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What happens when patients with diabetes do not have insurance?

May 26, 2015

According to recent polls, almost 43 million Americans are uninsured. I would like to know how many of those individuals have diabetes.

Today, I saw a patient who came in for a three month follow-up to review his labs and medications. I was surprised to see he was on metformin with a creatinine of 2.6 mg/dl; typically patients with a creatinine of > 1.5 mg/dl are not candidates for metformin.

I asked him why he was waiting so long between appointments and he informed me he did not have insurance. Holding back tears, he said he needed to choose between his mortgage or health insurance and the mortgage payment was priority. He also had lost his vision in his right eye due to a detached retina and was no longer seeing the retina specialist. He was driving with impaired vision and his wife admitted that he had almost crashed numerous times on his way to work.

Additionally, he told me was on metformin because it was the least expensive diabetes medication he could afford. Luckily, I have a friend who is a social worker. I am hoping he will be able to find resources for medical attention and possibly help him apply for temporary disability to allow him to physically and mentally heal.

However, I realized my actions were only temporary and wondered what would happen with his follow-up care. Often, we are able to provide patients with free samples or generic prescriptions, but it is difficult for many to continue the ongoing chronic care management needed.

Diabetes educators can be great individuals for helping patients learn to navigate the health care maze, and we often encounter the heart breaking stories of struggles no amount of education or medicine can cure.

I wanted to take this opportunity to you to share a story of one patient or event that made you realize how important your job as a diabetes educator was. Please share!


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  1. Dec 03, 2010

    Sometimes larger health care facilities also have 'discount' programs for uninsured or poorly insured. Check in to large hospitals or local pharmacies to see if there are resources locally available to your patients.
  2. Nov 16, 2010

    Look into city health centers and Nurse Practitioner run clinics. They offer free diabetes supplies -unfortunately the older insulins ,but its better than nothing they will also receive care at that site. Many times as an inpatient CDE I refer to these health centers when a patient has no health insurance. When I am in the outpatient setting and a patient looses their health insurance I refer them to a health center. its fine once in awhile to use samples but in the end you enable that patient to keep getting supplies. Instead empower them to go to a health center and get care. This is all part of the process in educating about self management A diabetes educator is only one of our roles- Be open to all the hats you will wear as you gain knowledge and experience in this field.

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