where the poor people are is where the amputations are
August 7, 2014 3:17 PM   Subscribe

Anecdotal data point: I would roughly estimate that 1 in 5 patients I worked with at a subacute rehab facility in the Bronx had undergone an amputation that was in some way related to type II diabetes.
posted by Triumphant Muzak at 3:31 PM on August 7, 2014 [1 favorite]

In addition, patients in low-income neighborhoods may not be as educated about their health and may have fewer places to buy healthy food or to exercise safely.
I am sure there are many factors but I think probably trying to educate people better (about their health) is one of the better ways to try to get these numbers down. Another of the above articles said:
...smoking is a very important factor in the development of peripheral vascular disease.
Last I checked, smoking rates were more strongly correlated to education than to income levels. So, college grads are less likely to smoke than less educated people even if they aren't making great money.
posted by Michele in California at 5:06 PM on August 7, 2014

I knew a guy who was diagnosed with diabetes, then lost his job and his health insurance and couldn't do a damned thing about it.

When you are being treated, diabetes feels like a betrayal of your own body that leads to slow creeping death and sometimes you think about saying "fuck all of this" and letting it do its thing, or helping it along. I can't imagine how much worse that feeling is when you know the only treatment you can get is in the emergency room when it's already too late.
posted by Foosnark at 5:08 PM on August 7, 2014 [3 favorites]

I wonder if there will be a difference in this effect in ten years between Medicare-expanding states, and states filled with Others.
posted by Dashy at 7:06 PM on August 7, 2014

Good point, Dashy. I live in a poor rural state with a high incidence of diabetes (Maine), and our legislature has twice failed to override the governor's veto of Medicaid expansion.

Plus they've supported his efforts to remove childless adults from Medicaid, as part of an unrelenting, mean-spirited and non-fact-based "welfare reform" campaign. And did I mention that the gov is a tea party Republican who's running for re-election? Nobody seems to grasp that Medicaid-funded diabetes management now will cost a lot less than drastic interventions later ...
posted by virago at 7:28 PM on August 7, 2014 [1 favorite]

It costs about $50 a month to provide yourself with a self-testing kit that you'd actually use. And without the feedback loop it is a great mystery if anything -- the diet, the exercise, any other lifestyle change -- is doing anything at all.

I can't imagine making any headway without good testing, and I can't imagine shelling out $50 a month when I'm struggling to put food on the table.
posted by Tell Me No Lies at 8:45 PM on August 7, 2014 [4 favorites]

My type 1 diabetes is functionally unmanagable without a continuous glucose monitoring system. I believe CGMS will become the standard of care for managing type 1 & type 2 diabetes within ten years. Until then we'll probably continue to see these problems.
posted by BrotherCaine at 9:41 PM on August 7, 2014 [2 favorites]

For many people managing diabetes is challenging. The stress and obstacles of poverty do not help. Hope to see the high-tech devices widely available soon. Could be part of the promise of the Affordable Care Act someday.
posted by ClaudiaCenter at 9:43 PM on August 8, 2014

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