Like millions of Americans, I start each day with an injection of insulin, and another oral medication that helps control my blood sugar levels. Throughout the day, I balance what I eat for breakfast, lunch, dinner and snacks to ensure those levels don’t rise or fall too much. It’s an inexact process, and I don’t always make it work. I’ve been doing this for 24 years.
Diabetes is a constant presence, demanding hour by hour that I pay attention to the signals for hyperglycemia (extreme high blood sugar) and hypoglycemia (extreme low blood sugar). Both have serious consequences for my long-term health. In the moment, an imbalance can cause dizziness, confusion, headaches and other immediate problems.
Like 95% of diabetics, I have Type 2, so my body is resistant to naturally produced insulin, leaving excess sugar (glucose) in the bloodstream that, over time, can cause damage to the organs. Type 1, also known as juvenile diabetes, is an autoimmune disorder in which the pancreas creates little or no insulin. 
Whether it’s Type 1 or 2, diabetes degrades the quality of life in insidious ways. The alarming growth in Type 2 has been attributed to poor diet, overall diminished physical activity, and cultural factors. It is the costliest chronic condition in the United States. The American Diabetes Association estimates that $1 out of every $4 in U.S. health care costs, or $237 billion, is spent on direct medical costs caring for people with diabetes.  Another $90 billion in costs results from reduced productivity.
For me and the other 37 million Americans who live with diabetes – more than 10% of the population–new drugs, devices, monitors and food options ease the trouble of living with diabetes. In recent years, endocrine researchers have made important discoveries. For seniors, the new $35 monthly cap on insulin for Medicare recipients provides welcome financial relief and will result in better medication compliance.
So much more needs to be done. As a member of the ADA Community Leadership Board, I support more federal funding for research and education, and interventions by state and local public health departments in low-income and racial and ethnic communities that have a higher prevalence of diabetes. I encourage foundations, private employers and individuals to contribute to diabetes organizations to help in finding a cure, while alleviating the toll this insidious disease takes on our friends, families and neighbors.
Individuals with diabetes living in low-income communities face unique challenges related to the food environment (food deserts with few opportunities to obtain healthy groceries, or food swamps with plenty of access to fast-food restaurants). Problems with accessing health care and medications create barriers to achieving optimal diabetes control and preventing complications.
Over the years, I’ve had friends and relatives with diabetes who struggle getting through each day. Far too many have died early from related conditions. My grandfather and father both died from diabetes-related heart disease. A college friend with Type 1 died before she turned 30. I’ve visited many people in hospitals who’ve had severe complications from kidney disease, vision problems, peripheral neuropathy. Not long ago, my friend Rob and I were scheduled to have lunch, but he passed away before we could get together.
At the state level, policymakers should remain attuned to opportunities to support access to affordable care and health insurance.  And supporting healthy lifestyles is a critical way to prevent Type 2 diabetes. We must continue to seek out opportunities to improve our food environment and provide opportunities for physical activity.  Every New England state ‒ except Massachusetts ‒ has passed insulin copay caps to help improve affordability. I hope this can be addressed in 2023.
First diagnosed 24 years ago, I’m a third-generation Type 2 diabetic. I have good health insurance, accessible doctors, work hard, exercise regularly and live comfortably. I’m not overweight and eat a fairly healthy diet.
When I was diagnosed, the doctor told me to exercise more and eat healthier foods. That’s sound advice for anyone, under any circumstances.  Still, the disease occupies my mind and body, every day.
Each diabetic, all 37 million of us, has a story about how this disease affects them and their families. We need to listen to their stories, and invest in solutions that bring to an end this costly health problem.
Jim McManus, a Worcester native, is a member of the New England Community Leadership Board of the American Diabetes Association. He is principal partner of Slowey McManus Communications, with offices in Worcester and Boston.


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