Financial Struggles of Living with Type 2 Diabetes
As we all know, it's difficult to live with diabetes.
It's hard enough when we have enough financial resources. A wealthy person diagnosed with type 2 can join a health club, buy exercise equipment to use at home, get expensive running shoes, buy books and get on the Internet for information, buy healthy fish, lean meats, and low-carb vegetables, and pay for any prescribed medications that are not covered by insurance.
Now try to imagine attempting to control your type 2 diabetes when you were living on the edge, barely making enough money to get to the next pay period, in a neighborhood that offered no fresh fruits or vegetables, only snack foods, canned foods, and fast foods.
Then imagine you were living in a small apartment and taking care of your mother, who had dementia, plus two children, one of whom was autistic. Your children's biggest problem was getting to school each day without being beaten up. You couldn't chaperone them because you couldn't leave your mother alone.
In an atmosphere like this, it's likely that the difference between a blood glucose (BG) reading of 120 and 300 wouldn't seem very important to you.
Johns Hopkins researchers recently tried to tackle some of these problems to see if they could get low-income, poorly educated people with type 2 diabetes to significantly improve their long-term BG control. They said that in the past, any diabetes education programs may show short-term results, but as soon as the program ends and the patients lose the program's support, they tend to revert to their former behaviors.
This program, published in the Journal of Internal Medicine, started by providing standard diabetes education, using materials designed to be at a fifth-grade reading level. But then instead of just telling the participants what to do, it tried to find out why the participants were not already making lifestyle changes.
Some reasons included the following:
1. They didn't have access to healthy foods near their homes.
2. It was too expensive to eat healthy food.
3. They didn't take their medications because they couldn't afford them.
4. They had family challenges, caretaking demands, and neighborhood violence that affected their ability to properly care for their own needs.
Instead of throwing up their hands and deciding it was impossible, the researchers decided to teach the participants problem-solving skills. Some learned to differentiate between "must have" foods and "wants." And some realized they could move their medications into the "must have" category, to be taken care of before some of the "wants" that had previously taken precedence.
Two participants, on their own, convinced the neighborhood grocery store to carry low-salt versions of canned vegetables. Still not fresh, but better than salty.
We need programs that will address these very real challenges facing low-income people with type 2 diabetes, who are in a real bind. Because of lack of funds, they often buy the cheapest food, which is starchy and fatty. Then they gain weight and are diagnosed with diabetes. Healthy food is now even more important than ever, but they still can't afford it.
We need programs to try to get fresh vegetables into poor neighborhoods. Many farmers markets focus on organic produce, which is nice for those who can afford it. But nonorganic fresh spinach is healthier than canned spinach and overripe bananas, which tends to be the choice today. So asking the farmers who sell at farmers markets in wealthier areas to serve the poorer neighborhoods might not be the best solution.
Just getting a chain grocery to set up in a low-income area might work better, with some kind of temporarily subsidized security system to make locating there more appealing. They could start small, focusing on the fresh produce that wasn't already available, and then enlarge if the demand was there.
Something has to be done. Otherwise lost eyesight, amputations, and dialysis will cost a lot more than programs to get the healthy foods to where they're needed.