Living with Diabetes update

So - here we are in Tampico, Tamaulipas Mexico. Not a place you'd want to be, as it turns out! I've already talked about the difficulties of getting hold of Glucagon and given my views on the underlying reasons. Living with Diabetes (Type 1 anyway) in this part of Mexico continues to get more problematic. Especially if, as my spouse, you follow the tight control regime using the 24 hour ultra-slow acting analog insulin, Lantus, once a day and the ultra-fast acting analog insulin, NovoRapid (or NovoLog in the States), before every meal. Very few, if any, Mexican Type 1 Diabetics can be on this regime. Why do I say this? Well, read below.

As most Type Ones on the tight control regime know, trying to keep blood sugar levels within the normal person's range of 70-100 mg/dl means frequent hypoglycemic episodes of varying degrees of intensity. In the US that fragility means high additional costs occasioned by the need for treatment from Emergency Services or from third party administered Glucagon or, at less extreme times, from self or assisted dosing with glucose jelly or tablets. Therefore, the problem for diabetics in the US is not the unavailability of the treatments - it is their cost. And that can be prohibitive if or when the diabetic is not covered by health insurance. The lack of government controls on drug pricing alone appears to mean that everyone involved in selling the vital products is out to make a fortune. Nevertheless the paramedical services, Glucagon and glucose jelly are available. Not so readily so once you step outside of the first world (not just the USA!), where if products are on shop shelves this week, they may well not be ever afterwards.

So: here in Mexico, there is the Glucagon Problem and its attendant costly Paramedical-Hospital visit Dextrose replacement Set Up difficulty. Avoiding the high expenses entailed in all but compulsory use of the hospital following the administration of Dextrose solution by paramedics necessarily means avoiding hypos altogether; and that means keeping the Blood Glucose levels higher than is good over the long term. No tight control regimen here!

Now you see, now you don't! About a month ago, the locally made glucose tablets that we had discovered disappeared from the pharmacy shelves of two US chain grocery stores in town. It took us a while to find them and they were more expensive and lower in carbohydrate values than their US counterparts - but they had existed. For about two months. As we bought them during our weekly shopping trips, we watched the numbers of their boxed bottles dwindle away to None-at-All.

As for glucose (dextrose) jelly - Ha Ha!! You must be Joking! (I mentioned its never presence in third world countries in an earlier post.)

Now we have just (almost, nearly...) hit another Block in Living with Diabetes in Mexico. The sudden disappearance from pharmacies (here in Tampico, at least) of NovoRapid (Novolog)! My spouse has just enough left for about 12 days! We had bought a box of cartridges three weeks ago from the closest branch of Mexico's largest chain pharmacy: Benavides. Now they no longer stock the insulin - not in either its cartridge or disposable pen form. We already knew that one of the US chain stores here did not stock either it or Lantus. So we took a taxi over to the other to see if their pharmacy stocked it. There was none readily available, and the best that could be offered was that the pharmacist would find out if it could be got for us!

Living without glucose tablets or jelly or even Glucagon can be and is edgy. But without the insulin - that, my friends, cannot be done.

But why not go back to using regular fast-acting insulin? Surely that would be available. Maybe, maybe not. However, long past experience tells us that that course is no option at all without ready access to Glucagon and glucose jelly. Before his doctor put him on these two insulins, my spouse had frequent comas, most of which I dealt with by using the Glucagon. For the equally frequent near comas, I used the jelly. We cannot go back to the dangers inherent in using regular fast-acting at mealtimes in a country where we do not have access to these two items. And living with high blood glucose levels is not an option, either.

So we wait until Monday, when we go again to the Texas chain store pharmacy to find out whether or not the insulin will be available to us.

Living with Diabetes in the third world is riddled with uncertainties and the vagaries of market capitalism. Quite probably the pharmacies here see no profit - literally - in stocking an insulin that has a market of only one. Let him use another! Let him eat cake!