Post cards from the edge of the epidemic
I have to enter a Dx code. On his first visit I coded him as a diabetes screening. On his second I coded him as unspecified glucose intolerance. But now, looking at his log book, I know what I have to do. He’s got two “Hi” readings. The meter isn’t being friendly. Plus three or four in the 400s. I sigh and pull the key board to me and enter 250.00; he’s now officially and for all time a Type-2 diabetic. I extend my hand to him, “welcome to my club.”
The club is growing at an alarming rate. It all came from our school screening that I wrote about a few weeks ago. Now I’m suffering from the fall out, and I’m seeing the same thing again, and again, and again, and again. Kids with complete first phase insulin response failure. They wake up in the morning at 88 BGL. Then they eat. Then they rocket up to 200, 300, 400, 500, or “Hi.”
So how the fuck do I treat this? These are not T-1s, remember. And I can’t use the one drug that would probably help. Byetta.
Byetta would… sorry… does restore first phase insulin response. It would be perfect. It would knock the sugars down, give the pancreas a break, and has no real risk of hypos. But its not approved for under 18. We could give it off-label if any of these kids were rich. But they’re not. This is a very poor part of the world. Most of these parents have a hard time keeping the heat on in the winter, much less pay for God-awful expensive drugs.
To be fair, I gotta say, Amylin has been super about providing Patient Assistance Program drugs to my adults. Thousands of dollars of Byetta has flowed into our clinic via PAP to help those over-18-years-of-age patients of little means.
AvandiaRoulette and Actos are also not options, the kids are too young again. I can use Metforim, but why bother? It doesn’t treat the problem I’m facing.
That leaves me with only one arrow in my quiver: NovoLog. But do I really want to put dozens and dozens of early teens on fast-acting insulin? Many of these kids are immature. The one in my office, although calm at the moment, is medicated for attention deficit disorder. He also plays with matches and starts fires, according to his mother.
He’d kill himself on insulin.
But if I do nothing the diabetes will take decades off his life.