WEBVTT - The Future of Diabetes Part One 0:00:00.160 --> 0:00:07.280 Brought to you by Toyota Let's go Places. Welcome to 0:00:07.440 --> 0:00:15.040 Forward Thinking. He there and welcomed up Forward Thinking, the 0:00:15.040 --> 0:00:17.400 podcast that looks at the future and says, I like 0:00:17.480 --> 0:00:19.759 to play the drums. I think I'm getting good, but 0:00:19.840 --> 0:00:23.239 I can handle criticism. I'm Jonathan Strickling, I'm Lauren Volga, 0:00:23.680 --> 0:00:25.919 and I'm Joe McCormick in. Today is going to be 0:00:25.960 --> 0:00:29.200 the first part of a two part series we're doing 0:00:29.360 --> 0:00:33.200 about the future of diabetes and diabetes treatment. And Lauren, 0:00:33.280 --> 0:00:35.800 this is a topic you have been hankering to do 0:00:35.920 --> 0:00:38.760 for a while. I've I've been suggesting it for kind 0:00:38.800 --> 0:00:42.360 of ever because I keep I keep running into all 0:00:42.400 --> 0:00:46.440 of these new research articles about amazing things that have 0:00:46.560 --> 0:00:51.440 been done in the in the treatment and diagnosis of diabetes, 0:00:51.560 --> 0:00:54.240 and and it's a really big issue. I mean, this 0:00:54.320 --> 0:00:57.120 isn't a thing that, like, you know, seven people are 0:00:57.160 --> 0:00:59.040 are dealing with. This is this is a little bit 0:00:59.120 --> 0:01:00.880 larger than that. Not not at things that only seven 0:01:00.880 --> 0:01:03.200 people are dealing with are not worth looking into me 0:01:03.320 --> 0:01:05.600 for those seven people, it could be it could be huge, 0:01:05.600 --> 0:01:08.200 But no, that is exactly the point that why we 0:01:08.240 --> 0:01:12.080 wanted to tackle this. Diabetes is something that affects millions 0:01:12.080 --> 0:01:16.200 of people, It's going to affect millions more in the future. Obviously, 0:01:16.640 --> 0:01:18.480 It's one of those topics that we should look at 0:01:18.560 --> 0:01:21.720 and say, what's the forward thinking approach to dealing with 0:01:21.880 --> 0:01:29.280 managing uh, diagnosing, perhaps in some distant future, curing diabetes. Yeah, 0:01:29.360 --> 0:01:32.920 I would say with diabetes, it's not exactly like all 0:01:32.959 --> 0:01:35.840 other diseases, not not just because it affects so many, 0:01:35.920 --> 0:01:37.880 but because it is one where I would say, at 0:01:37.920 --> 0:01:40.520 least from from where i'm you know, I'm no expert, 0:01:40.600 --> 0:01:42.920 but just in what I read the end does sort 0:01:42.959 --> 0:01:46.160 of seem to be in sight with diabetes more so 0:01:46.240 --> 0:01:49.760 than with many other chronic diseases. At the very least, 0:01:49.800 --> 0:01:55.200 the facility with which we can manage diabetes today has 0:01:55.360 --> 0:02:00.320 has increased exponentially over the last several decades. And there's 0:02:00.400 --> 0:02:04.640 just a lot of research progress. Yes, their entire organizations 0:02:04.680 --> 0:02:08.520 that have been UH in in existence for since like 0:02:08.560 --> 0:02:11.880 the nineteen forties, that have been dedicated to researching and 0:02:12.320 --> 0:02:16.600 treating and diagnosing diabetes. So ah, yeah, and before we 0:02:16.639 --> 0:02:19.600 got into this research, I didn't realize how long ago 0:02:19.800 --> 0:02:23.320 people knew about this. Wow. Yeah, we've got a timeline 0:02:23.360 --> 0:02:26.600 to go through. Yeah, I went a little crazy, y'all 0:02:27.000 --> 0:02:29.799 when I was researching the history of diabetes and our 0:02:30.000 --> 0:02:32.840 understanding of it, and uh, we should all know better 0:02:32.840 --> 0:02:35.280 than to put a history section in there. I kept 0:02:35.320 --> 0:02:38.359 thinking I should skip some stuff, but I kept finding 0:02:38.400 --> 0:02:40.679 things that were so fascinating. But first, let's let's talk 0:02:40.680 --> 0:02:44.880 about some numbers about why this is such a big deal. Yeah. Yeah, 0:02:44.880 --> 0:02:47.160 because he said millions of people. So I mean, so, 0:02:47.160 --> 0:02:49.880 so what's what's what's millions of people? We've got like 0:02:49.880 --> 0:02:53.000 like trillions of people on the planet. Not quite trillions yet, 0:02:53.000 --> 0:02:56.680 but sometimes it feels that way when you're on a 0:02:56.720 --> 0:03:01.760 crowded Marta train. But according to Center for Disease Control 0:03:01.880 --> 0:03:05.880 report in UH two thousand fourteen, there are twenty nine 0:03:05.919 --> 0:03:09.320 point one million people in the United States who have diabetes, 0:03:09.400 --> 0:03:13.000 and eight point one million of those people are undiagnosed. 0:03:13.360 --> 0:03:16.359 So there's only like three hundred and something million people 0:03:16.520 --> 0:03:20.560 in the United States. That's like significant percentage, nine point 0:03:20.600 --> 0:03:23.400 three percent of the population in two thousand fourteen, so 0:03:23.600 --> 0:03:27.960 not almost ten percent of the population having diabetes, and 0:03:28.120 --> 0:03:30.800 out of that group, twenty seven point eight percent of 0:03:30.840 --> 0:03:34.720 them don't have it as a diagnosed condition. They may 0:03:34.760 --> 0:03:37.720 be aware that something is wrong, especially if they're suffering 0:03:37.960 --> 0:03:41.280 some of the more severe symptoms of diabetes, but they 0:03:41.320 --> 0:03:45.720 haven't been formally diagnosed with the disease. Um percentage wise, 0:03:45.760 --> 0:03:48.360 the group that has the highest incidents rate of diabetes 0:03:48.520 --> 0:03:52.080 is the sixty five and older group. That's twenty five 0:03:52.120 --> 0:03:54.600 point nine percent of the population, more than a quarter 0:03:55.360 --> 0:03:57.240 of all people over the age of sixty five the 0:03:57.320 --> 0:04:02.240 United States have diabetes. As with many diseases, this is 0:04:02.280 --> 0:04:06.400 a disease where risk factor tends to increase with age. Yes, yes, 0:04:06.520 --> 0:04:10.440 and then uh, the actual largest as far as sheer 0:04:10.520 --> 0:04:13.839 numbers go, Like the largest number of people that would 0:04:13.840 --> 0:04:16.000 be in the forty five to sixty four year old 0:04:16.360 --> 0:04:20.240 age range with the thirteen point four million diabetics, but 0:04:20.279 --> 0:04:23.000 that only accounts for sixteen point two percent of people 0:04:23.080 --> 0:04:26.400 in that age range, So percentage wise it's fewer, but 0:04:26.560 --> 0:04:30.960 in sheer numbers it's the largest population. So uh, one 0:04:30.960 --> 0:04:32.760 of those fun things that you start to think about 0:04:32.760 --> 0:04:37.279 when you start, you know, grouping people into percentages. Uh. 0:04:37.520 --> 0:04:40.080 More men than women are diabetic in the United States. 0:04:40.120 --> 0:04:42.960 They're fifteen and a half million men with diabetes versus 0:04:42.960 --> 0:04:47.479 thirteen point four million women, and that same CDC report 0:04:47.960 --> 0:04:50.760 estimated that the total cost of diabetes in the United 0:04:50.800 --> 0:04:55.080 States in two thousand twelve was two hundred forty five 0:04:55.520 --> 0:04:59.479 billion with a B dollars two d forty five almost 0:04:59.520 --> 0:05:03.400 two hundred fifty billion dollars. Uh. So that includes both 0:05:03.800 --> 0:05:07.120 direct and indirect costs. So if you look at just 0:05:07.240 --> 0:05:10.359 the direct costs of diabetes, this being the diagnosis and 0:05:10.400 --> 0:05:15.239 treatment and management of the disease, that's seventy six billion. 0:05:15.400 --> 0:05:19.359 So still I mean enormous number uh, indirect costs in 0:05:19.400 --> 0:05:22.080 case you're wondering, well, what what the heck is that entail? 0:05:22.440 --> 0:05:26.120 According to the CDC, they were lumping in things like disability, 0:05:26.720 --> 0:05:29.000 loss of productivity due to the fact that people are 0:05:29.080 --> 0:05:35.960 missing work uh, and premature death as contributors to indirect costs. Globally, 0:05:36.120 --> 0:05:39.320 it's been estimated that about twelve percent of all health 0:05:39.360 --> 0:05:43.440 expenditure is going to diabetes treatment. So yeah, this is 0:05:43.480 --> 0:05:45.560 where the word trillion can be the start can start 0:05:45.600 --> 0:05:47.800 to get thrown around, because when you're looking on a 0:05:47.839 --> 0:05:51.640 global scale, uh, it is it is an enormous issue, 0:05:51.920 --> 0:05:55.640 both financially and obviously as a quality of life and 0:05:55.640 --> 0:06:00.200 and just health and survivability issues around the world, which 0:06:00.200 --> 0:06:04.440 is why we're really tackling it. It doesn't look like 0:06:04.640 --> 0:06:09.680 things are getting particularly better right now. The diabetes UH 0:06:09.800 --> 0:06:12.680 prognosis is that it's going to be on the increase 0:06:12.720 --> 0:06:15.880 over the next few years. Yeah, despite the optimistic news 0:06:15.960 --> 0:06:18.520 that we're going to have it lit like like like 0:06:18.600 --> 0:06:21.160 kind of the warning signs are out there. Researchers are 0:06:21.160 --> 0:06:24.839 sort of going like, hey guys. Yeah, According to one 0:06:25.040 --> 0:06:28.600 paper I was reading, by twenty thirty, there's an expectation 0:06:28.640 --> 0:06:31.520 that there will be five hundred fifty two million people 0:06:31.520 --> 0:06:35.040 with diabetes worldwide. And and it's difficult to make global 0:06:35.160 --> 0:06:38.080 estimates about this kind of thing because some researchers think 0:06:38.120 --> 0:06:42.520 that many more cases go undiagnosed and underestimated. Even in 0:06:42.560 --> 0:06:45.760 those undiagnosed cases in other parts of the world, the 0:06:46.200 --> 0:06:51.960 number of cases right now could be of what we 0:06:52.080 --> 0:06:56.240 currently think there are a k A about five hundred 0:06:56.240 --> 0:06:59.440 and twenty million cases worldwide, which would mean that you 0:06:59.480 --> 0:07:03.240 would guess that number for would be even higher because 0:07:03.240 --> 0:07:06.800 that was based upon sort of what we are pretty 0:07:06.880 --> 0:07:10.680 sure or what we know so far. Right right in 0:07:10.880 --> 0:07:14.280 the US alone, rates and expenses of diabetes are expected 0:07:14.320 --> 0:07:17.800 to very nearly double during that time period. Yeah, that's 0:07:17.840 --> 0:07:19.800 something else we'll be chatting about quite a bit. In fact, 0:07:19.880 --> 0:07:22.680 let's go ahead and kind of transition into that. There's 0:07:22.720 --> 0:07:25.000 been a lot of news over the past several years 0:07:25.560 --> 0:07:28.760 about increases in the price of insulin, and we're going 0:07:28.800 --> 0:07:32.360 to talk more about diabetes and what insulin you know, 0:07:32.400 --> 0:07:36.720 what factor insulin plays in diabetes management. But the important 0:07:36.720 --> 0:07:40.280 thing to remember here is insulin dosages are are something 0:07:40.320 --> 0:07:43.800 that that people with type one or type two diabetes, uh, 0:07:43.960 --> 0:07:47.920 that's usually part of their diabetes management. People with type one, 0:07:48.000 --> 0:07:50.440 you need it. People of type two, you might not 0:07:50.680 --> 0:07:53.760 need it, but you should certainly have access to it. Yes, yes, 0:07:53.840 --> 0:07:57.080 So there are a lot of different types of insulin, uh, 0:07:57.240 --> 0:08:00.800 not just in how it interacts the body, but how 0:08:00.800 --> 0:08:04.440 it's produced. And that makes this conversation a little more complicated. 0:08:04.560 --> 0:08:07.880 It it's not like we have a single that that 0:08:07.960 --> 0:08:10.240 says insulin and you just draw off as much as 0:08:10.280 --> 0:08:12.120 you need and you're good to go. There's actually lots 0:08:12.120 --> 0:08:14.600 of different types. There's long acting, there's short acting, there's 0:08:14.640 --> 0:08:18.960 instant acting. There's all different types of ways to derive insulin. 0:08:19.600 --> 0:08:23.600 So it gets pretty complicated. But The thing you need 0:08:23.640 --> 0:08:27.040 to remember is that the pharmaceutical game is a for 0:08:27.320 --> 0:08:31.480 profit deal. So as that it means, you know, the 0:08:31.520 --> 0:08:34.440 companies are trying to make a profit selling insulin no 0:08:34.480 --> 0:08:38.160 matter what the type. Maybe there's not as much competition 0:08:38.200 --> 0:08:40.440 as it sounds based upon the fact there's so many 0:08:40.480 --> 0:08:43.120 different types of insulin. There are actually a few major 0:08:43.240 --> 0:08:46.360 companies that are They provide the vast majority of insulin, 0:08:46.440 --> 0:08:51.160 and at least in the United States um and there 0:08:51.200 --> 0:08:53.480 are a lot of other factors that are playing a 0:08:53.600 --> 0:08:58.480 role here, including drug wholesalers, pharmacies, insurance companies, all of 0:08:58.480 --> 0:09:03.120 these things of act the price of insulin, and part 0:09:03.120 --> 0:09:05.720 of the price also depends upon something that is completely 0:09:05.760 --> 0:09:09.000 independent of diabetes and the demand for insulin, and that 0:09:09.200 --> 0:09:14.360 is that the overall drug sales have been on on 0:09:14.440 --> 0:09:17.080 a decrease like they would they've been decreasing over time. 0:09:17.160 --> 0:09:20.359 So that sounds like that's pretty good except for pharmaceutical 0:09:20.360 --> 0:09:22.800 companies that want to make a profit. One way you 0:09:22.840 --> 0:09:25.720 can offset your losses in one area is to increase 0:09:25.760 --> 0:09:28.440 the prices of another drug that's still in demand in 0:09:28.480 --> 0:09:32.079 another area. And while that's not the only cause, or 0:09:32.120 --> 0:09:36.800 even necessarily the primary cause for insulin prices on the increase. 0:09:36.920 --> 0:09:40.160 It is a factor. It is a contributing factor. Um. 0:09:40.200 --> 0:09:43.080 In fact, pharmaceutical companies said as much in a two 0:09:43.120 --> 0:09:46.640 thousand eleven Reuters Health summit. They admitted to the fact 0:09:46.679 --> 0:09:48.760 that part of the reason the insulin prices were on 0:09:48.800 --> 0:09:52.120 the increases because other drugs were not selling as much. 0:09:52.679 --> 0:09:56.640 So you cover your losses in one area by increasing 0:09:56.679 --> 0:10:00.680 the price on another. It's frustrating, but that's kind of 0:10:00.720 --> 0:10:06.319 how capitalism tends to work. So um. Anyway, the drug 0:10:06.320 --> 0:10:09.040 companies are are really seeing a benefit to the strategy, 0:10:09.120 --> 0:10:12.640 as you would imagine. I mean, you've got a growing market, 0:10:13.240 --> 0:10:17.080 more people being diagnosed with diabetes who need access to 0:10:17.120 --> 0:10:21.040 these medications. You can increase the price of those medications, 0:10:21.080 --> 0:10:24.520 so more people buying stuff for more money means yea 0:10:25.000 --> 0:10:29.280 for companies that make the stuff right. So um, And 0:10:29.400 --> 0:10:32.920 I don't want to demonize anybody in this. It's not 0:10:33.640 --> 0:10:37.800 I certainly have very strong opinions. Might not want to No, no, 0:10:37.960 --> 0:10:43.240 I I I absolutely understand their their strategy behind this. 0:10:43.440 --> 0:10:46.680 But when you when you hear stories about parents of 0:10:46.800 --> 0:10:49.719 children with type one diabetes who are paying as much 0:10:49.720 --> 0:10:53.320 as their mortgage every month to to get an insulin supply. 0:10:53.720 --> 0:10:57.120 It's like, oh, that's not that's not chill. Yeah. There. 0:10:57.240 --> 0:11:00.839 I do have a lot of strong opinions, but they 0:11:00.920 --> 0:11:03.439 also range on the political scale, which is why I'm 0:11:03.440 --> 0:11:06.760 trying trying to be as objective as possible. Absolutely that 0:11:06.800 --> 0:11:09.280 that was that was an emotional aside from me, and 0:11:09.760 --> 0:11:12.760 I completely agree with it for the record. But another 0:11:12.840 --> 0:11:14.840 issue that we have here is that the United States 0:11:14.920 --> 0:11:18.120 doesn't regulate the price of prescription drugs. So this this 0:11:18.320 --> 0:11:20.920 really plays into that. Right, we don't have a regulatory 0:11:20.960 --> 0:11:24.480 body that says you can't do that. We're we're seeing 0:11:24.559 --> 0:11:27.679 stuff play out right now in the United States that 0:11:27.880 --> 0:11:30.560 is sort of related to this issue. You know, we 0:11:30.600 --> 0:11:35.560 had the Congress calling up the CEO of the company 0:11:35.600 --> 0:11:39.679 that makes EpiPens to really talk about the increase in 0:11:39.800 --> 0:11:43.360 EpiPen costs over the last you know, five or six years, 0:11:43.920 --> 0:11:46.640 and so we're starting to see that kind of take 0:11:46.679 --> 0:11:49.040 a turn here in the US. But as of right now, 0:11:49.440 --> 0:11:52.360 there is no official body that says, hey, you can't 0:11:52.480 --> 0:11:57.920 charge that much because people real people are dying or 0:11:58.160 --> 0:12:02.439 suffering or or there they're taking extreme measures to stretch 0:12:02.520 --> 0:12:05.680 their supply as much as possible in order to be 0:12:05.800 --> 0:12:09.440 able to afford to live, and so there's there's a 0:12:09.480 --> 0:12:12.760 lot of that going on right now. Also, you might 0:12:12.800 --> 0:12:16.000 remember we did an episode about biologics, and insulin falls 0:12:16.000 --> 0:12:18.760 into that category, meaning that there they aren't as easy 0:12:18.880 --> 0:12:22.680 to replicate in the lab as small molecule drugs that 0:12:22.720 --> 0:12:25.880 you would you would create a generic for. Right It's 0:12:25.920 --> 0:12:29.640 it's a relatively uncomplicated biologic, but it's still much more 0:12:29.640 --> 0:12:33.760 complicated than for example, UH aspirin. Yeah, so you know, 0:12:33.880 --> 0:12:38.480 and patents can expire on the process for creating uh 0:12:38.840 --> 0:12:44.640 biologically um derived drugs, But that doesn't necessarily mean that 0:12:44.679 --> 0:12:47.760 someone's going to come along and create a cheaper, faster, 0:12:48.679 --> 0:12:51.920 uh more efficient method of manufacturing it and thus lower 0:12:51.960 --> 0:12:54.600 the cost and pass the savings onto you. That's not 0:12:54.679 --> 0:12:58.040 necessarily going to be the case. In fact, there's only 0:12:58.080 --> 0:13:00.199 so much cost you can cut from the manufacture RNG 0:13:00.200 --> 0:13:04.679 side on the on biologics, So, uh, that doesn't necessarily 0:13:04.679 --> 0:13:08.760 mean someone couldn't come in and sell the stuff for less. 0:13:09.320 --> 0:13:11.400 But why would you when you can be making all 0:13:11.440 --> 0:13:15.120 of this lovely money. But she can make a beautiful hat. Yeah, yeah, 0:13:15.240 --> 0:13:17.920 you can. You can sit there and uh and and 0:13:18.080 --> 0:13:23.000 light your your your giant stogie with your hundred dollar bills. Um, 0:13:23.040 --> 0:13:25.520 I'm sure they're using it for for drug development and 0:13:25.559 --> 0:13:28.559 paying many of their hard workers as well, not just 0:13:28.720 --> 0:13:31.959 for money, hats but but but exactly, I mean getting 0:13:31.960 --> 0:13:34.600 into numbers, it's hard. Another thing that it's difficult to 0:13:34.720 --> 0:13:37.959 estimate is is the actual cost of a drug here 0:13:37.960 --> 0:13:42.400 in the United States because the process of obtaining obsurance, insurance, 0:13:42.440 --> 0:13:46.320 and then obtaining drugs either through that or through another program. Um. 0:13:47.360 --> 0:13:50.079 It it means that we don't have like a solid 0:13:50.120 --> 0:13:53.160 price sheet for a lot of stuff. But you looked 0:13:53.200 --> 0:13:55.360 into one of the estimates, Yeah, this is okay, So 0:13:55.440 --> 0:13:59.120 this is This again illustrates how complicated things are here 0:13:59.120 --> 0:14:00.760 in the US and then other parts of the world 0:14:00.840 --> 0:14:03.920 to UH. You could have two people in line to 0:14:04.000 --> 0:14:06.440 buy the exact same drug, and one person is going 0:14:06.480 --> 0:14:08.200 to pay one price and another person is going to 0:14:08.200 --> 0:14:10.520 pay a dramatically different price, and it could all depend 0:14:10.600 --> 0:14:13.640 upon the way that they are paying for that drug, 0:14:13.679 --> 0:14:18.040 whether it's out of pocket through insurance, through programs like medicaid. UH. 0:14:18.080 --> 0:14:20.480 These all have an impact, and it's all because of 0:14:20.520 --> 0:14:24.400 the different relationships that are going on. Behind the scenes 0:14:24.880 --> 0:14:28.120 to set prices, and it gets kind of crazy because 0:14:28.280 --> 0:14:29.920 like we're used to the idea of you go to 0:14:29.960 --> 0:14:35.320 a store and if if Lauren wants to buy like, uh, 0:14:35.440 --> 0:14:37.680 some some chocolate milk, and I want to buy some 0:14:37.760 --> 0:14:41.600 chocolate milk, We're not charge different prices for that chocolate milk. 0:14:41.840 --> 0:14:43.440 I mean it might be it might be like twenty 0:14:43.480 --> 0:14:46.920 cents more expensive at like your favorite big box store, 0:14:47.240 --> 0:14:50.640 us my favorite, but if we're going to the same store, yeah, 0:14:50.760 --> 0:14:53.640 I mean, I mean, okay, let's be fair. Some stores 0:14:53.680 --> 0:14:55.600 they have a picture of me and they say, charge 0:14:55.640 --> 0:14:57.800 an extra dollar for chocolate milk. He is a chocolate 0:14:57.880 --> 0:15:01.600 milk fiend and he doesn't pay attuch the price tags. 0:15:01.680 --> 0:15:04.560 But in a fair world that doesn't happen. But in 0:15:04.600 --> 0:15:07.840 the drug world, that's it's totally different. So there was 0:15:08.080 --> 0:15:12.400 a research fellow, Dr Jing Lao, who was worked in 0:15:12.440 --> 0:15:17.520 the division of pharmacoepa, demiology and pharmaco economics. Wow, I 0:15:17.560 --> 0:15:19.360 didn't think I was going to get through either of 0:15:19.360 --> 0:15:23.320 those at Brigham and Women's Hospital in Boston. It wrote 0:15:23.360 --> 0:15:26.320 an article in two thousand and fifteen for JAMMA in 0:15:26.320 --> 0:15:30.480 Internal Medicine. I always like to go Jamma for this, 0:15:31.080 --> 0:15:35.520 you know, getting jam out. So he found that between 0:15:36.120 --> 0:15:40.840 two thousand and fourteen, medicaid costs per unit of insulin 0:15:40.920 --> 0:15:44.760 increased between six dollars and eighty six per unit to 0:15:44.920 --> 0:15:48.320 fifteen dollars and thirty eight cents per unit, depending upon 0:15:48.360 --> 0:15:51.520 the type of insulin. Now this was just through Medicaid, 0:15:51.720 --> 0:15:53.960 but but the same is true across the board. And 0:15:53.960 --> 0:15:56.720 he said, no matter how he cut or analyzed the data, 0:15:57.360 --> 0:15:59.560 there was always a price increase. It didn't matter how 0:15:59.600 --> 0:16:01.760 he was, like, you couldn't massage the data so that 0:16:01.800 --> 0:16:05.160 there wasn't a price hike, right to clarify, Yeah, like 0:16:05.160 --> 0:16:08.400 like like increasing by six dollars and eighty six cents 0:16:08.560 --> 0:16:11.960 was the lowest of the price increases that occurred. And 0:16:11.960 --> 0:16:13.640 and it went all the way up to that fifteen 0:16:14.760 --> 0:16:17.120 per unit per unit, and and that was and again 0:16:17.160 --> 0:16:20.200 it depended upon the type of insulin. Like we mentioned earlier, 0:16:20.200 --> 0:16:23.360 there were tons of different types of insulin um and 0:16:23.480 --> 0:16:26.640 some types of insulin, like long acting insulin, were affected 0:16:26.680 --> 0:16:30.200 more than others, largely because fewer diabetic patients were using 0:16:30.280 --> 0:16:34.520 long acting insulin and companies still had to produce it. 0:16:34.920 --> 0:16:37.920 There's still a demand for it, but to offset that 0:16:37.960 --> 0:16:41.360 manufacturing costs of producing something. When you know, if you're 0:16:41.360 --> 0:16:43.800 a company and you're producing insulin and no one is 0:16:43.880 --> 0:16:47.280 using this particular type, you could shut that production down, 0:16:47.480 --> 0:16:51.440 switch that those resources to something else and make more money. 0:16:51.480 --> 0:16:53.520 But if there's still a demand for it, but it's 0:16:53.520 --> 0:16:55.200 not as big a demand as it used to be, 0:16:55.440 --> 0:16:57.600 then the way you cover those losses again as you 0:16:57.840 --> 0:17:00.720 hike the price UH. And this sends up being a 0:17:00.720 --> 0:17:04.040 burden on people who are dependent upon that specific type 0:17:04.080 --> 0:17:08.000 of insulin. UH. This is a huge problem for a 0:17:08.520 --> 0:17:11.960 growing number of people, So it's it's even more more 0:17:12.000 --> 0:17:14.600 concerned than if it were just a huge problem to 0:17:14.640 --> 0:17:16.760 start with. It's a huge problem and the number of 0:17:16.760 --> 0:17:21.080 people effects is increasing. So diabetes is an illness that 0:17:21.119 --> 0:17:25.760 disproportionately affects people in lower socioeconomic classes, largely because they 0:17:26.080 --> 0:17:30.439 may not have access to UH a good healthy diet, 0:17:30.480 --> 0:17:33.040 and or they may not have the opportunity to do 0:17:33.680 --> 0:17:36.359 any sort of exercise routines or anything. Things that have 0:17:36.480 --> 0:17:41.440 been shown to, if not prevent diabetes, often either decrease 0:17:41.520 --> 0:17:45.920 its effects or or put off when it would actually 0:17:46.040 --> 0:17:49.440 set in for a person. So sure Sure also recent 0:17:49.440 --> 0:17:51.280 studies have shown and we'll talk about this a little 0:17:51.280 --> 0:17:53.480 bit later, that stuffit like a like stress and even 0:17:53.480 --> 0:17:58.919 air quality can can be increasing risks can can increase 0:17:58.960 --> 0:18:02.000 your risks of developing type two diabetes. And not only that, 0:18:02.040 --> 0:18:05.000 but you have people in these same socioeconomic classes who 0:18:05.080 --> 0:18:09.400 will go to extreme measures to skip or ration medications 0:18:09.440 --> 0:18:13.480 to reduce that financial impact they have for purchasing medications. 0:18:14.200 --> 0:18:16.919 That can also lead to patients attempting to manage diabetes 0:18:16.960 --> 0:18:21.560 primarily through diet, like in other words, trying their best 0:18:21.640 --> 0:18:24.800 to eat a healthy diet and not have to take 0:18:24.800 --> 0:18:28.320 insulin because insulin is so expensive, which certainly helps um 0:18:28.400 --> 0:18:33.080 and can in some cases lead to effective management of 0:18:33.119 --> 0:18:35.879 the disease, but in many cases it cannot. Right there, 0:18:36.520 --> 0:18:39.440 it cannot help in type one. I mean it will not, 0:18:39.640 --> 0:18:42.000 it will not magically have you produce insulin if you 0:18:42.000 --> 0:18:43.800 have type one diabetes. Will talk more about that in 0:18:43.800 --> 0:18:47.040 a second. If you have type two diabetes and it's 0:18:47.080 --> 0:18:50.720 not severe, it might be that through managing your diet 0:18:50.800 --> 0:18:53.200 and exercising more, that's all you need and you don't 0:18:53.200 --> 0:18:55.720 have to take any insulin shots or or have any 0:18:55.720 --> 0:18:59.879 other method of having insulin doses. But for some people 0:19:00.080 --> 0:19:03.040 that's just it's just not enough. It's physically not enough. 0:19:03.040 --> 0:19:05.199 It's not that they are bad people. Is not that 0:19:05.240 --> 0:19:07.280 they aren't working hard enough. It is not that they're 0:19:07.320 --> 0:19:11.639 not eating healthy enough. They literally aren't producing enough insulin. 0:19:12.200 --> 0:19:13.760 So I want to make that clear. I don't want 0:19:13.800 --> 0:19:16.240 any sort of blaming going on here for people who 0:19:16.240 --> 0:19:18.120 actually are suffering through this. I mean, if you can, 0:19:18.160 --> 0:19:20.000 if you can get a direct facts to that, to 0:19:20.080 --> 0:19:24.879 those people's like pancreas, pancreases, pancrea, um, then maybe you 0:19:24.920 --> 0:19:28.320 can blame the pancreas. Yeah, but as far as we know, 0:19:28.440 --> 0:19:31.440 the pancreas is not one of the more sentient organs 0:19:31.880 --> 0:19:35.000 and therefore hasn't made any you know, actual decisions. It 0:19:35.080 --> 0:19:39.439 never responds to my snapchats. Yeah, weird. I wrote a 0:19:39.440 --> 0:19:43.160 song about it. Yeah, yeah, he wrote a song about 0:19:43.160 --> 0:19:45.960 the pancreas. I don't remember that. I just remember that. 0:19:46.000 --> 0:19:48.280 There is one. That's all I wait, no, are you 0:19:48.320 --> 0:19:51.160 thinking of part of like a surgeon? No? No, no, 0:19:51.280 --> 0:19:54.480 that is that that song I could do from beginning 0:19:54.480 --> 0:19:57.680 to end right now, because he finally made it through 0:19:57.680 --> 0:20:00.119 med school somehow he made it through. But no, the 0:20:00.119 --> 0:20:04.440 there is to a karaoke episode. Sometimes oh man, she 0:20:04.520 --> 0:20:08.800 knows not what she asks for. So at any rate, 0:20:09.280 --> 0:20:14.080 we need to remember that these effects aren't just devastating 0:20:14.320 --> 0:20:16.760 for the people who can no longer afford or or 0:20:16.840 --> 0:20:20.880 have are having difficulty affording insulin. It affects all of us, right, 0:20:21.000 --> 0:20:26.000 because whether it's affecting us through insurance rates or other 0:20:26.080 --> 0:20:29.880 types of economic factors, even if you have no emotional 0:20:29.920 --> 0:20:34.000 connection with somebody who's going through this, there is an impact. Yeah, 0:20:34.000 --> 0:20:36.439 that the loss of productivity in a workplace, the the 0:20:36.520 --> 0:20:39.920 overall right, the rates of insurance, the the the rates 0:20:40.160 --> 0:20:45.239 of hospital availability due to those resources being taken up 0:20:45.280 --> 0:20:48.840 by by people who have unfortunately encountered side effects with 0:20:48.880 --> 0:20:51.640 that kind of disease. Um. I mean, you know, what 0:20:51.680 --> 0:20:53.440 I'm saying is is that you don't have to be 0:20:53.480 --> 0:20:56.840 a crazy socialist in order to get to want to 0:20:56.880 --> 0:20:59.639 help solve this problem. Now, this this problem is something 0:20:59.680 --> 0:21:05.479 that everyone, regardless of your economic philosophy, should want solved 0:21:05.560 --> 0:21:07.920 because no matter what, it does have an impact, right 0:21:08.119 --> 0:21:11.480 you know. So uh and so yeah, so, what what 0:21:11.680 --> 0:21:14.119 is diabetes? We've been talking about it for like for 0:21:14.200 --> 0:21:18.080 like trillions of well, you know, like like I wanted to. 0:21:18.160 --> 0:21:20.000 I wanted to do that thing where we go like like, hey, 0:21:20.040 --> 0:21:23.080 there's this problem, you've maybe heard of it, and then 0:21:23.119 --> 0:21:24.840 we describe what it is. It might have been better 0:21:24.880 --> 0:21:28.919 to do it. This is great, all right, Yeah, diabetes, 0:21:30.040 --> 0:21:34.520 Let's let's talk about diabetes. Yeah, so diabetes. Hey, and 0:21:34.560 --> 0:21:36.960 I'm gonna take laughter wherever we can find it in 0:21:37.000 --> 0:21:39.600 these episodes, because this is something that I feel very 0:21:39.600 --> 0:21:42.280 strongly about. In the interest of full disclosure, one of 0:21:42.320 --> 0:21:46.560 my parents is type two diabetic, so this I I 0:21:46.800 --> 0:21:50.440 and I also obviously I am concerned. I'm I don't 0:21:50.440 --> 0:21:52.440 know if you guys know this, Lauren, you do because 0:21:52.440 --> 0:21:54.080 you bring it up all the time. I'm getting up 0:21:54.080 --> 0:21:57.240 there in years, so I am concerned about this sort 0:21:57.240 --> 0:21:59.600 of stuff. I think that if you go back through 0:21:59.600 --> 0:22:02.680 the record, did Joe and I have equal mocking Yeah, 0:22:02.720 --> 0:22:04.679 but you are also my co host on text for 0:22:04.760 --> 0:22:08.000 two years, so I don't think I've ever mocked your age. 0:22:09.720 --> 0:22:11.920 Usually you're the one who brings it up, That's true. 0:22:12.000 --> 0:22:14.400 I I am probably the most guilty of the three 0:22:14.400 --> 0:22:19.080 of us. So. Diabetes, also known as diabetes militis, is 0:22:19.119 --> 0:22:21.800 a disease in which the body suffers due to blood 0:22:21.800 --> 0:22:24.359 sugar levels that are too high. So glucose levels in 0:22:24.400 --> 0:22:29.920 the blood are above healthy levels. And glucose, to be fair, 0:22:30.040 --> 0:22:32.520 is important stuff. I mean, it is what our cells 0:22:32.760 --> 0:22:35.760 use as a fuel source. But to get the glucose 0:22:35.800 --> 0:22:38.639 where you need it, your body produces a hormone called insulin, 0:22:39.359 --> 0:22:43.680 and diabetes is a disease really kind of a family 0:22:43.800 --> 0:22:48.160 of diseases that impact insulin production leading to increased blood 0:22:48.200 --> 0:22:51.160 sugar levels. So you mainly have type one and type 0:22:51.160 --> 0:22:53.400 two diabetes. There are other ones as well, but those 0:22:53.400 --> 0:22:56.680 are the two big broad categories, right, and so the 0:22:57.480 --> 0:23:00.720 common distinction that is made is the type one diabetes 0:23:00.840 --> 0:23:05.080