Canada should fund advanced diabetes treatment
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NOVEMBER 2022 was Diabetes Awareness Month, and it also marked 101 years since discovery of insulin made survival as a person with Type 1 diabetes possible.
This is also the best time in history to be a person with Type 1 diabetes — but only if you can afford it. Few in Canada can or are covered for costs through public or private plans. I’m one of the lucky ones.
The technology available to help manage Type 1 diabetes is life-changing. I use it every day. Even before I wake up, my blood sugar is being measured while I sleep, and the results are sent to my phone, where software can warn me if my blood sugar is out of range.
But even better than alarms, the software, which is called a closed-loop pump algorithm, can automatically make changes to the amount of insulin I am getting from my insulin pump, to prevent my blood sugars from going out of range.
The best part is I can sleep through the whole process and get up rested and well.
The ability to have this type of technology is made possible by the development of continuous glucose monitors (CGM), which are wearable devices that track your blood sugar every few minutes, day and night. This technology has changed my life, and the lives of countless other people with Type 1 diabetes and their caregivers.
Before CGM, measuring blood sugar involved sticking your fingertips with a sharp piece of metal to draw blood and putting the blood on a strip in a machine called a glucometer. It sucks; fingertips are sensitive, and you have sore fingertips all day, every day.
Not to mention, you tend to only check your blood sugar before and/or after meals, so you are only seeing your blood sugar levels a few times a day.
Managing blood sugars for a person with Type 1 diabetes is a little like steering a big ship — you need to make changes in direction before they need to happen, otherwise you crash into lots of things. Glucometers are like steering the ship with your eyes closed; CGM opens your eyes.
Knowing your blood-sugar level and where it is going is very important, because while insulin is a wonder drug that keeps me alive, it is also incredibly dangerous.
Every time you take insulin, you put yourself at risk of low blood sugar, also known as hypoglycemia, which is a common cause of emergency-room visits for people with Type 1 diabetes. If untreated, it can kill.
CGM use has been shown to be very effective at reducing time with low blood sugar. The flip side of low blood sugar is high blood sugar, which long-term is associated with poor outcomes such as heart attacks and kidney disease.
The use of CGM helps with this as well, increasing the time people with Type 1 diabetes have their blood sugars in a safe range.
Unfortunately, CGM costs between $3,000 and $6,000 a year. Most provincial and territorial health and drug plans do not cover the expense. Among the few that do, there are often age restrictions. For instance, Manitoba has coverage for CGM, but only to those under age 25.
But people with Type 1 diabetes get old, too — so where does that leave them for the rest of their lives?
Many private insurance plans also do not cover CGM. I work full-time as a university professor, and CGM is not covered by our plan. Fortunately, I am lucky enough to be able to afford the out-of-pocket costs.
Without coverage, CGM simply costs too much for most Canadians with Type 1 diabetes.
Right now, the Yukon is the only place in Canada that gets the coverage right. It covers CGM for everyone with Type 1 diabetes, and I bet it will be rewarded for this with fewer emergency room visits, lower long-term costs related to Type 1 diabetes care, and happier, healthier and more productive people with Type 1 diabetes and their families.
The federal government’s long-promised pharmacare plan has so far amounted to words, words and more words, but no action — and no guarantee CGM will be included should it ever materialize.
In the meantime, the other jurisdictions in Canada need to follow Yukon’s lead. If the provinces and territories all worked together, the costs for CGM would come down and everyone in Canada would benefit.
Dylan MacKay, who lives with Type 1 diabetes, is an assistant professor of nutrition and chronic disease in the department of food and human nutritional sciences and the department of internal medicine’s endocrinology section at the University of Manitoba.