Before Winnipeg pickleball player Brian MacKenzie’s blood sugar drops dangerously low, an alarm goes off on his blood-glucose monitor to let him know.

“It’s lifesaving,” said the active senior with Type 1 diabetes who’s long advocated for the expanded coverage of glucose monitors and insulin pumps for diabetics announced with great fanfare in this year’s provincial budget.

Manitobans with Type 1 diabetes pay close to $10,000 annually out of pocket and people managing Type 2 pay up to $6,702; both are among the highest costs in the country, Diabetes Canada says.

That can adversely affect the ability of some to manage their disease, impacting quality of life and risking short- and long-term health.

Type 1 diabetes is a genetic condition that often shows up early in life, and Type 2 is mainly lifestyle-related and develops over time. Type 1 — sometimes referred to as juvenile diabetes — is an autoimmune disorder in which the pancreas creates little or no insulin.

Those diagnosed with Type 2 create insulin, but their bodies are resistant to its efficient use, leaving excess glucose in the bloodstream that over time can damage body organs and systems. Type 1 is not curable.

Mackenzie said he’s already benefited from the expanded coverage of glucose monitors that, as of Tuesday, allowed him to put the $95 cost of his monitor’s sensors every two weeks toward his Pharmacare deductible. Now he is waiting to see when the government rolls out no-cost insulin pumps.

“It seems they make statements first and don’t follow up immediately,” said the 76-year-old.

Another concern is a loophole that excludes the vast majority of Type 2 diabetics from the expanded blood-glucose monitor coverage, said Trevor Kirczenow, who co-founded the advocacy group Emergency Diabetes Support for Manitobans.

The fine print not included in the budget news releases explains that expanded coverage of monitors applies only to patients with Type 1 or Type 2 diabetes currently on both basal and bolus insulin or using an insulin pump.

“That is not the norm for a majority of Type 2 diabetics,” Oakbank pharmacist Glenn Sanclemente said Friday, adding most Type 2 diabetics are not taking two types of insulin.

That exclusion wasn’t mentioned in government advertising of the budget or by politicians on social media touting expanded coverage for those with either type of diabetes.

Diabetes and Diabetes-Related Out-of-Pocket Costs: 2022

Sanclemente said learning of the limitations was a letdown to the majority of Type 2 diabetics who are ineligible.

“There’s excitement when they hear about it and then disappointment when they’re not eligible,” he said. “A fairer comment from the government would have been, ‘We’re covering Type 1 diabetics and extremely bad cases of Type 2 diabetes where somebody is going to be on two types of insulin.’”

Covering all Type 2 diabetics for the glucose monitoring devices could prevent them from developing “extremely bad cases” and save the health-care system money in the long run, he said.

“If you were aggressively monitoring your sugar levels, you can prevent a lot of problems down the road. We all know the different problems that diabetes can lead to… heart attack, stroke, loss of limbs, blindness, the list goes on,” Sanclemente said.

“The better you control your diabetes and your sugar levels, the less likely you are to develop these conditions as your life goes on.”

The expansion of coverage is positive news but much more is needed, he said.

As for the eligibility for no-cost insulin pumps, information will be available “in the next several days,” a government spokesperson said.

“The province is asking people who may be eligible to wait until the program fully launches and coverage is in place, so they don’t have any out-of-pocket costs that won’t be covered. As more information becomes available, it will be shared directly with health-care providers, specialists, pharmacies and others in the health-care system,” the spokesperson said.

MacKenzie, who filed a human-rights complaint more than a year ago because the province agreed to cover the cost of insulin pumps, but only for those 25 and younger, is waiting for an update.

“Quite frankly, I’m not going to drop my human-rights complaint until I’m satisfied this is going to really and truly happen,” he said. “If it does happen… it’s life-changing.”

Governments need to move fast because the devastating impacts on health and health-care budgets resulting from the chronic illness are growing worse, said Diabetes Canada spokeswoman Joan King.

“The trajectory for diabetes is grim,” King said. “It’s getting worse in terms of prevalence, and in the cost of diabetes in our acute-care system.”

Diabetes cost Manitoba’s health-care system $152 million in 2022 and Diabetes Canada projects that the disease and its complications will cost the province $157 million in 2023 and $198 million by 2032. It estimates that 80 per cent of the cost results from treating diabetes-related complications in acute-care settings.

In 2022, there were 412,000 Manitobans diagnosed with type 1 and 2 diabetes, undiagnosed type 2 diabetes and those with prediabetes. In 2032, that number is expected to hit 496,000.

King is waiting to see a comprehensive diabetes action plan from the Manitoba government with a strong emphasis on prevention.

“We’ve got to start preventing Type 2,” she said. “If we don’t get a handle on that, the epidemic will never end,” she said. “We’ve got to do better with the screening. There are many people living with Type 2 who haven’t been diagnosed, so they’re not being treated and therefore their complications may have already started,” King said by phone from Edmonton.

“If governments want to get a handle on this public-health issue, they need a strategy with measured outcomes, with targets and with accountability to meet these targets so that changes can be made in the whole diabetes spectrum — from prevention to improving health outcomes and lowering costs in the health-care system.”

carol.sanders@freepress.mb.ca