diabetes Association, it was found that people with diabetes who do not have health insurance have 55 percent more emergency department visits than those who have insurance. The study also found that patients without insurance have 79 percent fewer physician office visits than those with insurance. 
The risks related to unmanaged diabetes are staggering. In addition to its links to life-threatening health conditions such as heart disease, stroke and sleep apnea, diabetes is:
  • the leading cause of blindness
  • the leading cause of need for dialysis
  • the leading cause of amputation
  • the sixth leading cause of death
A Little Help
Unable to keep up with the expense, Sandy decided to stop using the pump and return to using needles to administer her insulin until she was insured again. This caused her blood sugar levels to become erratic and she was referred for a consult with an educator from the Diabetes Self-Management Program. 
“When I am on the needles it gets really tricky. The educators are very hands on and they are accessible, which is really helpful when you’re between doctor’s appointments and have a question,” says Sandy. 
Although it took time working with the self-management team, Sandy was able to bring her A1C levels down from the high 9s to a 7.8—a vast improvement. However, Sandy was still experiencing highs and lows in her blood sugar due to the brittle nature of her condition. 
“It is very hard to manage a case like Sandy’s with injections,” says Patsaros. “We were looking at having to go to seven injections a day, which is a lot. Fortunately, we were able to get her back on the pump.”
Sandy was able to make a plan to start back on the pump and enroll in a new healthcare plan to help keep the costs at a manageable level. She is working with the educators on the self-management team, each of whom is pump certified, to program her new pump and re-train herself. 
“What the healthcare community knows about diabetes is always changing. Educators like us, we are living and breathing the research so we can help our patients with the latest information,” explains Patsaros. 
“Our goal isn’t just to teach our patients about the pump or needles. Diabetes can be overwhelming. Our educators teach you how to take care of yourself so you can get the most out of your life.”

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