Impossible Choices: Food Insecurity, Diabetes and Tradeoffs

Diabetes is a chronic disease affecting over 29 million Americans.  Another 86 million adults in the United States have  prediabetes — without significant changes nearly a third of these individuals will develop type 2 diabetes in the next 5 years. The costs of diabetes are crushing. Beyond a $200+ billion price tag to the health care system and economy, diabetes places tremendous burdens on communities, families, and patients.

What do these burdens look like? A person living with diabetes faces dozens of difficult decisions each day in order to properly manage their disease. Diabetes is characterized by metabolic problems centered on the break down, use, and storage of sugar. Everything we eat and every action we take impacts our blood sugar.

A “typical” day for a diabetes patient may involve 2-3 blood sugar tests, complex meal planning and adjustments, strict adherence to treatment regimens that include multiple medications, devotion to a physical activity plan, and constant dedication to self-management planning and corrections. But no day is “typical”. Every day presents deviations from the best laid plans that challenge diabetes control. Poorly controlled diabetes can result in long-term complications (stroke, heart attack, blindness, amputation, and death) and in short-term acute crises (hypoglycemia). Diabetes management is incredibly difficult – even in the “best” of circumstances.

So what happens when circumstances aren’t optimal? Proper nutrition, blood sugar testing, and medications all come at a financial cost and require that patients have the skills and resources to best control their diabetes. By definition, food insecurity means not have reliable access to these resources. Diabetes patients living in food insecure households thus have added complexities to what was already a difficult disease to manage. Decisions come in the form of tradeoffs: do I chose to spend money today on blood testing supplies or groceries, on my medications or my rent, on a clinic co-pay or an electric bill? The consequences of these tradeoffs are dire: diabetes patients facing food insecurity have increased risk for poorer disease management and worse health outcomes.

The Hunger in America 2014 study found that two-thirds of client households reported making spending tradeoffs between food and medicine or health care. The same report found that a third of all households had at least one member living with diabetes. This intersection of diabetes and food insecurity impacts millions of Americans each year.

As a public health nurse and diabetes educator, I’ve worked for years with patients who, resiliently and creatively, deal daily with the dual challenge of diabetes and food insecurity. We learned more about these challenges during the diabetes pilot, and we are currently conducting a clinical trial to identify effective food bank-based interventions to support people with diabetes. But we have a long way to go to before declaring victory.

Diabetes is just one of many chronic diseases impacted by nutrition. Hypertension, congestive heart failure, kidney disease, and a litany of other illnesses all require adequate nutrition in order to be properly cared for (or prevented in the first place). Food insecurity complicates management of these diseases as well.

Feeding America is committed to research and programming that builds evidence around effective approaches to promoting the health of food insecure households. We recognize the linkages between hunger and health are both real and consequential, and we are committed to working to alleviate food insecurity and improve health. We do this with the belief that no one should have to make these difficult and harmful tradeoffs.

In short, we are working to make the impossible, possible.

Morgan Smith is the Interventions for Health Manager on the Community Health & Nutrition Team at Feeding America.  He is a Registered Public Health Nurse, Certified Diabetes Educator, and a Clinical Nurse Specialist with a focus on community health programming.  Before joining Feeding America in 2015, he managed the Diabetes Wellness Program for three years at the Redwood Empire Food Bank as part of the Feeding America / Bristol-Myers Squibb Foundation Diabetes Initiative.