- It's the eighth leading cause of death in the United States, affecting millions of Americans on a daily basis.

Tonight, we will look at the total costs of this disease, the financial and the physical.

- I would say the biggest toll really is for my kids.

I think emotionally... ...not knowing if I'll be around when they're older.

- Diabetes, the silent killer.

On tonight's episode of Community Conversation: The Cost of Diabetes.

- More than 37 million Americans have diabetes, just over 11% of the total population, according to the Centers for Disease Control and Prevention.

November is National Diabetes Awareness Month.

During this program, we will discuss insulin costs and the toll living with diabetes can take on a person.

We'll speak with doctors, cost experts, lifestyle coaches, and people living with the disease.

I'm Brittany Sweeney, and we are coming to you from the Univest Public Media Center in Bethlehem, Pennsylvania, for this Community Conversation: The Cost of Diabetes.

Earlier this week, I spent time with two Allentown residents living with type one diabetes.

Ian Collins was diagnosed in his late 20s, while Yamelisa Jimenez Taveras has been living with the condition since childhood.

- I was 28 in undergrad, and had to use the bathroom a lot.

And I lost a whole bunch weight.

I'm already tiny.

I just thought it was stress, and I was really tired all the time, and I would walk upstairs and be exhausted, and I thought, "Oh, I'm just really out of shape."

you know, all those excuses.

But then I had really epic dry mouth, no family history.

No one in my family has type one.

- I was born in Dominican Republic.

My family and I came when I was nine years old, and just a short year later, I was hospitalized.

I started losing weight.

I started struggling with eating.

I went into the hospital, got diagnosed with diabetes, was hospitalized for two weeks.

I had a huge fear of needles my entire childhood.

And at that point in time, I really didn't have a choice, but to learn.

- With type one, my pancreas stopped producing insulin, so I have to basically think like my pancreas all the time.

So, right here is the actual CGM.

Continuously sends glucose readings to my app on my phone.

Here's actually my insulin pump.

Gives me insulin throughout my day to keep me stable.

I also give myself insulin, as well.

I have to think about it all the time.

I don't have a break.

- Being diabetic, as a whole, it's difficult.

I mean, you need to learn how to eat differently, how to live differently, how to manage everything.

Because I'm grown up with it, I've kind of shaped my life around it.

Now I know that if I'm taking a trip, I have to make sure that I have enough insulin with me.

Now I use an insulin pump.

So with the insulin pump, I have to know how many days it's going to last.

When do I have to replace it?

What equipment I have to take with me?

So all of it, it really is a process.

So, this is my tandem insulin pump in here.

It actually has my insulin already inside.

There's also what's called a CGM.

It's a Continuous Glucose Monitor, which sends my current numbers to my pump, and then, it's actually able to provide insulin as needed.

It's like a small catheter that goes into your body.

It's like a sticker, stays on for however many days.

You keep your insulin pump on, and then you switch it out.

So usually 2-3 days.

So I do wear my pump 24/7, yes.

As a diabetic in general, I think the biggest struggle is our struggles with the health care system, and with having insurance or the appropriate coverage for our medications.

Our medications are very expensive.

- Like, a nine-month supply of vials could be over $3,000.

- I've gone through times of having to ration my insulin.

- People who've died because they may have to choose between insulin or... ...their food.

- I've gone through times where I didn't have insulin at all, or being on trips and my pump failed.

- If you have an insulin pump, that's even more expensive than like a vial and syringes, and then you also have insulin pens.

So everything kind of costs depending on what you're doing.

I do have a co-pay, so I do have to pay like $70.

And I mean, I'm very blessed to have good health insurance, but not everyone does.

- The biggest cost of diabetes, I think, is all of it.

It takes a toll physically, of course.

I mean, your organs have to work overtime.

So, there's a physical toll that it takes on you.

It takes a toll emotionally.

I would say the biggest toll really is... ...for my kids, I think, emotionally... ...not knowing if I'll be around when they're older, understanding that diabetes at one point was a death sentence.

It's no longer, there's obviously the ability to have quality of life knowing that, yes, I can live with it, I manage it, I thrive with it, but I'm more likely to die early.

- And I'd like to thank Ian and Yamelisa for sharing their stories, their time, and their insight with us.

Earlier this month, the American Diabetes Association published a comprehensive analysis assessing the financial burden of living with diabetes in the United States.

The detailed report revealed that in 2022, the annual cost of diabetes surpassed $412 billion.

To continue this conversation on the cost of diabetes, we have Dr. Robert Muscalus, a representative from Capital Blue Cross, and Christina Correy, a patient living with type two diabetes, both here with us now.

Thank you both so much for joining us.

- Thank you.

- Dr. Muscalus, we'll start with you.

$412 billion.

What's your initial reaction to that?

Does that sound right?

To the average person, that sounds like a lot of money, but what about in the medical world, is that a lot of money even in the medical world?

- Brittany that is a lot money.

Compared to other types of conditions, it certainly ranks up with many of the conditions that impact individuals' health and, of course, health care costs overall.

- Sure.

Dr. Muscalus, you are representative today of Capital Blue Cross, but what's your background in all of this?

- Well, I'm trained as a family physician, practiced for several years, transitioned to the health insurance world.

But in between, I also served six years as the Pennsylvania Physician General.

So I come to this topic having practiced and treated patients with diabetes, dealing with diabetes and public health, and now, on the insurance side, helping individuals with diabetes be able to manage them using resources that are available to them.

- Sure.

And when we talk about the cost of diabetes, it goes far beyond just a diagnosis and buying insulin, right?

- Oh, yes, the costs are not just financial, they are significant, but there are costs that are associated with time.

When someone develops diabetes, it may be in addition to other conditions that they have.

It can impact not only another layer of care that they need, that is in addition to conditions that they have, but it can also impact their family.

It can require additional doctor visits, additional testing.

So, yes, there are a variety of additional costs that come with diabetes.

- Sure, and sometimes complications that happen.

- Absolutely, we know that individuals with diabetes need to be closely-monitored because it can lead to vision problems, problems with kidneys.

If they're not treated well and appropriately, it can lead to more serious and more costly complications.

- Sure.

That $412 billion...

I almost said million, but billion dollars also trickles down in ways of copays, out-of-pocket expenses.

Can you talk a little bit about that?

Stuff we don't think about every day?

- Well, obviously, the co-pays, deductibles, co-insurances are all going to vary based upon the type of insurance that someone has, whether it's through their employer or whether it's something that they've purchased individually.

They will find that their costs may be different than someone that they know who has diabetes, cost of medication, cost for office visits.

So clearly, those costs will increase if someone is going to need additional care.

But the cost from one person to another will certainly vary based upon the coverage that they have.

- Sure.

And I'd like to bring Christina Correy into this conversation, Christina, thank you for joining us.

You're living with type two diabetes, which is a little bit different than what we saw with Ian and Yamelisa.

So talk to us a little bit about your diagnosis.

When did you receive this diagnosis and what's happened since then?

How are you treating it?

- Okay, I was pre-diabetic for a few years, and then, I developed diabetes two.

At first they thought it was uncontrollable, because it was such a high number.

So, they decided to put me on the insulin and pills, and then, I brought my number down, and then, again, it went high again.

So now, I'm on two insulin and more pills.

And the cost of it is higher for me.

- Sure, let's talk a little bit about that cost.

From what I understand, you've been one of those people who's had to ration your insulin.

- Yes.

- Talk to us about that.

How does that work, and how does that make you feel that you have to do that?

And why have you had to do that?

- Recently, I lost my insurance.

I had Capital BlueCross BlueShield.

They covered, but they only covered a certain amount.

And so, I have my insulin, and I'm supposed to take it every day, but I take it every other day until I can apply for more insurance, which I'm looking, but has been a little difficult.

I'm trying to find some programs that will help me assist to get my insulin and be able to take my medicine, because unfortunately, it's not a good thing to stop taking it.

- Absolutely.

We're going to ask Dr. Muscalus about that in one moment.

But first, talk to us about that cost.

What does that cost look like to you?

Whether it be the financial burden or the mental burden?

- Well, the financial burden is one of my insulin pills, are $100, and the other one is 79.

And then, it goes on to $40 for my pill, everything.

And it adds up, and it's so much... - And how often?

- It's monthly.

- Monthly, okay.

That's a costly bill.

And what about that mental burden?

- The mental burden is I go to my doctor and I explain my situation and try and best to help me the way I can.

But it's kind of hard with not having insurance, but they're going to see exactly what they're going to do.

- Sure.

And Dr. Muscalus, I'd like to bring you into this conversation here, just the specific case, but it's a case we hear so often, people either in between insurance, going off of insurance, coming back on different insurance.

Are there programs that can help?

- Yeah, absolutely.

In fact, in response to not only the rising cost of diabetes in general, but also the rising cost of medications to treat diabetes.

Capital has put in place programs.

We have obviously care management programs where we have nurses available to work individually with patients who have diabetes.

We also have programs that can prevent diabetes, manage diabetes, and even reverse diabetes for those with type two diabetes.

And finally, I always encourage patients to talk to their physicians and providers about other programs that are available to help reduce the cost of medication.

We do, at Capital, have programs that if someone qualifies, can have significant reduction in their out-of-pocket costs for many medications.

We have done these things in response to what we've seen with regard to the rising costs of treating diabetes.

- Sure.

Is this a story you hear often, people going on and off of their insurance, and not being able to get the insulin they need?

Have you heard of insulin rationing before as well?

- We've heard of it.

And I know that in our programs, we have ways to identify through social determinants of health in getting individuals' family histories.

If there are issues where they're having difficulty in getting the things that they need, we'll look to not only resources that Capital has, but we'll also help them get connected to community resources where they can also find additional help.

- Sure.

And with your medical background, can you explain what happens if someone doesn't take their insulin correctly?

- Well clearly, patients need to take all of their medicines when they're supposed to.

And if they don't, they run the risk of developing complications.

And if those complications occur, that can be even more difficult to treat.

- Sure.

What are some of the symptoms of that?

- Well, we know that regular blood work is needed to monitor kidney function, along with blood sugar levels, seeing an eye doctor, ophthalmologist on a regular basis to look for changes that might indicate diabetes impacting vision, even evaluations of nerves to see if there's any evidence of neuropathy or damage to the nerve.

So as I said earlier, when someone has a diagnosis of diabetes, they really need to be closely monitored.

- Sure.

And Dr. Muscalus, if someone wants some of these resources to look into that, how can they do so?

- Well, clearly, if they have a personal physician, they should reach out to their provider's office.

And always, Capital Blue Cross is very happy to speak with anyone through our member services department.

- Sure.

Christina, are these programs that you think that you'd be interested in taking part of?

Are they programs that you've taken part of in the past?

- Yes, I would be interested.

I just have to do a little bit more research.

And then, if anything, look into the community as well.

It's always good to keep your options open.

- Absolutely.

How does it make you feel to hear that there are resources available?

- It makes me very happy because I would like to continue to be healthy and there for my family.

- And we want people like Christina to be happy, to have access to what you need.

We don't want you to have to worry about managing your diabetes.

We want to be able to come alongside and help you do that.

- Absolutely.

And we're going to talk to more of the resources during this program just a little later.

But in the meantime, Dr. Muscalus, Christina, thank you so much for joining us.

- Thank you.

- Thank you.

- One in four health care dollars spent in the US is for patients diagnosed with diabetes.

Some in Congress are working to reduce that medical cost to the average person, including our local legislators like Congresswoman Susan Wild, who represents Carbon, Lehigh, and Northampton, as well as parts of Monroe counties.

- Americans represent 15% of the global insulin market, yet we generate almost 50% of the pharmaceutical industry's insulin revenue.

Some might say that these price-capping announcements are examples of corporate responsibility.

Let me correct the record.

I say, it's about damn time.

I say this action is a hollow, decades-too-late example of big pharmaceutical companies attempting to shirk regulation as they face the most realistic possibility ever of being held accountable for price-gouging Americans.

- And joining us now is Congresswoman Susan Wild.

Thank you so much for joining us.

- Thank you, Brittany.

Happy to be here.

- Glad to have you.

And this has been something you've been touting, and this has been something you've been championing for.

Lower medical costs, especially when it comes to medications, throughout your entire run in office.

So why is that so important to you?

- Well, I have to tell you, it started back in 2018 when I was running for office, and when I was out and about talking to people, people I'd never met before, I heard about prescription drug prices more than any other subject which was a little bit startling to me because, up until that point, nobody in my family had encountered anything particularly high like that.

And what I really came to find out was that diabetics were the ones that were really, really struggling with the price of insulin.

It was an erratic price.

People couldn't afford it.

Their insurance wouldn't cover enough of it.

The price changed from month to month, and it was devastating to hear.

So it became my mission when I got to Congress.

- Sure, between 2014 and 2020, the price of insulin just skyrocketed.

It has since leveled off a bit, but I think that's a lot in part to what folks in Congress are doing.

What are some of the things you've done over the past years in office?

- Thank you.

I would like to think it is because of some of the pressure that's been applied by Congress.

Most notably, last year, the Inflation Reduction Act was passed and signed into law, and it capped insulin for Medicare recipients at $35 per month, which is great.

I'm really happy that happened, but it's not enough.

We have to keep working to get insulin prices down for everybody.

Among the people that I met included parents of younger children, one in particular that I will always remember, a 14-year-old girl, and her father's greatest concern was what was going to happen when she went off her parent's medical insurance.

This is the kind of thing that we absolutely have to keep our eye on.

We cannot just say, "Okay, now we've got $35 a month insulin "for Medicare recipients," not nearly enough.

So I'm really happy that also part of the Inflation Reduction Act, which I worked relentlessly to get passed because of the prescription drug provisions, was a negotiation program, the idea being that Medicare would be able to negotiate with the drug companies.

And it's a phased-in thing, so in August of last year, they announced the ten medications...

I'm sorry, August of this year, they announced the ten medications that would be the start of the pilot.

And it's for people with chronic illnesses, rheumatoid arthritis, heart failure, Crohn's disease, things like that.

And it's going to be a game-changer for people.

It literally will bring down the prices of those ten medications for people who have no choice but to take them, they are life-saving medications.

So that's part of what we've done.

But as I keep saying, there's more to be done.

And it's staggering to me, how slowly this has evolved.

What many people do not realize is that, until this Inflation Reduction Act passed, Medicare could not negotiate any prescription drug prices with any pharmaceutical company.

So think about that.

Medicare is the single largest purchaser of medications in our country, and yet, they were not able to negotiate with the sole providers of these medications.

That's why this bill is so important.

And as a result, what has happened is that Americans have been subsidizing the price of prescription drugs for people in other countries.

So people in other countries, as we know, get these drugs at much lower prices because they do have the power, their governments have the power to negotiate.

We don't.

That's what's really going to be a game-changer.

- And I was going to ask you about that.

Why is it that people can go to Canada or Mexico and get their insulin cheaper than here in the United States?

- Well, I'm afraid it's because of the pharmaceutical lobbying.

There are two pharmaceutical lobbyists for every member of Congress, if not more.

An astronomical amount of money is spent by Big Pharma on the lobbying efforts.

And by the way, for people who will claim or be concerned that this price negotiation, bringing the prices down will somehow affect their ability to do research and development on new drugs, and that kind of thing, Pharma's marketing budget and lobbying budget is infinitely larger than its R&D budget.

And so, it just tells you that they're concerned about essentially price-fixing, or getting the maximum that they can for these drugs.

- Sure.

And just to point out that you've been working on this for a while now.

We saw Yamelisa Tavares.

We met her earlier in the program, and she was someone you took to the State of the Union.

Why did you decide to take someone with diabetes?

- I took her, she was one of the people I met when I was first running for office.

And I believe it was Yamelisa who told me the story of dropping a vial of insulin on her bathroom floor and having it shatter, and that feeling of desperation because she wasn't going to be approved by her insurance to get another vial until the next time that her prescription was up.

And so, this was such an important subject.

And diabetes, by the way, is very, very prevalent in Pennsylvania, and certainly in Pennsylvania's 7th.

I thought it was really important to bring somebody to the State of the Union who had experienced this, and whose stories I had relied on, in terms of what I did in Congress.

- Sure.

Congresswoman, you have a couple of other bills that you're working on to continue this fight against the price and the cost of insulin, and other drugs.

What are you working on?

- Well, the Affordable Insulin Now Act would cap insulin for everyone, not just Medicare recipients, at $35 a month.

And let me tell you why I'm picking on insulin, so to speak, not because it's more important than these other drugs, but insulin, when it was invented, the patent for it by the inventor was sold to the United States government for $1 because the inventor thought that it was so important that people have access to this drug.

And what we have seen over these many, many, many decades, and by the way, the formulary for insulin has not changed in any meaningful kind of way, and yet the price just keeps going up.

To me, that is just outrageous.

So that's one.

Also, the Lowering Drug Costs for American Families Act would allow people with private health insurance, not Medicare, to have access to the lower drug prices that will be afforded as a result of Medicare's negotiation with the drug companies.

And then, there is also a really important bill, the PROTECT 340B Act, which takes on the middlemen who actually undermine the prescription drug discount program that so many seniors and lower-income folks used to get the care they need.

And then finally, I just want to mention that there is a group of us in Congress, a cross section of the Democratic Caucus who are working on a number of things that we're hoping to introduce in the next Congress.

And I say in the next Congress, why?

Because I don't see any possibility of it being brought to the floor in this Congress.

And I want to point out that the Inflation Reduction Act was passed in the last Congress and the current GOP-controlled Congress has talked about wanting to repeal it.

So all of these great prescription drug-pricing issues would go away.

But this group that's working together is trying to make sure that we are not only focused on the pharmaceutical companies, but also the insurance companies, the pharmacy benefit managers, and making sure the access supply chain, that kind of thing, is protected.

- So, Congresswoman, that's what's coming down the line, and what's coming up in the future?

What have you heard from people since you've been able to help get a cap on insulin, and that kind of thing?

Have you heard stories from people that this kind of saved their life, or made their life better?

- Well, yes, I have.

I've done a few senior forums.

By and large, people are very, very happy.

And by the way, some of those forums were done before the price actually dropped, which was July 1st of this year.

So they were very anxious for it to happen.

Other people expressed concern about these other medications that I just mentioned, not just the ones that I specifically mentioned, but drugs that are really vital to fight cancer and heart failure, and as I said, rheumatoid arthritis and Crohn's disease, and asthma and that kind of thing.

And the other thing that I heard a lot from people, and this is a frustration that I share, is that these things take too long.

We passed the Inflation Reduction Act in 2022.

I was one of the people saying, "Why do we have to hurry up and wait?

"Why can we not just get this done?"

At that time, I would say, "Why do we have to wait until "the summer of 2023 to get started on negotiation?"

So I'm happy that's happened.

I'm happy that the insulin for seniors has been capped.

But it is frustrating, the amount of time that this takes, and that's something else that this group I'm working with is trying to curb.

- Sure.

Would you say insulin is a basic human right?

- I say that health care is a basic human right.

Insulin is part of that, life-saving prescription medications are a big part of that.

- Sure.

Congresswoman Susan Wild, we really appreciate you coming on and answering our questions today.

- Thanks so much for highlighting this very important subject.

- Absolutely.

Thank you for joining us.

If our goal is healthy living, then preventing illness may prove far more valuable than curing it.

And a first step to reducing your risk is knowing if you have pre-diabetes.

That's the idea behind a new campaign from the CDC.

Earlier this week, I spoke with their director of the Division of Diabetes Translation, Dr. Christopher Holliday.

Dr. Holiday, thank you so much for joining us.

- It's a pleasure to be here.

- Absolutely.

Most people are familiar with diabetes, but not the difference between type one and type two.

Can we start there?

Can you explain what the difference is between the two types?

- Yes.

Type two diabetes is what we'll be talking about more during this time, but it's essentially how the body changes food into energy.

And sometimes that's challenged by different factors, including overuse of the pancreas and the lack of insulin, or the overproduction of insulin in the body.

And so, the body is challenged with breaking down that food into sugar to use for energy.

And so that's type two diabetes, which is essentially a lifestyle-related disorder.

Type one, on the other hand, is more genetically linked and it is more congenital.

So people can be born with type one diabetes, or they can acquire it as they get older.

And that is essentially one in which they are insulin-dependent and they require insulin, whereas the lifestyle changes that are modest with diabetes can be done without use of insulin.

But that's determined by your health care provider.

- Sure, so the difference between type one and type two is type two can be modified with diet and exercise, while type one folks are going to be living with that for their whole life?

- That's right.

And once you have a diagnosis of diabetes, whether it's type one or type two, you'll always need to manage it and make sure that you're working closely with your health care provider.

- Sure.

Dr. Holliday, where does gestational diabetes fit in with the type one and type two?

- So as we talk about pre-diabetes, or those that are at high risk for type two diabetes, we're talking about how to prevent progression of type two diabetes.

So, the campaign that we're launching, or the continuing campaign that we have with the Ad Council, Do I Have Pre-diabetes, is releasing new PSAs today, Be Your Own Hero, and it's really focused on adults across the nation, one in three of which have pre-diabetes, and 81% of them don't know they have it.

So, that's 98 million people in the US that have prediabetes.

And the campaign essentially helps them to be aware.

So it's an awareness campaign where they are encouraged to go to DoIHavePrediabetes.org, a website, to take a simple one-minute risk test to know where they stand.

And that risk test asks about certain factors like whether if you're a woman, you've ever had gestational diabetes, whether you have some added weight, whether or not you have a sedentary lifestyle or have a close family member that's had type two diabetes, like a mother, father, sister or brother.

And these factors can put you at high risk for having pre-diabetes or undiagnosed diabetes.

And so, taking that risk test really helps you to be aware of your stance.

- Sure.

From a medical perspective, what is pre-diabetes?

- So, pre-diabetes is when a person's blood sugar is higher than normal, but not high enough to have a diabetes diagnosis.

It is a serious health condition like diabetes, but it puts you at risk for other serious health conditions like progressing to type two diabetes, but also heart attack and stroke.

And so, pre-diabetes is really a wake-up call.

It's an opportunity to reverse or prevent, or delay progression to type two diabetes.

- Sure.

So how many Americans, if you had to guess, are living with pre-diabetes?

And do many of them know that they're living with pre-diabetes?

- Yeah.

As was mentioned, one in three Americans has pre-diabetes.

That's 98 million people across the country.

And because it doesn't have symptoms, 81% or more don't know they have it.

So that's why taking this risk test really increases their awareness and their knowledge of the possibility of having prediabetes.

And then, they can talk to their doctor and have a confirmatory blood test to see if they actually have prediabetes.

And then there are several options that they can take from there, including having their physician refer them to a lifestyle change program that's part of CDC's National Diabetes Prevention Program.

And this essentially is a lifestyle change program that affords the participants a coach, a lifestyle coach that helps them to make modest changes to their lifestyle, to help prevent progression to type two diabetes.

And that includes losing 5-7% of their body weight, it includes helping to manage stress.

It includes helping to eat better and to move more, and getting the requisite amounts of physical activity every day, which is really 20 minutes.

- Sure.

Dr. Holiday, a lot of people who are living with diabetes talk about the cost of insulin, medications, living with this disease.

So getting checked and trying to reverse pre-diabetes sounds like a more cost-efficient way to combat this illness.

Would you say that's the best way to keep costs low?

- Absolutely.

Not only is it the best way to improve your health outcomes, but it absolutely helps to reduce health care costs.

People with diagnosed diabetes are two-and-a-half times more costly to the health care system than someone without diabetes.

And recent reports out of the American Diabetes Association shows that $412 billion in health care costs are expended annually, and that's due to lost wages or lost work for people that have diagnosed diabetes.

So this is not only a public health crisis from a health perspective, but it's an economic one.

We want to make sure that we are preventing people from progressing to type two diabetes for better health outcomes, but also for curbing costs.

- Sure.

So when talking to patients, what are you telling them, ways to reverse diabetes?

What are the tips you let them know?

- First of all, being aware is the greatest tip.

Knowing where you stand.

Being Your Own Hero and taking that one-minute risk test is so simple.

We don't have a lot of minutes in the day, but we can spare one minute to go and take - and answer a few questions, and really know if you're at high risk for prediabetes or type two diabetes, and then, talking to your health care provider and making a plan.

So that's the real takeaway message from today.

- Sure.

So when you're talking about eating healthy and exercising, are we talking about switching to salads every single day from here on out, and exercising hours each day?

Or can it be in moderation and a gradual work towards a better lifestyle?

Yes.

- The beauty of preventing or delaying progression to type two diabetes are modest lifestyle changes, very small changes.

Again, losing 5-7% of your weight is 10-12 pounds for the average adult.

Not just eating salads, but being able to balance your nutrition.

And this is where the lifestyle coach that's part of the National Diabetes Prevention Program helps with.

How do you take what you're already eating and tweak it a bit to make it a little more healthy?

How do you take what you do in your day-to-day and engineer in more physical activity?

So it's a support system that is built within this lifestyle change, one that it really helps people to make those lasting lifelong changes that will, in the out years, prevent progression of type two diabetes.

- Great, Dr. Holliday.

And if folks want to check out those resources one more time, where can they go to get them?

- To check out the resources, they can go to DoIHavePrediabetes.org.

Take the one-minute risk test, and also find out about resources that are within the National Diabetes Prevention Program.

- Wonderful.

Dr. Christopher Holliday from the CDC, thank you so much for taking the time for us today.

- Thank you for having me.

- Some great information from the Centers for Disease Control and Prevention.

And speaking of those PSAs, let's take a look at one right now.

- Even the mighty might not see it coming.

It's prediabetes, and it captures one in three adults.

You may not even know you have it, but you can escape.

Take the one-minute prediabetes risk test to know where you stand.

With early diagnosis, you can change the outcome and prevent or delay.

type two diabetes.

Be your own hero on smartphones everywhere, at DoIHavePre-diabetes.org.

- If you're an adult at high risk of developing type two diabetes, there are some lifestyle changes that can change that.

Eating healthier, increasing physical activity, and some moderate weight loss can reduce the risk of developing type two diabetes.

Joining us now are representatives from two organizations that work with people across the Lehigh Valley living with diabetes.

Maribel Tandazo is the senior director of Community Impact at the Greater Lehigh Valley YMCA.

And Carmen Bell is the senior director of Healthy Aging from the United Way, Greater Lehigh Valley.

Ladies, thank you so much for joining us for this conversation.

- Thank you.

- Carmen, let's start with you.

The United Way offers program funding and other resources to people living with diabetes here in the Lehigh Valley.

Can you tell us a little bit about those programs at the United Way?

- Sure.

Our goal is to help mitigate the impact of diabetes in our community.

And we know that it is a public health crisis.

So we work as a funder to organizations that are providing direct programming to individuals to help them with that.

We also have a diabetes coalition of the Lehigh Valley.

Maribel's also a member of that coalition.

And our goal there is to build education and awareness around this disease, to let people know that it is a silent killer and let them know the steps that they can take to mitigate their risk and to reduce the impact that it has on their lives.

- Sure.

Can you elaborate on that coalition?

Who makes up that group?

So it's a community coalition consisting of residents, people who have diabetes, those who work in the health care industry, anyone who is concerned about diabetes and its impact on our community.

So it runs the gamut from nonprofit partners to medical professionals, to your typical resident who's living and managing that disease.

- Sure.

And as your role working with folks who are elderly, how does all of this play out for them?

How does diabetes impact that group of people?

- Well, we know that there's a propensity for people who are over the age of 60 to develop adult-onset type two diabetes.

We know that this does not have to necessarily be the case, so we want to encourage them to be mindful of their diet and lifestyle choices so maybe they can prevent the onset of the disease.

But once it occurs, we want to make sure that they are connected to resources so that they can adequately manage it, and they know the risks that are involved to the other systems in their body.

- Sure.

What about the cost of insulin?

Is that an issue among that age group?

- Definitely has been an issue, so that's why we've been so happy that there's been some efforts made by our government to lower those costs of insulin.

And then, you have those diabetics who are not insulin-dependent, but they are using the testing materials.

And for instance, those can cost up to $200 just to get started with the daily testing to see where your blood sugar is.

- Carmen, what are some of those efforts that the government has done to help reduce that cost on the older population?

- Well, there's been a direct impact to lower the cost of prescription drugs through the federal government, and to allow Medicare to now begin to negotiate with big pharmaceutical companies to lower those costs.

- Sure.

And we heard Congresswoman Wild talk a little bit about that.

Now, when it comes to funding from the United Way, from what I understand, you use some of that funding, you grant some of that funding out to other organizations.

How does that all work?

- So we provide funding to our coalition to support their efforts to be out in the community.

And they are currently, we have a couple of volunteers who are out in the community and delivering programming at the places that people already congregate.

We thought it was important to make information and services accessible.

We also have a new initiative, community hubs that we started this year, and what we wanted to do was make nutritious food programming that includes information about diabetes and other health activities, creating a social network for older adults so that they know that they have others that they can turn to.

And in an effort to not put the diabetes front and center to them, but develop other ways to talk to them about the disease so that they might pay attention to it and be able to manage their own situation.

- Great.

I'd like to bring Maribel into this conversation, from the Greater Lehigh Valley YMCA.

Thank you so much for joining us.

How does the YMCA support people living right here in the Lehigh Valley with diabetes?

From what I understand, you have some programs.

- Absolutely.

We heard Dr. Holliday from the CDC mention prevention programs.

At the Y, we are fortunate to offer the National Diabetes Prevention Program with the aim of reducing the onset of type two diabetes, or delaying the onset.

What we know at the YMCA as a national organization of a provider for prevention programs that prevention works.

With programs like this, we have over 58% chance of reducing the onset of type two diabetes.

With this program, we aim to build healthier communities.

So we're working through a yearlong program to not only provide resources and information, but build a support system for healthier habits.

- Sure.

So what does that program look like for someone who's signing up at the Y?

- Sure.

We're very fortunate to offer this program virtually, which means that there are no barriers to participation with location.

If you have any barriers with technology, we're able to support those efforts as well.

And for any qualifying adult, 18 and over, who is eligible to participate, we are fortunate to receive grant funds that covers the cost of the program currently.

- Sure, because we've heard throughout this program that this disease and this diagnosis often comes with a cost, so there are financial options for people who want to take part in some of those resources.

- Absolutely.

For those who are looking at the prevention of diabetes, type two diabetes, we have programs like the prevention for those who are managing diabetes or looking for healthier options.

we are the Y.

So we are fortunate to be able to provide an entire suite of healthy living programs aimed at all ages, from birth all the way to our senior population.

- And you mentioned Dr. Holliday, I want to bring Carmen back into this, because Carmen, you had mentioned to me during that piece that you are someone who once lived with pre-diabetes.

- Yes.

Getting that diagnosis was a little shocking.

But I should not have been as surprised, since there was a history of diabetes in my immediate family and in my extended family.

And so, you know that you need to do things to mitigate the impact on yourself.

But sometimes, the disease just progresses, and it has morphed into type two diabetes.

So now, I'm trying to manage my situation through monitoring the blood sugar on a daily basis through limited medication and through lifestyle changes.

- Sure.

And what has the cost been like on your life?

You know, we've heard a couple of people say it's not just financial, but it's mental as well.

- Well, you know, that diabetes can have devastating impact on you.

It can lead to heart attacks, stroke, kidney failure, eventual dialysis, amputations, I mean, loss of vision.

So you just have to be very mindful of what's happening.

And it's a little stressful.

It can be quite depressing to think about all of the things you have to be concerned about because you have this disease.

So you're constantly watching, monitoring what you're doing.

- Sure.

So all the more reason to persevere and push through, and join the coalition and get some of those funds out there.

Is there anything else you think people should know about the United Way's efforts to fund some of the diabetes programs throughout the community?

- Sure thing.

So we have our coalition, which is open to any and everybody who lives in the Lehigh Valley, or even who don't live here, if they're interested in the information that we have to offer.

We partner with agencies like the Greater Valley Y and some of our other community hubs to make sure that there's access to healthy, nutritious food, that there's access to social networking engagements, exercise programs, etc.

So, we are trying our best as to support those programs that can help people manage their lives.

- Sure.

And if folks want to get more information or get involved with all of that, how can they do so?

- So they can go to our website, UnitedWayGLV.org, and scroll to the Healthy Aging page.

- Sure.

And I'd like to ask Maribel the same thing.

If folks want to get involved with the YMCA, what should they know and how do they do that?

- What they should know is that we are for all.

So do not hesitate to reach out to either branch specifically, or visit us online at GV-YMCA.org.

- Wonderful, ladies, thank you so much.

Maribel Tandazo, from the Greater Lehigh Valley YMCA, and Carmen Bell from the United Way, Greater Lehigh Valley.

Some really great resourceful information here.

Thank you very much.

- Thank you.

- Increased physical activity, moderate weight loss, and eating healthier are some of the lifestyle changes you can make to cure and even prevent type two diabetes, as we've heard throughout this program.

Jessica DeLuise is a certified culinary medicine specialist and physician's assistant.

She stopped by our studio to cook up some healthy and tasty food that's not only good for you, but it's low-cost, as well.

Jessica, it's so great to have you.

I'm so excited to cook with you today, Brittany.

Thank you so much for joining us.

Now, diabetes, one of the ways to help curve type two diabetes and pre-diabetes is with diet.

So we have a diet-friendly, a couple of diet-friendly recipes today that can help with the diabetes, you know, lowering some of the symptoms and that kind of thing.

Yeah, absolutely, and I do want to say that more than 38 million people in the US have diabetes, almost 100 million have pre-diabetes.

And of those, many don't even know that they have it.

There may not be warning signs to diabetes or pre-diabetes.

So this is very important, I do want to encourage everyone to get their blood checked, check in with your primary care provider, really know your numbers, so you can start to implement some of these changes before it's too late.

Sure, earlier in the programme, we heard the CDC say with diet and exercise, you can take that pre-diabetes and kind of quell the symptoms.

So we're using some foods today, and you brought some examples of healthy, diabetic-friendly foods.

So tell us about what you've brought.

You got it, so often what we might recommend to a patient is something called the Diabetic My Plate Diagram.

Now, this is a really nice visual representation.

I have a picture right here for you to look at of how we might build our plate in a balanced way to eat for diabetes and pre-diabetes.

And what we do with this My Plate method is we'll actually cut the plate in half, on one half of that plate, we will do non-starchy vegetables, things like lettuce, spinach, broccoli, cauliflower, things like that.

In the other half, we're actually adding carbohydrates and then our proteins.

So carbohydrates, of course, are going to be something that we're going to focus on very heavily with diabetes and pre-diabetes.

And when we choose carbs, it's going to be more of those wholegrain carbs, whole wheat carbs.

Some examples here, lentils, wholegrain, pasta, oats, legumes.

Corn is actually a wholegrain as well.

Of course, fruit will end up in that little compartment as well.

And then our proteins, fish, chicken, plant-based items like tofu and some great healthy, unsaturated fats, avocados, nuts, olive oil, things like that.

What are we going to be making?

We are making two meals, I'm very excited about this.

They fit the Diabetic My Plate diagram.

And we're going to be making first what I call a dump minestrone.

We're dumping everything in one pot.

Easy clean-up, easy recipe, kind of no measurements here, we're just going to go for it.

And then we're going to make a tuna taco.

Not the most traditional taco recipe, I'll give you that, but very, very tasty and we can get started, are you ready?

Yeah.

OK.

Sounds really good, it already smells good.

I know, I already have some onions sauteing.

You want to move that right onto the burner.

All of these ingredients came from my local dollar store.

So when we talk about diabetic friendly meals, it doesn't have to be expensive.

Got you, so it's cost-effective, too.

Am I putting this whole thing in here?

Put that whole thing in, one can of diced tomatoes.

All right.

I also have a can of broth.

So because typically some pre-made broth or stock is higher in sodium, I am not going to add any additional salt to this recipe.

OK, that's kind of a really good tip there.

We have chickpeas.

Chickpeas, yeah.

Minestrone typically will have kidney beans.

chickpeas are totally fine and then canned pumpkin.

I know this sounds a little odd, but canned pumpkin is going to make this nice and creamy and thick.

I've never cooked soup with pumpkin.

I know, typically we only bake with pumpkin, right?

But we're going to get great fibre, lots of antioxidants and vitamins.

So that's probably good enough there.

right.

And then our frozen veggies, another tip when we talk about cost of food, buy frozen.

I mean, frozen is such a cost-effective and convenient way to keep veggies on hand.

Sure.

Stock your freezer, buy them when they're on sale.

You can get about a pound of veggies like a pound bag for a dollar, sometimes, pretty easy.

Great.

And inexpensive, and then we're going to add... look, we have basically we're representing this My Plate method.

We have all of our non-starchy veggies, thank you, mix it up.

We have our frozen veggies, beans in there, and now we have our carbohydrate, which is going to be a little bit from the beans and from our wholegrain brown rice.

This also came from my local dollar store.

Great.

It's part cooked, so I'm going to pop it in.

I could also use a little pastina or pasta in this recipe if I wanted to.

As soon as all of the veggies come up to temp, remember, our frozen veggies are already cooked and our rice, we can turn this up a little bit, and our rice softens up, we're good to go, that's it, we're totally done.

So easy.

Jessica, I want to ask, you know, sometimes there's a misconception about canned or frozen vegetables.

Are they just as good as some of the fresh?

Yeah, so frozen or canned, just as good.

They are often frozen at the peak of ripeness.

So you're getting them essentially right from the farm.

They've frozen those veggies for you, the only caution I will give consumers is if you're buying canned vegetables or canned beans, rinse all out that salty brine.

That's where a lot of that sodium comes from is that liquid.

Just rinse it and then rinse your veggies, you're good to go.

I actually already did that with potatoes.

We're going to add some potatoes in there, too.

That's a great little tip, and there you go, your soup is done.

How easy could that be?

Oh, gosh, that was so easy.

It's super, super easy and fast.

Now, if you can't get to your I got the onion, that's the only thing I did not get from my local dollar store.

If you cannot get fresh onion at a wholesale club with very inexpensive, use dehydrated onion.

Absolutely, you can do that.

You can swap it out?

Yes, and then seasoning, whatever season you want there.

Italian seasoning, basil, parsley, you're good to go.

Wonderful, I love that and how long are we cooking that for?

Just to bring everything up to temperature.

I would say 15, 20 minutes and you have a meal.

Great, as easy as that.

And this is impressive.

And we probably spent less than $10 on this entire thing.

It's going to feed a whole family.

Great, so it's healthy, it's good for people with diabetes, as well as prediabetic, really the whole family and then it's cost-effective as well?

Absolutely, yes, definitely.

You want to do another one?

Sure, let's do another one.

Again, this is going to be a taco, but not... grab that spatula, would you please, Britney?

So this is going to be a taco, not the most traditional recipe, I'll give you that, we're using canned tuna.

I like this idea, I never thought to use tuna in a taco, canned tuna.

Canned tuna, a great source of protein.

Great source of omega three fatty acids.

Of course, we don't want to eat it every single day.

Tuna is one of those fishes that we eat sparingly.

So go ahead and put the tuna right into my pan here.

I bought the tuna in water and I've already drained the majority of water out.

So we'll add a few cans there, maybe we'll do two would be, I think, enough for this.

OK. And then a little bit of taco seasoning.

Alternatively, if you're not a big fish family and you want to use a rotisserie chicken, I say go for it.

Awesome.

I like that idea.

Yeah, rotisserie chicken is on repeat in my house.

It's one of the few things that our three-year-old will actually eat.

Kid friendly as well.

Exactly, and it's cost-effective.

So I'm going to use a little bit of taco seasoning and we'll basically just let that come up to temperature, warm through.

So that's going to be the protein part of the meal.

Then we'll have some corn tortillas that I'll throw just on to this pan and toast them up on either side.

So this is going to be, any corn products, of course, corn is a whole grain.

Right.

It's also is one of those seed veggie wholegrain combination foods.

Any corn-based products like a corn tortilla or tortilla chips you could use would count for the carbohydrate portion of this meal.

So once these are toasted up on either side, I'll raise our heat, we're going to kind of let this all come to life.

We'll move over and we'll plate it up and then we'll add a lot of these veggies on top are going to be the non-starchy veggie.

So onto my plate, I might do a little bit of lettuce here, while I'm waiting for those to toast up, like this, and some of my black beans.

So this is a great plant-based source of protein.

Great little side here.

Great little... Yeah, exactly.

My corn, this is a little bit of a carbohydrate, so we're not going to overdo it here.

Salsa, salsa adds so much flavour and it's 100% vegetables.

It's a good one, it's a good one to put on eggs, too.

Oh, yes, absolutely, that's a great point that you make there.

We could absolutely do this.

I'm going to flip my little corn tortillas here.

We could actually do this for breakfast, right?

We could swap out tuna, swap in some scrambled eggs, right?

Love it.

Yeah, and then, of course, on top, we'll do a little bit of plain yoghurt, I love plain yoghurt instead of sour cream, a little bit more protein, some probiotic content.

One of the nuances with dairy and that My Plate is that sometimes your dairy has that lactose sugar.

So you want to make sure that the lower fat dairies they'll count as your protein, but maybe if it has too much fat or sugar, it'll count as your carb.

Just be careful with your dairy when you're adding those to meals.

Great.

And then we'll do a little avocado as a nice healthy fat as well.

As I cut up this avocado, you want to put our tortillas right on that place?

Absolutely.

And Jessica, where did you learn all of this?

Oh, my goodness, well, you know, I grew up in an Italian household, so I grew up cooking for sure.

But I work as a physician assistant, so I've been seeing patients for 13 years and more recently, which is very, very exciting, patients are asking about food.

They are really curious about what steps they can take at home to kind of ameliorate those risks of chronic disease.

I also have a certificate in culinary medicine, so I got that from Tulane University back in 2019, and we talked a lot about food as medicine... Not in place of medicine!

And that's a big misconception.

Sometimes we need medicine to make sure that we stay safe, but we can use food in adjunct and maybe we can decrease the need for medicines or multiple medications, which is really great.

Absolutely.

Those look amazing.

I have these tacos all played it up with some tuna... and some avocado, there you go.

And then you can put this on and you can see quite easily I can bring this to my table and I could just build my own taco right there.

And I've really achieved the diabetic My Plate method.

Sure, Jessica, I love it, this looks absolutely delicious.

What are some of the foods that people should be avoiding if they have either pre-diabetes, if they're diabetic, or people who just in general want to eat a little bit healthier, What would you suggest?

Absolutely, I don't think this is very complicated and most of us already know the answer to this question, Brittany, but if we look back over here at this display I have here, when we're choosing carbohydrates and we'll hone specifically in on carbohydrates, we want to choose the ones that are in the most whole food form and that those foods are often going to have a lot of fibre antioxidants nutrition, versus some of the cookies, the cakes, those refined wheat products, baked items like muffins or bagels, things like that.

Of course, our fast foods, those are things that we're typically not going to want to be eating every single day.

It is easy to prepare meals at home.

We can control the added sugar, we can control the sodium.

And I think that's really, really important... That's looking great.

It does look really good.

How do folks check out some of the work you've done?

So head to the wellness kitchenista.com.

You can see all of my social media platforms linked.

There's some content that I've created, I produced a television show a few years ago.

It's all linked there and you can get access to all that.

Wonderful, shall we plate up this soup?

I think we should.

Looks absolutely delicious.

Let's see, do we have a spoon.

A ladle, yeah.

Do we have a ladle?

I'm not sure.

Oh, my gosh, we have lots of knives here.

Oh, we have one.

Good, good.

Fear not, here you go.

I'll let you plate it up, I'll grab this bowl.

This looks absolutely delicious.

And if there's one thing you want to leave folks with when they're cooking and trying to eat a little bit healthier in the kitchen, what would you leave them with, what kind of tip?

I would say that you didn't get to this place sometimes with these habits overnight, so a lot of people expect to make change overnight, it's not like that.

It won't happen that way, make little changes that are sustainable, so make a little change every day, or a little change every week or every month.

Go at your own pace and eventually you'll get to where you want to be.

It's also, if I may add, one more little quick little thing?

Sure.

It may not be realistic to totally go zero to 60 just like that, right, so taking all of these kind of more processed foods out of your diet immediately might not be realistic or sustainable long term.

So talk with your health care provider about ways to incorporate those foods in a really balanced and safe way.

Sure, absolutely, and this soup looks like a great one you could freeze and pull out.

Oh, definitely.

You know, down the road or for lunch the next day.

These recipes look absolutely delicious.

Definitely ones I'm going to try in my own Arsenal.

Jessica de Luis, thank you so much for joining us.

And we want to thank Jessica again for a wonderful segment and some tips on how to stay healthy in the kitchen.

More resources for living with diabetes are available on the CDC and the American Diabetes Association websites.

And that will do it for this community conversation, The Cost Of Diabetes.

We want to thank all of our guests for joining us and, of course, you for watching.

From all of us here at PBS 39 and Lehigh Valley News.com, I'm Brittany Sweeney, have a good evening.