For Newtown residents, managing their diabetes during the pandemic has ranged from navigating the challenges of using new technology with only telehealth support to rationing insulin and blood sugar monitoring test strips after losing health coverage; and from suffering risky exposure situations just to keep their health insurance to grappling with the stress of balancing diabetes therapies with surviving leukemia.

Meanwhile, another resident confessed that the pandemic and resulting move to working from home actually brought an important realization — and a means to better control his illness.

Managing a lifetime disease like diabetes often comes with a high price tag and can take a toll on a person’s mental health. Connecticut advocates and providers said the addition of a pandemic has left patients dealing with an even heavier burden of financial, physical, and mental health needs.

After losing her job and employer-provided health coverage, Bridget Seaman said she has gotten to the point where she is rationing her insulin and minimizing the use of blood sugar test strips to help stretch her supply. Luckily, she found a popular drug discounting program that helps a little.

“With a GoodRX coupon, I just paid over $80 for about a 17 day supply,” she said. “Hopefully, I will have the insulin company giving me some sort of break after the new year.”

People like Seaman who have Type 1 diabetes are completely reliant on insulin; without it, they could die. But the average price of the drug has nearly doubled in the last five years, leaving individuals and families spending thousands of dollars out-of-pocket each year. “The expense,” Seaman said, “is horrifying. Why are there no generic insulins? And test strips?

“I am supposed to test my blood sugar 5 times per day,” she explained. “Those strips are over $1 apiece.”

People with Type 1 diabetes, which is often diagnosed in childhood, lose the ability to naturally produce insulin, a necessary hormone for regulating blood sugar. This lifelong disease occurs for reasons not entirely known to experts, though there can be genetic and hereditary links.

Barbara Kugler, a registered nurse with Type 1 diabetes, said during the first COVID-19 surge earlier this year, she tried to keep safe and protect her family by utilizing the Family Medical Leave Act. That allowed her to step back from the long-term care and rehab facility where she works, while preserving her position and her all-important healthcare benefits.

But now that Connecticut is facing a second surge and Kugler has exhausted her FMLA allocation, she is utilizing stepped-up personal protective equipment, some of which she buys herself, and heading off each day to care for others despite the enhanced risk of virus transmission and her more immunocompromised status.

“I’ve had Type 1 diabetes since childhood and been on an insulin pump for years, so I don’t really know what life is like living without it,” Kugler said. “I really should be on leave but I’m keeping the job. The job security and the health care coverage is critical because I have this high-risk condition.”

On the other hand, Kugler said a friend and colleague with Type 1 diabetes decided the risk of exposure was too great and left her position. Kugler said her friend is now struggling with the challenge of managing her situation with no financial offset for insulin or supplies.

The only other change the pandemic instigated for Kugler was a switch from personally reordering her diabetes supplies and insulin to having the order filled automatically.

“This way I don’t have to monitor my supplies,” she said. “It just comes to the house every three months.”

A Lesson Learned

Mike Powers, another local resident with Type 1 diabetes, is something of an exception.

“If anything the pandemic made it easier to manage my diabetes,” Powers said.

He said up until the time his employer, an engineering firm, started having him work from home, he was having lunch every day at the company’s cafeteria.

“They have good lunches here — maybe a little too good,” he said. “Once I started eating at home, I was cutting down on portions and cutting out a lot of the extras so my blood sugar dropped.”

That meant Powers was able to reduce the amount of insulin he was previously taking. The flexible nature of his work-from-home schedule also gave him more time to do work around the house — boosting the level of exercise he was getting.

“That also helped my blood sugar,” he said. “And now that I’m back [in the office] I’m still bringing my own sandwich, so I’m avoiding the contact risk with others in the lunch room, as well as all the added food.”

The most common form of diabetes is Type 2, which accounts for the majority of an estimated 275,500 adults in Connecticut with diagnosed diabetes, according to an October state report. It occurs when a person’s body becomes resistant to insulin produced by the pancreas, or when the organ does not produce enough.

Treatment can involve nutrition, exercise, medication, and lifestyle changes.

Dan Krauss is one of those Type 2 diabetics. He said one of the biggest challenges forced on him as a result of the pandemic was eliminating nearly all in-person interactions with his medical support team.

“It’s been interesting and challenging for me,” Krauss said. “Back in April, I was switched onto a Medtronic insulin pump and continuous glucose monitor (CGM). It involves lots of training with Medtronic to learn how to use the pump and CGM.”

But instead of hands-on assistance, Krauss was assigned three sessions with a trainer and one with a nutritionist.

“With everything shutting down and going virtual, these sessions were the first meetings for me done over Zoom,” he said. “It was challenging as the pump and CGM are fairly involved. And even though I’m pretty tech savvy, it was a little concerning that I didn’t have a person right next to me guiding me.”

Krauss said it took several weeks and more than a few e-mails, texts, and sending photos to his medical and hardware support members to illustrate the issues he was having as he acclimated to his new system from one with less technological capacity. And, like Powers and Kugler, he was blessed to have the level of health care coverage so he did not have to stress over any diabetes-related expenses.

The Cost Of Diabetes

Altogether, diabetes and its complications account for $1 in every $7 spent on health care in the United States, according to the American Diabetes Association.

Diabetes of any type can be successfully managed, but that depends on a lot of factors — especially health insurance coverage. Dr Laura Nally, a pediatric endocrinologist in New Haven, said this pandemic has left people struggling with that in different ways.

“Many families of children with diabetes lost their jobs, which can disrupt their access to health insurance and puts them at risk of rationing,” she said.

Nally has Type 1 diabetes herself and is an outreach lead with the Connecticut chapter of #Insulin4All.

“And, of course, as we’re reaching January, those with high deductible health insurance are financially preparing for when they’re going to have a new deductible to meet, so that’s definitely been a problem,” she said.

The Connecticut legislature passed a bill this summer in a special session that caps costs for insulin and other diabetes management supplies. Governor Ned Lamont signed it into law, but most of the policies don’t take effect until 2022, which is not helpful for anyone during the pandemic.

It is still a good start, said Jill Ely, a family nurse practitioner and diabetes care and education specialist at Stamford Health. Ely testified in support of the legislation earlier in the year.

“You know, the medications, the testing supplies, the physician visits, educational visits, co-pays seeing specialists, and the stress — there is no way to measure all of that,” she said.

Newtown resident Doreen Murphy Kelleher, who has lived with Type 2 diabetes for more than 30 years, is also managing a leukemia diagnosis. She, like Krauss, lives with the insulin pump and CGM, which keeps her stable — but she finds the biggest concern is managing stress.

“It’s astonishing to me how much stress affects your sugar levels — it’s not all about the food,” she said. “Managing the stress has been the hardest for me, especially with the pandemic.”

Kelleher said she is helping to mitigate her stress by taking a virtual chair yoga class three times each week through the C.H. Booth Library, and she gets out to the beach on occasion to decompress.

‘Stress Isn’t Helping’

“Now when it seems like my blood sugar goes up for no reason, I have to think. Maybe it was because when I was out at the mailbox a few minutes earlier, a group of walkers without masks on all came over and said hi to me,” she said. “Those situations might mean I not only have to take steps to physically calm down, but I might have to take an added boost of insulin.”

Kelleher also said she has noticed how much more generally stressed she is all the time since the virus hit Connecticut back in the late winter. But she is also benefiting from everyone else’s greater awareness and their inclinations to heed masking, disinfecting, and distancing practices.

“Even without the pandemic, I’m so immunocompromised I would need to maintain pandemic-like interactions anyway. But the stress isn’t helping,” she said.

Diabetes educator Ely and her colleagues have been working to keep patients connected to their health care resources during the pandemic, especially with the use of telemedicine. And it has not been all bad — Ely said many of her patients have used the time and circumstances to improve their health.

“For some, it was a decrease in stress because they didn’t have all that commuting they had to do,” she said. “Maybe they were able to exercise more. Maybe they could now cook at home to save money, and maybe there was a better option to eat healthier.”

But Ely acknowledges that the downsides of the pandemic have been significant. Stamford’s diabetes program had to cancel its in-person support group meetings for Type 2 diabetes, which Ely said has some patients feeling emotionally and mentally isolated from others.

Griffin Hospital in Derby is one local medical provider offering free and effective diabetes management programs. Its Diabetes Education & Support Group can help individuals manage the challenges of living with diabetes through education and peer support. In addition to monthly support from people facing the same challenges, guest speakers often present topics of interest and provide expertise.

Individuals diagnosed with diabetes can learn how to take control of the health disorder and get control of their lives again through a free six-week diabetes self-management workshop. The Live Well Diabetes Self-Management Workshop focuses on several topics for those with diabetes, including what to eat, foot care, low and high blood sugar, sick day guidelines, tips for dealing with stress, and how to set small and achievable goals.

Griffin also offers GlucoseZone — a digital health exercise solution that helps patients reduce body weight, improve A1C, and lower medication requirements by offering exercise guidance based on diabetes type, real-time blood sugar levels, and other biometrics.

Learn more at griffinhealth.org/manage-your-health/diabetes — or for other types of support and referrals, call Infoline at 2-1-1.

This report uses CT Mirror content by Nicole Leonard of CT Public Radio.