LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, December 26, 2012

A Merry Tandem Christmas

Have you ever noticed how much the Tandem Diabetes logo looks like a Christmas tree? No? Huh. I guess that’s because it really doesn’t look much like a Christmas tree at all. But the blue T under my tree this year is as wonderful to me as that blue Tiffany’s box has been to generations of the fairer sex.

Yep. I’m going back to pumping. I’m leaving the stone tools and bear skins of syringes and vials behind and rejoining the 21st Century with a shiny new Tandem t:slim insulin pump. It’s both an early Christmas present and a late Christmas present for me. Early, because before Christmas I got the call that my dirty-rotten health insurance that I always complain about approved the new pump. (I guess I need to reassess my insurance-anger issues now that they bought me a pump.) And late, because due to the timing of the approval, and the holidays, I won’t actually get the machine until today at the earliest.

Still, the mere knowledge that it was coming made for a happy holiday. I got the call last Thursday and the first thing I did—you know, after all the jumping up and down, whooping, and punching the air—was to call my wife and tell her to chill that bottle of Layer Cake Malbec we’d been saving for a special occasion. We had a reason to celebrate.

The second thing I did was, for the first time, wonder if the “fringies” were right. I just got approved for a new pump on 12-20-12. Maybe the world really will end tomorrow, I thought. Anyway, as you all know, the world is still here. So yay for that.

So I’m sure the question on all your minds was why the Tandem? And why now? I’ll take the second question first. For complicated reasons that would bore even my biggest fan, whoever you might be, now was the time. I could get a pump now, but very likely couldn’t get one later. And, bizarrely, the way my insurance works with durable medical goods vs. pharmacy benefits, it’s actually cheaper for me to be on a pump than to use 12¢ syringes. Yeah. I know. The world didn’t end, but it’s still all fucked up.

You know, at first, I didn’t even want to be on a pump again. I was extremely happy using the Lilly half-unit pen during the day, Levemir with vials and syringes in the morning and night, and tracking and controlling everything on my iPod Touch using the RapidCalc app, with the gem-like, beautiful, and stunningly accurate iBG Star meter plugged into the base. My life was simple and well-integrated. My gear burden was light. I actually had the best A1C I’d had in years. It was the first time I’d walked the ground of the sixes since I can remember.


There’s always a “but” in diabetes. We should start calling it Buttabetes.

But, my health insurance—which as of last week I have mixed feelings for, rather than blind hatred towards—refused to cover the Lilly pen fills. Humalog is off-formulary. Their view was that if I needed half-unit delivery I should use on-formulary Novolog and a half-unit syringe. (The NovoPen Jr. does half unit steps, but only beyond a full unit. The only pen in the States that will deliver 0.5 units of insulin is the Luxura.) And my insurance also refused to pay even one cent towards the iBG Star test strips. The only strip they will pay for is the Accu-Chek Nano.

So I had to abandon the diabetes control system that made me happy and actually worked. I literally could not afford to keep myself alive that way. And—rubbing salt in the wound—I spend every waking hour helping people with their diabetes, which saves the insurance companies gazillions of dollars, and they won’t repay me by helping me keep myself healthy? Not that I’m bitter about it.

Sarcasm alert: I have been the King of Bitter the last few months.

I ended up, at gunpoint (well, insurance-point), back in the past with the stupid little plastic half-unit syringe. And the stupid little Nano meter. And my control went to hell. It’s not that you can’t control your diabetes with simple tools. It’s not that I was intentionally making a mess of my health just to get back at them. It was just that the extra effort of tracking everything, carrying everything, juggling everything, was just too much with my 80 hour work week. I just didn’t have the time to do all that I needed to do to keep myself in prime condition once my time-saving tools were taken away from me.

Thus, my mind returned to pumps. Ironically, it would have been cheaper, in terms of their direct cost, for my insurance to cover my simple system rather than pay for a pump and its ongoing supplies; but the pump is cheaper for me out of pocket than the syringe and vial is. My durable medical goods benefit is much better than my pharmacy benefit. Crazy, but I’ll take it.

And again, now was the time. Things are changing. As we get closer and closer to insurance reform, the pump window gets smaller and smaller for me. I was believed that I had very few months to make the move back to a pump before the pump window closed on me completely. And that meant that I dare not wait for something new and wonderful to be FDA approved, moved into production, and be available to the masses. (That said, worrying that my assessment of this could be wrong did keep me awake a few nights. But I was convinced that I needed to choose from the pumps on the market right now.)

So let’s review the Cast of Characters in the Pump Follies: The Med-T Revel, the Animas Ping, the OmniPod, the Roche Accu-Check Combo, and the Tandem t:slim.

I’m actually a fan of the Revel. When it’s working. Which for me, is not very often. I went through five of them earlier this year during my review of the mySentry system. For some reason that no one at Med-T can fathom, my body or my environment seems to reject that particular pump. Revel was out.

I can’t get excited about the Ping. While I like the look of it, and I like its reputation for toughness, I wore one for about a month or so a few years ago and hated the menu design. I liked the fact that, in theory, you could control the pump from the meter, but it turned out to be such a pain in the ass to do so that it was hardly worth the effort. It’s also insulting that the meter is twice the size of the damn pump. There were other things I must have disliked about it, too, but it’s been so long ago that I can’t recall the details. The Ping just left a bad taste in my mouth. On top of that, I have only one patient on the Ping and he hates it and can’t wait for his warranty to run out so he can get something else. Even though Animas seems most likely to be the first to integrate Dexcom G4 sensors into their pumps, the Ping was out, too.

OmniPods are cool, and as one of their certified trainers, I suppose I should feel more loyalty towards them. They also just got approved for a new, smaller pod. But while my many pod-using patients are happy as clams with their systems, for the several months that I wore the system when it was first available, I was always knocking the frickin’ pods off of my body. OmniPod was out.

I’ve played with the Accu-Chek Combo at several conferences but it seems rather primitive for something “brand new.” It’s underwhelming. It just doesn’t seem to have much to offer.

That left the new Tandem. I like the fact that it’s small—always a plus. On the other hand, I don’t like the fact that it doesn’t have a meter that “talks” to the pump. This means that anytime I’d need to correct my blood sugar, I’d have to move blood sugar numbers from one device to another device. Manually. And at first I freaked out over the fact that it’s rechargeable. A rechargeable insulin pump? What if the batteries run low out in the boonies? What if there’s a blackout? But when I thought more about it, I realized that I’ve been living for years with a rechargeable CGM, cell phone, and more recently, the iPod Touch. If there’s a blackout, I’ll go fire up my Jeep and just plug in and charge up in the driveway.

The first time I played with a t:slim in the flesh was at the Keystone Conference this last summer. That was before I had an iPod and I wasn’t too sure I liked the whole touch-screen thing. I’m kinda old-fashioned. I like buttons. My first impression was that it was an ordinary, if nice, pump with nothing more to offer than a fancy interface.

But I did love the t:slim’s IOB tracking, which is CoZmo style, which is to say it tracks both meal and corrective insulin. I also liked it’s innovative delivery system, and the fact that it used the industry standard luer-lock connection to any brand of infusion set. Boooo, Hisssss to Med-T for making their own proprietary system to corner market share.

And t:slim lacks features I wish it had. But that wish list is really moot, as no one else has what I wish for either. I wish it would let me program basal patterns by day of week and change automatically. I wish the correction factor would get more aggressive as the BGL gets higher. I wish it had a built-in meter for one less thing to carry. I wish it kept track of missed insulin while suspended when I’m in the shower in the morning. Pie in the sky? New ideas? Hardly. All of those and more were part and parcel of the circa 2006 model 1800 Smith’s Deltec CoZmo. May it rest in peace.

So perhaps more from a lack of choice than from actual excitement about the product, the Tandem was the clear winner.

My “choice” made, it turns out the local rep wasn’t sure my health plan had ever approved a Tandem yet. Lucky me. The frickin’ trail blazer. As Christmas closed in on me, rather than visions of sugar plums, it was visions of denials that danced in my head.

Initially I was blasé about the whole notion of being back on a pump. If I get it, I get it, I thought. But once my doc signed the paperwork, I started to get excited about the whole notion of being a “pumper” again. I also gotta say that Melissa Lee’s most excellent review at Sweetly Voiced helped me get excited about the machine itself. Within 24 hours I was a complete wreck and it was going to be the end of the fucking world if my insurance said “no” (again).

But the world didn’t end. The insurance didn’t say no. And today I’ve got one eye on the horizon looking for a Brown delivery truck.

A new year. A bold new adventure. And it starts with one question: do I use my last pump settings or start from scratch?

I haven’t decided yet. But either way, it’s a sweet way to start another year with Buttabetes.

Wednesday, December 19, 2012


It was a pleasant, if cold, night. Pleasant, that is, right up to the very moment Frederick Fleet screamed “Iceberg, right ahead!” From that point on, things really went downhill for the passengers and crew of the RMS Titanic.

Yesterday, in what should have been a snoozer of a Patient Centered Medical Home steering committee meeting, I had an iceberg, right ahead moment.

We were weeding our way through the myriad requirements we must satisfy to apply to be recognized as a Patient Centered Medical Home. Among them are assorted issues dealing with communication among hospitals, specialists, and primary care settings. I won’t bore you with the details but let’s just say there’s a problem with hospitals that’s about to get a whole lot worse.

The root of the problem is that when congress plotted the metaphorical course of healthcare reform from Liverpool to New York, they didn’t take into account the possibility of icebergs. And in the case of healthcare reform, the icebergs are the absolutely chillingly named unintended consequences.

Among many other things, the reform moves health spending from fixing problems to preventing problems. That sounds great, both for money saved and for healthy populations. Well, it sounds great unless you’re in the business of fixing problems. In which case, you now have a problem. The solution for the hospitals (the ultimate fixers) is that—like cosmic black holes—they have begun sucking up and destroying all the medical practices around them. It’s really economics 101. To survive, they need to control a greater degree of the “production line.”

So increasingly, if someone is hospitalized, rather than refer them back to their primary care doc for follow-up, there’s a huge incentive to instead refer the patient to the hospital-owned doctors for follow-up. In fact, why even bother to let the patient’s main doc know they were in the hospital at all? It’s an opportunity to “steal” the patient.

A little while back, before we steamed into these iceberg-infested waters, I noticed the water was getting pretty cold. First, my own insurance was getting a tad… unreasonable. Then I started getting calls from my patients that all kinds of business-as-usual diabetes items were suddenly not being covered. My analysis? The health plans know that the golden goose is in the oven. The free ride is coming to an end. They get 30 million new customers next year, but those fuckers are really sick. Many of these folks are the ones the plans have been denying coverage to for years. These people, God forbid, might actually use their health insurance. The jig is up, and the plans know it.

The next 12 months will be hell for those of us that need anything from our health insurance. And what happens after that? Honestly, God only knows. I even chatted with a health plan actuary recently, and he told me his plan is scared shitless. There are so many variables that they really don’t know if they are gonna make a mint or lose their shirts. It could go either way. So during the one last dying ray of light before the sunset, they gotta make all they can. Right now.

My health insurance, designed for the working poor in my state, goes away in 12 months and 13 days. Poof! It will be gone for all time. My premiums will go up, up, up. My deductible will go up, up, up. My coverage? Well I don’t know yet, but I’m not feeling too optimistic at the moment. Of course, given my coverage woes over this last couple of months, things might actually get better.

Wait a minute. Did I really write that? Huh. I must have drunk more than I thought I did.

So I’m probably just getting paranoid at this point, but a recent article by my D’Mine colleague Mike Hoskins about the possibility of generic test strips bummed me out, rather than cheering me up. If, in the unlikely event this new company survives the barrage of law suits filed against it by behemoth J&J, and actually gets a cheap semi-universal test strip to market, it’s a game changer of epic proportions. And maybe not for the best.

There could be unintended consequences. Iceberg, right ahead.

What if Medicare decides to cover only such third-party generics? On one hand, it would serve the greedy bastards right. On the other hand, bye-bye new meters. Ever. There would be no financial motive for the big players to innovate. In no time we’ll all be back to using four-pound plug-into-the-wall Ames Eyetone meters. Will we also be forced off of pumps, pens, even disposable syringes? Will we be back to one glass syringe and two needles (that you have to sharpen when they get dull) per diabetic?

Iceberg, right ahead, indeed.

Wednesday, December 12, 2012

Just call me Czar

So I got some guff for trashing the IDF’s Global diabetes guidelines the other day. Among other things, I got an email saying, “Well, if you’re so fucking smart, what would you do instead?”

You know what? I don’t know what I’d do to stop the epidemic, but I know how I’d do it. And it doesn’t involve sitting around an air-conditioned boardroom with a bunch of people with alphabet soup behind their names talking about best-case care, and then throwing my hands up in the air when it comes to places with no money, no roads, or no electricity. Pontificating about what’s best in theory is meaningless and pointless. You need to get out into the field to understand the problems at the grass-roots level, and then fix them regionally. Hey, diabetes is not one size fits all. Nor can the fix be one size fits all. There is no big fix when it comes to diabetes. We need to stitch together a quilt of solutions.

That said, I think the effort should be centrally organized, so we can swap resources and ideas. So to that end, I nominate myself as Global Diabetes Czar. But I’m going to need a few things.

Like a small team… and a jet. Well, the loan of a jet, anyway. Something big enough to get me and my crew to sundry parts of the world, but small enough to land at flea-bitten dirt air strips off the beaten path in the Third World. And I need the jet stocked with a generous supply of chilled Malbec wines, insulin, Evan Williams cinnamon whiskey, and a never-ending supply of CAO Eileen’s Dream and Caramelo Joe cigars. In the 4.7 inch long, 30-ring size, please. I think better when I’m smoking or drinking, and do my best thinking when I do both together. And this job is gonna require my best thinking.

What kind of a team do I need? I need a whip-smart epidemiologist who can help me understand local variations of cause and effect. Why does one group of dFolks in a given country do OK, and others do not? I need a cultural anthropologist to help me understand how the locals view health, disease, and medicine. I need an economist who really understands global finance and can work up national and societal cost/benefit ratios of various therapeutic options on the ground, and sort through the complexity of global supply chains. And I need a political scientist, some brainy sort who knows how every government is supposed to work and how each one really works. The King doesn’t have any power? Really? Who knew? The Minister of Agriculture actually runs the show here? Well, let’s go talk to him. And I need a pharmacist, probably a European one. I need someone who can help me understand the multitude of non-FDA drugs I’ve never been exposed to. I think that’s it. To be honest, I don’t need a doctor or an Endo. I understand the disease. It’s the total environment of the patient groups that I need to understand.

All of these people have to have diabetes. Sorry, no sugar-normals allowed. Except for the flight crew for the jet, of course.

That’s it. That’s all I need. Four people, a jet, the booze and cigars. Oh, right. And food and insulin and test strips and stuff for me and my crew. Got any gazillionaires in your rolodex? Hell, someone with a few billion could easily write a check for this project; it really isn’t that expensive. Fund me for five years and I’ll change the face of the epidemic. I bet if we had one quarter’s revenue from Januvia we’d have money left over in the end. Of course, Merck wouldn’t want to fund this. Slowing down the epidemic—
much less halting it or reversing it—would be bad for business.

And I’ll need a few part-timers, too, in addition to my core team. Folks that speak the local languages to interpret when we arrive.

So what would I do with this team and the jet?

I’d go all over the world. To every country. All 196 of them. Even Korea and Iran if they’ll let me land without shooting me down. And I wouldn’t talk to the political leaders, or health ministers, or big shots. I’d talk to the folks in the trenches. The docs in the field. The nurses at the clinics. The community health workers who visit the small villages. Hell, I’ll even talk to the witch doctors if that’s what they’ve got. And I want to talk to pharmacists and patients and families. Teachers, priests, soldiers, bankers, street vendors, prostitutes, and the guy that runs the corner grocery store. Because I want to understand the total environment in each place. The problem isn’t that we don’t understand diabetes. The problem is that we don’t understand diabetics.

How would I talk to these people? I’d be myself, frankly. I’m not going to be the white guy wearing a tribal gown in a sea of black faces. I don’t have time for that kind of nonsense. Political correctness be damned. And that’s what I’d tell everyone I meet. Sorry, I’ll probably make a social buffoon of myself, but I’m the Diabetes Czar, you people have a diabetes problem, and I don’t have time for a tea ceremony. Let’s go somewhere where I can smoke a cigar so I can think, and let’s talk about what’s working and not working around here. Oh, do you happen to have a bottle opener on you?

I’ve found in my travels that most people prefer it when you’re genuine, when you’re yourself—so long as you’re open minded—rather than when you try too hard to dot every cultural “i” and cross every cultural “t.” Well, except maybe in Japan. But hey, this is a disease that’s in many ways an American one (compare global diabetes rates before and after the arrival of McDonalds restaurants), so I think cowboy diplomacy is justifiable.

We need to learn some basic things before we write a prescription. Does education work for a given group of people? Hell, if not, let’s medicate them and move on! Will certain cultural groups not take white pills? Let’s color the pills blue and get on with it! These guys over here don’t trust the white-coats? OK, how do we get the witch doctors on board with metformin? It’s just French Lilac, after all.

Not enough medical folks? Who can we train? Diabetes doesn’t need a doctor. It just needs treatment. Treatment that’s tailored to the patient and takes into account the patient’s total environment. No electricity for insulin? How can we get enough Frio packs to the right places? I don’t think there’s any problem that can’t be solved if we think outside of the box, especially if we take our brains to the site of the problem and look with our eyes, touch with our hands, and listen with our hearts. And to do that, you’ve got to get out in the field. You can’t do this by committee from Brussels.

I think it would take five years. Four years to globetrot the epidemic and see what is being done and not done. To visit places where things are working. Then visit places where things aren’t working. One more year to figure out what will work where, and make it happen. To cut and paste ideas. To create a global solution, but one that’s tailored for each and every place. Each and every patient.

Wednesday, December 05, 2012

Tomorrow is yesterday

So this is what my life has come to. Well, my career anyway. The assignment was so depressing it took me several weeks to get it done. Not only was the research difficult—no one has ever done this before, so I’m on uncharted ground—but I had to deal with alternating waves of depression and rage.

It’s not easy being the Harbinger of Death.

I suppose I should consider it an honor that I was chosen for the task. It shows that the powers-that-be have great faith in my abilities. But still…

It’s not like anyone is ever going to see it, but I felt that the document needed a preamble. A declaration of sorts. That’s not something that you typically include on medical standing orders.

I wrote: With worsening economic conditions and growing numbers of un-insured who do not qualify for assistance—as well as under-insured or financially strained patients who can no longer afford co-pays on frontline meds—a reverse protocol is required for moving diabetes patients off of frontline therapies into older, less effective, but more economical therapies. The Medical Team acknowledges that many of these therapies are both riskier and/or less effective than the preferred medications in our decision trees, but that in the spirit of harm reduction it is necessary to make compromises…

Well… now that I re-read it here, it doesn’t seem as eloquent as I was making it out to be in my head. Thomas Jefferson definitely has me beat hands down.

So, yeah, my assignment was to create a “Poverty Protocol,” a medicine decision tree to move people backwards in time. To figure out how to reverse engineer Lantus back to NPH. Novolog back to “R.” To figure out how to best replace meds that are working, but can’t be afforded anymore, with ones that are generally considered to be in the dust bin of diabetes history.

How big a difference can this make, really? Well, it can absolutely help the pocketbook. Take Levemir for instance. The average retail price if you don’t have insurance is $136 per vial. If you’re a type 2, you could very well need five vials in a month. That’s $680. If you just lost your job and your insurance how can you afford that? Or maybe you still have your job. But your spouse just lost hers and the family budget just took a hit. Or maybe you wake up one day and discover that your health plan has just created a new Tier 4 copay on your insulin that requires you to pay 30% of the retail cost.

Me to the “rescue.” Our clinic can buy vials of NPH for less than $1 per vial. Money. That I can save you. But what will it do to your health? Lord only knows. We won’t know for a few years.

NPH is erratic. It’s short lived. It has a nasty peak. Basically, it’s the angry mule of insulin, and I’m surprised in this world of Lantus and Levemir that it’s even still made at all. But thank God it is. Better angry mule insulin than no insulin at all.

And the problem is not just limited to insulin. Thirty days’ worth of Merck’s best-selling pill Januvia costs $216 dollars. That’s $7.20 per pill. The nasty pancreas-breaking pills called sulfonylureas, that wring the type 2 pancreas out like a sponge to get every drop of insulin possible out of the failing organ, only cost a penny each.

So that was my new Third World toolkit. NPH. R. Mix. And cheap pills I regard as poison—use those damn things for very long and you’ll need the NPH and the R.

Once upon a time there must have been protocols for moving people from NPH to Lantus. You know, back when it was first approved twelve years ago. But that was back before the internet was the fountain of info it is today. I couldn’t find any guidelines at first, and I’d long since thrown mine away. Who needed them? Everyone had already been moved off of NPH. I called Endos and CDEs in my “pack,” but no one could remember what they did back then. Finally, I found an archived prescriber’s newsletter from 2009 that had guidelines for how to upgrade people from that nasty ol’ NPH to Lantus and Levemir. I was able to reverse-engineer those as a starting point.

But there were other considerations. It isn’t as simple as “here’s your new vial, and your new dose is ___.” For one thing, most of our people use pens. No NPH pen. Patient, meet syringe. Syringe, meet patient. No trauma there. And back when we all took NPH we understood the peaks. At least I did after NPH landed me in the ER. Going from an insulin with a peak to one that is peakless, or nearly so, is a breeze. Think about what it will be like for patients who have always had peakless insulin to adapt to an insulin that acts differently two hours after you take it. And differently again in four hours. And differently yet again in six hours. And still differently again in eight hours…

And I had to think not only about what to do for people who were in control and can’t afford their meds, but also about those who are out of control and can’t afford their meds. How do I upgrade their therapy and downgrade their cost at the same time?

My proposed “decision tree” sketch began to look like the organizational chart of the Pentagon.

And I’m in the same leaky boat myself, although I recognize that I have it waaaaaaaay better than most. First, I lost my battle to get my beloved iBG Star covered and have had to stop using it. Then I had to go from using a pen to using syringes for my fast-acting. I was paying for the Humalog out of pocket, but now the price has gone up on me. My health plan won’t cover the Humalog cartridges my half-unit pen requires. Their opinion: Use a half unit syringe and a vial of Novolog. It saves them a few pennies a month. So that is what I had to do. By the way, do you know how hard it is to draw up a half-unit of insulin in a syringe? I had to pick up a syringe magnifier. Then I accidently sprayed insulin into my left eye when trying to clear bubbles from one of those fucking syringes. It wasn’t as painful as you’d think, but it just goes to show the kind of week I’m having.

I get bitter and angry because I’m working 80 hours a week to help people be healthier and I can’t even get the tools I need for my own care. I get angrier still when I think how many millions of dollars I’m saving the health plans via my work, and they fight me over every penny, both for myself and for my patients.

Several weeks ago I was at the 2012 DiabetesMine Innovation Summit at Stanford. There were all these amazing people with great visions of tools that can help us rise above the challenges diabetes places in our way. Patients, clinicians, inventors, investors, and industry were at the table together. Even the FDA was there talking frankly and openly about their desire to advance the safe use of technology.

But the 800 pound gorilla was missing. The health plans left their seats at the table empty. What good will the best gear do if no one can afford it? How do we make them understand that healthy us makes wealthy them? I just don’t understand it. I suppose it comes down to the quick buck. The myopic vision of Wall Street. Live for today with no thought for tomorrow.

There’s a lot of talk about the fiscal cliff in Washington. But I’m more worried about the brick wall. The one we are careening towards at 100 miles per hour. In 1980, we spent $256 billion on health care. In 2010 we spent $2.6 trillion. That’s 17.9% of GDP. How much more can we spend? Are we going to spend half of every dollar in the country on health?

So between my own losing battles, writing the Poverty Protocol, and being charged $9.30 by my bank for not having enough money in my account for them to invest, I’m pretty depressed about where we’re headed as a society. Especially when it comes to where we’re headed when it comes to health “care.”

Sometimes I feel the money men are building themselves fancy new buildings using our tombstones for bricks. And in my darkest moments, I wish a plague of diabetes on their houses. Of course, even if that should happen, they’d be fine. They’d still be getting the Levemir, the Januvia, the pens, and the iBG Stars.

They’d never experience my Poverty Protocol.