Anti-diabetes activists hope resolution for Ketoacidosis Awareness Day will be only first of many diabetes bills to pass House, Senate

Rep. Danny Bentley holds an insulin pen at a Jan. 16 press conference. Rep. Deanna Frazier, R-Richmond, looks on. (Legislative Research Commission photo)

By Melissa Patrick
Kentucky Health News

A resolution to increase awareness of a health condition that can kill diabetics, called diabetes ketoacidosis, has passed the state House. It is one of several diabetes-related bills filed this session, including measures to address the rising cost of insulin.

The sponsor, Rep. Danny Bentley, R-Russell, told the House, “We always talk about diabetes, but we don’t talk about how people die from it.”

More than one in eight Kentucky adults have been diagnosed with diabetes, and 1.1 million Kentucky adults, or nearly one in three, have pre-diabetes that has been diagnosed or undiagnosed, according to the 2017 Kentucky Behavioral Risk Factor Survey. In that year, diabetes was the seventh leading cause of death in Kentucky, according to the federal Centers for Disease Control and Prevention. 

House Resolution 14, which passed Jan. 23 on a voice vote, proclaims April 26, 2020 as Diabetes Ketoacidosis Awareness Day in Kentucky. DKA happens when a person lacks sufficient insulin to help move glucose, a type of sugar, between the bloodstream and the body’s cells, where it is used for energy. When this happens, the body breaks down fat for fuel, which results in a buildup in ketones, which are acid.

If this persists for an extended period, the ketones build up in the blood, causing excessive thirst, frequent urination, nausea and vomiting, abdominal pain, fatigue, confusion and fruit-scented breath.

DKA can result in dangerous levels of dehydration, low levels of potassium, swelling of the brain, fluid in the lungs, and damage to the kidneys and other organs due to fluid loss, diabetic coma and death.

Bentley, a pharmacist who has Type I diabetes, a condition where the body produces no insulin, said people with Type I have the highest risk of DKA, but it can also happen in those with Type II diabetes, where the body produces some, but not enough, insulin.

The resolution says DKA may account for up to 75 percent of all Type I diabetes-related deaths in patients under 30 years of age.

Other diabetes-related bills to watch 

DKA can be prevented with the effective treatment of diabetes, but with the skyrocketing cost of insulin and other supplies needed to manage the disease, many diabetics go untreated or are under-treated because they ration their insulin to make it last. Several bills have been introduced this legislative session to address this.

Bentley and advocates held a press conference to discuss
several diabetes-related bills. (KHN photo by Melissa Patrick)

Bentley held a press conference Jan. 16 to talk about diabetes bills he is sponsoring. He was joined by lawmakers from both sides of the aisle, as well as representatives from Kentucky Insulin4All, the American Diabetes Association and the Kentucky Medical Association. 

“For those who require insulin to live, the cost has spiraled out of control as Representative Bentley has mentioned. And for many it’s beyond their reach,” said Gary Dougherty, ADA’s chief state-government lobbyist. “This has forced one in four insulin users to use less than their doctor has prescribed for them, putting their lives and health at risk.”

Bentley thanked Gov. Andy Beshear for drawing attention to the issue of diabetes and the high cost of insulin at his Jan. 14 State of the Commonwealth address.

Beshear said, “There are a number of bills in the legislature right now to curb the costs of insulin. Representative Danny Bentley, a Republican, and Representative Patti Minter, a Democrat, are sponsoring one such bill. Let’s pass it. The approximately 530,000 diabetics, according to the American Diabetes Association, in this state are counting on it.”

Bentley said Beshear “realizes that we have people in this state who are allotting their doses and dying from ketoacidosis.”

Minter, a Bowling Green Denocrat whose son has Type 1 diabetes, is a co-sponsor of Bentley’s resolution and House Bill 12, which would cap the cost-sharing requirements for prescription insulin at $100 per 30-day supply, no matter the type or amount of insulin a person is prescribed. This bill would only apply to private insurers, not Medicaid or Medicare. Including Bentley, it has 71 sponsors. It has been posted for consideration in the House Health and Family Services Committee.

Similar legislation has passed in Colorado and in Illinois, where it awaits the governors’ signature.

Minter has also introduced HB 21 that would require insurance companies in Kentucky to keep covering pre-existing conditions in the event the federal Patient Protection and Affordable Care Act is overturned. Diabetes is considered a pre-existing condition, and prior to the ACA, an insurance company could deny coverage to those who have it.

Bentley said in the last 14 years, the price of insulin has gone up over 550%. He said retail cost for his own insulin requirements would be about $6,000 a year.
“When we adhere to good management, we save dollars on diabetes,” he said. “If we can help a person manage their disease, we save money for the state, taxpayer and everyone.”

Rep. Charles Booker, D-Louisville, who has Type I diabetes, offered his support of Bentley’s bill and told about his experience with ketoacidosis.

“I’ve had to make decisions on whether to put food on the table for my girls or pay for my insulin,” said Booker, a U.S. Senate candidate. “And I’m going to choose my girls every time, and I fell into diabetic ketoacidosis. . . . I couldn’t move. I couldn’t hug my girls. I thought I was done. A lot of Kentuckians are not as fortunate as I am to be here.”

Bentley has also introduced HB 72, which he called the “Rx Accumulator Bill.” It would require insurers to apply any financial assistance used by a patient, like a rebate or coupon, to their deductible. This bill would not only help people with diabetes, but also those with other health conditions. It has been posted in the House Banking and Insurance Committee.

He has also filed  HB 248 and HB 249, which deal with the cost of insulin, including issues related to cost transparency.

“As a Type 1 Diabetic, I know firsthand the struggle diabetics face when they do not have access to insulin,” he said in the press release. “These pieces of legislation will help take the burden away for Kentuckians who are diabetic.”

Two diabetes-related bills have also been filed in the Senate, both by Sen. Phillip Wheeler, R-Pikeville. Senate Bill 23 would create an insulin assistance program. It has been assigned to the Senate Health and Welfare Committee. SB 69 would also cap the co-payment for prescription insulin at $100 per 30-day supply. It has been assigned to the Senate Banking and Insurance Committee.

Last year, the state passed a Bentley bill to allow pharmacists to dispense insulin and respiratory inhalers in the smallest supply available in an emergency. Kentucky already had a law to allow pharmacists to dispense a 72-hour emergency supply of a prescription medicine, but because insulin and most inhalers are not available in doses that small, they couldn’t dispense them.

The law is called “Kevin’s Law” for Kevin Houdeshell, an Ohio man with diabetes who died after running out of insulin on New Year’s Eve in 2013, despite multiple efforts to reach his doctor to get the refill.

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