New cost-saving drugs website

Mark Cuban Cost Plus Drug Company’s online pharmacy launches with the lowest prices on 100 lifesaving prescriptions.” Cost Plus is a direct to consumer pharmacy. It reflects the current need, with 1 in 10 Americans needing to skip doses of their medicine due to cost. I need to credit my friend Scott Strumello who posted this on Facebook. I trust Scott, he’s all over the cost of diabetes medications and how companies make their money.

Scott also tweeted, “So far Mark Cuban Cost Plus Drug Company has already beat the price on rosuvastatin calcium 10 mg tabs (generic Crestor), AND I had bypassed my own insurer’s pharmacy benefit to buy it for less elsewhere. His cost: $7.50 for a 90-day supply, which is half of what I was paying.

As shown above for the diabetes meds, they don’t carry insulin presently, but there are a few type 2 pharmaceuticals you might do better on. For myself, I looked up Levothyroxine, which is the generic for Synthroid. Here, I have to say they were not cheaper than the cost-saving app, GoodRx. After paying $18 for a 90 day supply on my Medicare United Healthcare plan, I found on GoodRx I could get the same supply for just under $13.00. At Cost Plus, it’s listed for $4.20 – but that’s for a 30 day supply – so 90 days will cost you $12.60, which is just about what I got it for on GoodRx.

So while you may do better, when you look up what you want to price, you might want to compare it to Good Rx or any other cheaper cost drugs app. That said, given this is the online venture of a pharmacy business, I’d say it’s a bit of hope shining through the darkness of the overinflated cost of drugs.

A page on the Cost Plus website below

“There is no vials here,” said the pharmacist

Pam and her husband Dave in the Italian countryside

Late last year I got an email from Pam Saylor, a writer living with type 1 diabetes. Pam offered to do a guest post here for you. I’m always open to guest posts by the way. This story below is from Pam. Much like her travel book, Braving the World: Adventures in Travel and Retirement, Pam’s post takes us on a journey to the Vatican City with diabetes playing a major character. Sit back, relax, have a cup of tea and read on.

Thank you Pam.

§

It was hot and our bus moved slowly.  I lifted the hair off of the back of my neck and leaned towards the bus window hoping to catch a breeze.  The sounds of Rome’s morning rush hour traffic came in through the window—blaring car horns, motorcycles revving their engines, and the wheeze of buses stopping and starting.  I closed my eyes and fanned the back of my neck with my passport.  It seemed like hours but was probably only twenty minutes before I felt a gentle jab in the ribs from my husband Dave, who was sitting next to me.  Startled, I looked at him and he pointed at the electronic display at the front of the bus.  The next stop was ours.  We were on our way to the pharmacy in Vatican City to buy insulin—and I didn’t have a clue what to expect.  

Only a year before our bus trip to the Vatican City pharmacy, in 2016, early retirement unexpectedly became an option for Dave and me.  We jumped at it.  Dusting off the dream trip we had imagined for years, to live for one entire year in Italy, we began serious planning to make it a reality.   

Like giddy kids, we bought two one-way tickets to Rome.

But buying the plane tickets was the easy part.  Trying to figure out how life would work for me, diagnosed as a Type 1 diabetic only three years earlier, was harder.  Trip planning was thrilling and exciting, but I had a lot of questions. Would I be able to buy insulin in Italy?  Would it be affordable?  Would my prescriptions be accepted at pharmacies?  The unknowns of our dream trip woke me up at night. I couldn’t rely on the typical advice for short-term travelers and take “double the diabetes supplies that you think you will need.”  That advice didn’t apply to me.  I didn’t have a year’s supply of insulin to take to Italy.

As a confirmed planner and anxious list-maker, I researched every single detail that I could before we left the country in 2017.  I found an online group of expats in Rome who assured me that all Italian pharmacies would have insulin.  That was the good news.  They also told me that Italian pharmacies would not accept my American prescriptions.  That was the bad news.  Another helpful expat chimed in to tell me about the Vatican City pharmacy inside Vatican City.  This pharmacy not only accepted American prescriptions, but it had cheaper prices and lower taxes than a typical Italian pharmacy.  And so that is how, after only a few weeks of living in Rome, Dave and I came to be on a bus headed to the Vatican City pharmacy ready to test the advice of an anonymous online source and buy insulin.

Arriving in Vatican City, we hopped off the bus.  With passports and prescriptions in hand, Dave and I walked to St. Anna’s Gate, a little north of St. Peter’s Square where the Pope held his weekly outdoor audience.  I went first through the gate and handed my paperwork to the guard on duty.  Slowly and carefully he examined the papers and then handed them back.

“You must leave.” The guard sounded stiff and unhappy.  My stomach dropped and I looked at Dave with wide eyes. Now what? The guard continued talking. “It is not yet time to open.”  I glanced at my watch.  It wasn’t 8:30 yet.  We left and after an espresso, returned to the gate where the same guard slowly and carefully examined my paperwork again—as if it might have changed in the last 10 minutes.  These security guys did not mess around.

Once through the gate, we went into the small office next door and handed over our passports to a guard behind thick bullet-proof glass in exchange for a clip-on visitor’s pass.  Following the signs outside, we walked to the building marked Pharmacia and entered.

The room was already full of people.  On a screen near the ceiling, digital displays flashed red numbers.  This was a familiar setup—like the deli counter at the grocery store back home.  I needed a number.  Squeezing past packed bodies, already smelling faintly of sweat in the hot room, we got to the ticket machine and I pulled out a numbered ticket.  Waiting for my turn with a pharmacist, I wandered around the room looking at the shelves of cold medicines, lotions, and soaps for sale.

When my number flashed on the overhead screen I hurried to the window and handed my insulin prescription to the pharmacist in the white coat.  He disappeared into the backroom and returned with a box of insulin pens instead of the insulin vials I used to fill my insulin pump.

“Do you have insulin vials?” I asked.  Opening my purse I pulled out the small bag of diabetes supplies I carried.  I handed my vial of insulin to the pharmacist.  He turned it over in his hand and read the label, frowning, he disappeared again into the backroom.  When he came out, talking to another man in a white coat, I saw them shaking their heads.  Returning to me, he said, “There is no vials here.”

Some insulin was better than no insulin and I knew I could use the insulin pens to fill my pump, so I accepted the pens in place of vials.  One box of NovoRapid a/k/a NovoLog insulin pens (five pens per box for a total of 1500 units of insulin) cost a total of €46 or $56.

After paying for my insulin, I found Dave in the crush of people and we left together to collect our passports and catch the bus home.  I bounced down the pharmacy steps into the warm sunlight with the all-important box of $56 insulin in my purse.  

We still had eleven months of travel in our futures and I did not know then if I would be able to buy affordable insulin down the road.  Visa problems had forced us to change our travel plans and now our year-long dream trip would include living in Croatia, London, and Venice.  

But my trip to the Vatican pharmacy gave me confidence that things would be all right, somehow, one way or another.  I would find a way to solve problems.  This adventure didn’t come with an answer sheet and that was okay.  I would figure things out one day at a time and wasn’t that what diabetes had already taught me?

§

Pam is a retired paralegal and a contented travel addict. Her book, Braving the World: Adventures in Travel and Retirement, is her first book and is available on Amazon at http://www.amazon.com/dp/B091BCNVWQ To see pictures of her year of travels, visit Pam’s website at www.bravingtheworldbook.com

How to deal with higher blood sugar from a cortisone shot

As much as I know about diabetes, I really wasn’t sure how to deal with the blood sugar rise from cortisone shots. And yes, I’ve had cortisone shots before – one for my trigger thumb last year, one some time ago for another sticky finger, and most recently shots for a tailbone that decided to grow a bone spur, or at least make me aware one was there.

I got the cortisone shot Friday afternoon around 2:30 pm and within a few hours I was already watching my blood sugar rise, and rise, and rise (on my Dexcom CGM). And even though I was injecting half unit, after unit, after half unit, it was like I was treating with water. I really got the visceral experience of being insulin resistant, which I am not. I was fearful, frustrated and fretting.

Of course the fear is of taking too much insulin and when it will all kick in, particularly while sleeping overnight. Through the evening my blood sugar rose to just over 180 mg/dl and then came down to about 167 and hovered there all night. That afternoon and evening, all I did was keep dousing myself with extra insulin, and watching the numbers on my CGM.

The next day I googled what to do about this. Surprisingly, this did not occur to me the first day, fool that I was. The best article that I found was on Healthline, “Yes, Steroids Spike Blood Sugars – So Beware.” The bottom line is, as diabetes educator extraordinaire Gary Scheiner, actually had emailed me the last time I had a cortisone shot:

– most people need to raise their basal insulin by 50% starting about 6 hrs post injection, then double their basal on days 2 and 3, then taper down.  Some need to triple their basal.  The humalog doses can remain as-is (correct any highs and cover meals as usual); the extra basal takes care of the insulin resistance caused by the steroid.  

So that’s exactly what I did. I took my Tresiba dose of 6 units/day up to 9 units for days two and three, and watched it. Today, day 4 I’ve dropped it down to 7 units and tomorrow anticipate going back to 6. Watching my blood sugar today, it looks like it’s back to normal.

This simple tip has worked like a dream. Still, it’s scary when you normally take a small amount of insulin and merely think of doubling or tripling it let alone do it! Terrifying actually. But unfortunately that’s what’s required for most of us when we get a cortisone shot.

I hope this offers some help next time you get a cortisone-induced rise in your blood sugar. I’m confident you’ll sleep a whole lot easier. I know I have.

Connected to the circle of life: Go forward with kindness

I was going to write a sort of year end wrap up and post it last night, but perhaps it was fortuitous that I was at my mother’s house and so could not access my blog. Perhaps it is better that I just post today an email I got in the last few days with a sentiment I so appreciate, a way to go forward into 2022.

The email was an email blast from a site/podcast called Sounds True. Sounds True was founded by Tami Simon and she’s the interviewer on the podcast. I have enjoyed many of the “new age,” spiritual interviews I’ve listened to. I also notice that during this time of incredible distress for the world and us, pockets of spirituality are sprouting everywhere. So I’m going to share this email with you on this, New Year’s Day.

Dear Riva,

I was on a solitary retreat in the Colorado mountains when I discovered how a very small action can make a huge impact. 

I had been meditating for several days as part of a 10-day solo retreat. And I had gotten in the habit of taking a walk each day toward the sunset hour when it felt like it was definitely time to stretch my legs and get outside.

On one of these walks, I saw a person in the distance headed toward me. I hadn’t seen a human being for several days, and I felt a strange adrenaline rise as I noticed him in the distance walking in my direction. This person I didn’t know continued to approach, and when we were about 10 feet away from each other, this stranger smiled at me with a genuine sweetness … and kept on walking.  

That was it; that was the small action. 

And for whatever reason (maybe because I had been meditating all by myself for several days), this human act of softly reaching out to me with a gesture of connection broke my heart right open.

Your words matter. Your phone calls matter. Your emails matter. Your genuine smile matters. The way you hold space for another matters. With the smallest of gestures, we lift each other up

Here on the last day of 2021, I want to remind us all that we matter … to each other. My sense is that we have no idea how many people we touch in small ways with huge impacts. Thank you for every act of compassion you share. I feel grateful to be in connection with you.

I’m committed to bring more kindness into ordinary days. Little feels more important right now. As Simon says, “With the smallest of gestures, we lift each other up.” As I have often said, even with diabetes, look up and see your possibilities.

Happy New Year

Dear Santa, will you please take this diabetes away?

I’ve posted this six previous times on this blog, the first being in 2009 best I can tell. Hey, when something’s good, enjoy it again. Merry, merry, happy holidays.

Dear Santa,

All I’d like this Christmas is for you to take this diabetes away. I’m so tired of it already. All the time stabbing my fingers for blood and guessing when my sugar’s too high or too low.

Now that I’m in menopause I can barely tell whether I’m sweating because I’m losing estrogen or because my blood sugar’s crashing at 50 mg/dl!

And, can we talk… I mean the constant figuring out how many carbs are in a ravioli or bread stick or that fried calamari that will be at the company Christmas party. Some days I just want to lie down and shoot myself. Please, please, Santa, would you take this diabetes away?

Sincerely,
Riva

***
Dear Riva,

I’m very sorry you’re having a tough time during my favorite season. I only want people to be singing carols and drinking eggnog and feeling good cheer. Unfortunately, it says in my contract that I’m not allowed to interfere with life’s natural occurrences. So here’s my suggestion: although you’ve already opened your holiday gifts, go back and look under your Hanukkah bush for the gift in having diabetes.

You may have to spend a few days looking, so why don’t you schedule it for the week between Christmas and New Year’s while you have some down time? Then you can start the new year fresh.

Best wishes,
Santa and the gang

***
Dear Santa,

A gift in my diabetes? What are you, crazy? Meshuggah? Thanks, but no thanks!

Riva

***
Dear Rabbi,

I seek your wise counsel. I wrote to Santa to take away my diabetes, but he wasn’t helpful at all. Surely you who have studied the Torah and represent our people who have suffered throughout history can help me with this awful diabetes.

It’s such a strain, Rabbi. I have to test my blood sugar when I really want to be lighting the sabbath candles. I forgot all about the High Holy Days this year because I was so busy counting carbs in the Challah, bagels and honey cake.

Rabbi, please, what solace can you offer me? What words of wisdom? Surely you would tell me to just forget about this diabetes thing and go shopping, right?

Please write soon,
Riva

***
Dear Riva,

Santa and I just returned from the Caribbean, and he told me about your difficulty. He said he told you to look for the gift in your diabetes. I concur with Santa; there are many gifts to be found in diabetes, if you look. For one, my child, you won’t have to drink the traditional Manishewitz holiday wine anymore. The Counsel all agree that it is much too sweet. Bring out the Chardonnay!

When Santa asks you to look for a gift in your diabetes, he is not saying this because you are not Catholic and he is not bringing you anything, although this is true. He is speaking like our brothers the Buddhists, who profess that there is a gift in everything if you look for something positive that it can bring into your life.

Let me tell you a story, my child. My own Aunt Sheila had diabetes, and after she stopped kvetching, she went to a spa and learned how to eat healthfully. She shopped along Rodeo Drive and bought a cute little jogging outfit and started running. On her jog along the ocean she met her fourth husband, Marvin, and they’re very happy. They just moved into a $6 million mansion in Jupiter, Fla. — right next to Burt Reynolds! Everyone’s plotzing! The house was in foreclosure so they have even more money to decorate!

Darling girl, find a gift in your diabetes, because to be honest, since you’re not orthodox, and all I have are these great wigs I got on sale from my cousin Schlomo, I’m not bringing you anything, either. And really, it’s not very pleasant to whine.

Shabbat Shalom
Rabbi, Local Union 107

***
Dear Rabbi,

I thought about what you and Santa said and have decided to become a Buddhist. I picked up the Dalai Lama’s book, “The Art of Happiness.” He says, “Happiness is a butterfly, which when pursued, is always just beyond your grasp, but which, if you will sit down quietly, may alight upon you.” I told my friend Joe I like butterflies, and I like the robe, so these aren’t bad gifts.

Joe said the quote meant that we are the source of our happiness, that happiness can only come from inside us, regardless of what happens in our lives. Hmm, I said, maybe I need to learn more. So I booked a flight to Tibet.

Now if only I didn’t have to drag all this damn diabetes stuff with me…. ohm… ohm… oy.

My new treat: a protein shake for lunch

I am not one of those people who enjoys drinking my meals. So when my friend told me that for the past few months she’d been making and enjoying a protein shake for lunch, I thought, yuck not me. But, I am now among the converted.

I tried it largely because many days I do a version of intermittent fasting. I make a cup of coffee when I first wake up. Yes, tis true, I put cream in it, but I sort of don’t register this as breaking my fast. Some will argue, but so be it. That cup of coffee with cream around 8 am fills me up until around 10:30 or 11 am. And here’s something interesting: It’s not that I’m trying not to eat, I’m literally just not indulging in the habit of breakfast, and so find I’m not hungry those first few hours of the day.

So, most days I eat my breakfast – yogurt, a half slice of cinnamon coffee bread (I make myself), a spoonful of almond butter and two spoonfuls of tahini – around 11 am. That means I’m once again not hungry at the proverbial lunch hour. Instead around 2 pm I have an edge of appetite and make myself a protein shake. It’s just perfect to fill that little hole in my stomach with something filling, nourishing and tasty. There are a zillion protein shake recipes online. Take a look.

My shakes (only been doing it a few weeks) are a variation on a theme. Typically, I use a third of a banana, to keep the carbs low and add some berries, which are already low in carbs. I add a few spoonfuls of plain greek yogurt, a cup of almond milk, the green in the picture above was made green by adding some red Swiss chard, (you can add any green veg that doesn’t have a strong taste, many use spinach), then, while the serving size appears to be one scoop, I’m using half a scoop (after all, I am not protein deficient) of my Plant Fusion vanilla protein powder, 4 ice cubes (the ice cubes add heft) and I blend it all in a blender my mother likely gave me when I moved into my first apartment after college.

There are a lot of protein powders out there. I bought this one I’m using above in Whole Foods but I see they also sell it on Amazon, which is the link I included above. I bought PlantFusion because I read all the nutrition labels of all the choice, and this one seemed to hit the trifecta of low carb, healthy ingredients and price.

When I told my friend I was making using that old blender my mom gave me, she said, “Why don’t you get a Nutribullet?” Whereupon I replied, “Why should I? This is doing all I need!” The defense rests.

So if you’re tired of what you’re eating for lunch, or you’re experimenting with different ways of eating, you might consider trying a protein shake for your breakfast or lunch, whatever suits you. My prejudice of not wanting to drink a meal has disappeared. It’s so tasty, satisfying, filling and nutritionally sound. It’s been a wonderful discovery for me, and I don’t see that stopping anytime soon.

When in the void, what to do

As the year winds down, good and bad, I wanted to post this poem. When it was first sent to me, it spoke to me. I found it beautiful and true. No matter what we do, actions great and small, I do believe the world speaks to us if we can be quiet enough to listen.

I have talked a lot over these past 20 years. How many words I’ve uttered on stages, and from behind lecterns, around the world in an attempt to uplift others with diabetes, and the health professionals who tend us. All the words I’ve written that look back at me in three books and hundreds of articles. It’s all good and I am proud.

Still, greeting this moment, this ever present, every changing moment, I wait quietly as the song that is my life falls down into my cupped hands. This is particularly poignant for me as I reflect upon the current stream of my life with the passing of this year.

Please Dexcom, fix this

Why is it at least 50% of the time I put on a new Dexcom G6 sensor, I get this message? I follow the instructions, yet this pops up way too often. What’s happening? And beyond whatever is happening, this not knowing whether or not my sensor will work, I notice increases my stress level. As if type 1 diabetes did not already require 24/7 hyper vigilance.

Of all the things people hope the G7 will be – that the sensor is smaller, thinner, more accurate and gives you a farther range, I’m hoping this screenshot above will be history.

Gray Thursday came before Black Friday

I took this photo in front of a Pilates studio in my neighborhood because I thought it was funny. It wasn’t quite as funny when it became true.

At 2:45 am, the morning of Thanksgiving, I awoke with low blood sugar. I was in my mother’s home. I padded out of bed to rummage around the refrigerator looking for juice or fruit or something to raise my blood sugar. Yes, I could have taken a glucose tablet, but when my blood sugar isn’t dangerously low, I’d rather imbibe something nutritious.

No juice to be found, dried fruit would take too long, a jar of raspberry preserves went by unnoticed, I reached for some pomegranate seeds and began munching. Oops, I felt one get stuck in my teeth. Upon closer inspection, there was no seed there, and there was even less of a tooth there. I had cracked my molar and now a piece of it was missing. For the next four days my tongue kept returning to the emptiness where once there was enamel, and getting scraped in the process.

Thanksgiving at my mother’s friend’s home with a broken tooth meant a bit of turkey, roasted sweet potato and something I haven’t eaten in likely three decades for blood sugar reasons, white mashed potatoes. Boy, they were good!

Since it was Thanksgiving weekend, I couldn’t call my dentist until today, and now I’m booked in to see him tomorrow at 9 am. The good news is my tongue has gotten used to the new tooth terrain and is getting scraped far less often. Bad news? That remains to be seen. Still, I’m thankful, there are other teeth in my head standing in for their wounded comrade.

So while my mouth undergoes some redecorating, I am still enjoying my favorite of all seasons, the fall, as the leaves are still golden around here and I smile as the lights begin to come on for Christmas.

One more step to make insulin affordable

I received a mass email this morning from the American Diabetes Association (ADA). In short, the U.S. House of Representatives passed the ‘Build Back Better Act’ that has a national $35 insulin co-pay cap, and allows Medicare to negotiate the price of insulin. This was, in part, aided by the thousands of letters and emails, from us, urging our representatives to support this.

Yet, the bill isn’t a done deal yet, so the ADA is requesting continued support. It’s easy with this form to press this through, it’s mostly written for us.

Let’s keep on them and get insulin down to an affordable price. For the first time I feel it’s within reach.