Diabetes in Nova Scotia: Op-Ed

I was recently diagnosed with type 1 diabetes (T1D) at the age of 24. It wasn’t a disease that I knew much about, but it is one that is now going to change my life. T1D is an autoimmune condition where my body’s immune system mistakenly destroys insulin-producing cells in my pancreas. The hormone insulin allows my body to use sugar (glucose) from carbohydrates in the food I eat. Without this function naturally occurring in my body, I cannot properly regulate blood glucose levels. This can lead to me suffering from hypoglycemic or hyperglycemic events that can lead to life threatening complications.

Managing T1D is a 24/7 job without any breaks. I require multiple injections of insulin each day to survive. And it’s not just one type of insulin. I have long-acting insulin which is meant to mimic the body’s natural insulin production, and short-acting insulin which is administered when I eat to correct high blood sugar levels. This means I also need to count the carbs I eat to ensure I can accurately measure how much insulin I need at mealtimes.

Some people are fortunate to be on an insulin pump, which is a small, computerized device often worn on a belt or in a pocket that is attached to the body through a small needle inserted into the skin. The pump delivers a continuous low (basal) dose of insulin. And when a person eats, they push a button on the pump to deliver an extra amount of insulin called a bolus to provide insulin for their food.

But it doesn’t stop there. I also need to check my blood-sugar levels throughout the day with several fingerpicks. However, there are advanced glucose monitors that do this automatically for you. A flash glucose monitor (Flash GM) is a small sensor worn under your skin, which measures your blood glucose levels continuously throughout the day and night. You find out your levels by scanning the sensor whenever you want to.

Similarly, a continuous glucose monitor (CGM) is a sensor just under the skin that measures the tissue-glucose levels in real time. The levels are then relayed to a receiver, smartphone or insulin pump which displays the readings. This also means if my blood sugars go too high or too low when I’m sleeping, an alarm will go off alerting me, or anyone else who received my readings. This means I can sleep throughout the night without worrying that I’ll suffer from my blood sugars going way out of range.

All these devices allow greater flexibility with meals, exercise and daily schedule; improved physical and psychological well-being; smoother control of blood-glucose levels and they enable virtual care, allowing my healthcare providers to see what is happening inside my body without me needing to physically be in an office.

While these devices are life-changing, they also come at a high cost without private or public coverage. That’s why I was anxiously awaiting the 2023 budget out of Nova Scotia, hoping to see T1D devices finally covered – but they weren’t. Disappointment does not come close to how I’m feeling. Without public coverage of these devices, I cannot access them.

Nova Scotia is now falling behind all other Atlantic provinces in this area, failing all Nova Scotians living with T1D. New Brunswick recently announced expanded coverage of devices by removing the existing age cap on the insulin pump program and adding CGMs to coverage. Newfoundland is now piloting a CGM project examining effectiveness and outcomes of this device. Last year, Prince Edward Island announced expanded coverage of Flash GMs and CGMs, now offering the most comprehensive coverage of devices in the Atlantic region and most of Canada.

The most frustrating part is we know that these devices are both cost effective and improve health outcomes. Last year, JDRF Canada commissioned a study to examine glucose monitoring systems, comparing Flash GM, CGM and self-monitoring of blood glucose (finger pricks). Not surprisingly, it noted that use of these devices leads to fewer complications, reduces long-term costs associated with hospitalization, leads to improved mortality rates AND are cost effective when looking at acceptable thresholds.

There was absolutely nothing that I did to become diabetic, but now have no choice but to do my best to survive every day with it. By providing increased public access and coverage for essential medical devices like Flash GMs/CGMs and insulin pumps, it would allow for people with diabetes, like myself, to thrive and manage this lifelong disease day to day with ease, rather than to go through each day without them.

Emma Perry

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