#long-term diabetes

[diabetickidneydiseasehealth]

Breakfast Choices for Individuals with Diabetic Kidney Disease

Managing daily life and dietary choices can be challenging for those dealing with diabetic kidney disease, a common chronic condition. Breakfast, often hailed as the most important meal of the day, holds particular significance for individuals living with both diabetes and kidney disease. This article explores dietary strategies for the breakfast of individuals with diabetic kidney disease, aiming to assist them in better managing their condition and enhancing their overall quality of life. Whether you are personally managing diabetes or a concerned family member, the information provided here can be valuable to you.

1.Egg Custard with Mixed Vegetables

Seafood Egg Custard (60g egg, 10g dried shrimp, 2g sesame oil)

Colorful Vegetable Mix (150g, including purple kale, bell peppers, and leafy greens)

Whole Wheat Bread (2 slices, 50g)

1 cup of milk (250ml)

This meal offers a diverse array of vegetables and high-quality protein from seafood and eggs, providing a well-rounded nutritional profile.

2.Broccoli with Chicken

Broccoli Salad (150g broccoli, a pinch of salt, a drizzle of sesame oil)

Chicken Breast Slices (50g chicken breast, 2ml light soy sauce, a touch of sesame oil)

1 cup of soy milk (300ml)

Half a Red Date and Sweet Potato Steamed Bun (30g small bun, 1 red date, 20g sweet potato flour, made from a mixture of wheat and sweet potato flour, fermented and steamed)

This meal includes a variety of vegetables, lean protein from chicken, and whole grains. Adjust the portion of chicken and broccoli for those with smaller appetites.

3.Seaweed Rice Roll with Yogurt

Seaweed Rice Roll (150g cooked rice, 1 sheet of seaweed, half a carrot, a little ham, 1 egg, a moderate amount of sesame oil, a pinch of black sesame seeds, half a cucumber, and a lettuce leaf)

1 cup of unsweetened yogurt

The seaweed rice roll combines the main carbohydrate source with various vegetables. Paired with yogurt, it becomes a convenient and nutritious breakfast option, especially suitable for individuals with diabetes on the go.

4.Oatmeal Porridge

Oats are renowned for their stomach-nourishing and lung-moistening properties, helping prevent post-meal high blood sugar. Oatmeal porridge, often referred to as the “longevity porridge,” is favored by many centenarians. Adding millet to the oats creates a fragrant and soft porridge with calming and sleep-enhancing effects, along with stomach nourishment and lung moisturization. Oats are high in dietary fiber, providing a satisfying feeling of fullness without causing spikes in blood sugar levels, making it an excellent choice for preventing post-meal high blood sugar.

[defilerwyrm]

you know you’re at a country vet clinic when the doc says she needs to take a urine sample from your cat and what she comes back with as the collection vessel

is one of these

(yes this actually happened this morning. it was very effective)

[britneyshakespeare]

Another Thing Wrong With The Former Gifted Kid Discourse, Since I Can't Stop Thinking About It:

people have such an unhelpful tendency to universalize their own experience when talking about the plights and struggles about Gifted Kids™—and what they are talking about is not necessarily invalid, but they're more often talking about their individual responses to their particular schools' policies. This Is Not A Systemic Analysis. it's helpful; i sympathize with you. But You Are Not Dismantling The Inequities by saying this or that happened At Your School when you were a child, and it affected you this or that way because of Who You Are.

example. i always see people talking about neurodivergence in this conversation, which is actually helpful in spotlighting how the Gifted Kid discourse often glosses over such complex intersectional issues. you can talk about how you were Gifted & Neurodivergent and how those experiences lead you to future disappointment. this is, i must stress, valid. but your analysis of your own life Is Not A Systemic Analysis. your experience alone will never speak for how the educational system and trends in policy among schools across the united states affect ALL neurodivergent people negatively because there are neurodivergent people who are Different From You. not to mention that when people point out that very often "Gifted Kid" usually correlates with some degrees of privilege, people push back and go nooooo I'm neurodivergent. people across all other marginalized identities who are systemically disadvantaged by the educational system can be neurodivergent. this does not make you, initially, when you were as a young Kid determined to be Gifted, NOT also in fact privileged.

if you are not ready to discuss experiences that were different from your own growing up, you aren't really engaging in the discourse of how to improve public education in the united states. it's a diiii-verse country we live in. not only in the ways we traditionally think of. when we think of "marginalized" or "oppressed" people, some specific and historically significant groups come to mind. when it comes to advantages that set up a child for future educational success, these broad categories often leave gaps because they lead people to generalizations, and ultimately, fatalism.

but there's really so much hope in early childhood education if we were to make things more equitable, ie like i always say UNIVERSAL PRE-K. these kids who are determined as "gifted" more often than not were just from more enriched home environments that prepared them for learning how to read, write, and do math. it's often not special innate abilities that leads to differences in outcomes for different students, but That's How The Kids Interpret It When Some of Them Are Called "Gifted." they're more often than not, not doing something that's truly exceptional or precocious for their age. they're displaying signs of age-appropriate development, when often, the kids who may be lagging behind them skill-wise just Haven't Practiced Those Skills As Much.

so yes, that's why there's a correlation in things like upper- and middle-class white kids being seemingly more successful in school (and more commonly deemed "gifted") at a young age. it's from privilege. it's not even just the implicit biases of their educators already working in their favor for their race and class. it's the fact that being more privileged, generally, means their family and parents had all of their basic needs provided for. they had more time to read with you. they could buy more development-promoting toys. they probably had better mental health to cope with the demands of child-rearing. if they suffered chronic or sudden physical health issues, they were insured. privileged children are usually less exposed at a younger age to the harshnesses of this world, as every child should be. ALL of these little advantages build up, in terms of what a child can be provided with before they go to school. anything that's going wrong in a child's family system can negatively impact them without them even being old enough to understand it.

you may not think of yourself as Privileged. you might prefer to think of yourself as Gifted. Gifted is so nice, even if it's demoted to Former Gifted. at one point you were told you were superior and it felt really good. and You, reader, i do not know You. i'm not calling You privileged, even if you are! hell, everyone's privileged in some way. i am at the point in the post where for transparency's sake i think i should say I Could Be What Some People Call "Former Gifted". i was called smart as a kid and given special homework sometimes etc. i'm not calling any Former Gifted people stupid for not realizing this either. what i mean is that this kids Are Not Usually Actually Gifted. this is a compliment given overwhelmingly to children who were just simply not deprived. when people say they were once Gifted, they're more often than not saying I Had The Early Opportunities To Learn Everyone Should Have, But Doesn't. this doesn't make you an outlier. It Might Just Be A Sign of Privilege.

[shuckstruck]

ALSO!!! MY DOG IS OKAY!!

this fucking dog just survived a panic of xylitol gum (insanely poisonous for dogs) several vitamin D pills (also poisonous) and a bunch of zoloft (JUST NOT GOOD TO EAT A LOT OF). how the poisoning happened is a convoluted story- he basically stuck his head in a stray purse.

But he’s miraculously okay! He’s home now, he’s responding well to the liver protecting medication, having seen him again today you truly wouldn’t guess that anything is wrong. he has vet appointments every day for the next week. but he’s alive!! and he’s okay!!! i really thought he was dead- im so grateful

[eevyerndracaneon]

.

[lifechangingtips]

Benefits and Risks of a Ketogenic Diet

Understanding the Advantages and Dangers of a Ketogenic Food regimen So, you have heard in regards to the ketogenic eating regimen, proper? It is that high-fat, low-carb eating regimen that is been making waves within the well being and health world. However earlier than you dive headfirst right into a sea of bacon and butter, it is necessary to grasp the advantages and dangers of a ketogenic…

[diabetes-health-corner]

10 Complications of Diabetes Mellitus

Diabetes is a metabolic disorder, caused by the body’s inability to use the insulin produced by its own pancreas or insufficient insulin production. As glucose begins to accumulate in the bloodstream, it begins to damage the blood vessels in organs large and small across the body.

Read more how to Reduce Complication of Diabetes: https://www.freedomfromdiabetes.org/blog/post/10-complications-of-diabetes-mellitus/2713

[fatliberation]

they have a point though. you wouldn't need everyone to accommodate you if you just lost weight, but you're too lazy to stick to a healthy diet and exercise. it's that simple. I'd like to see you back up your claims, but you have no proof. you have got to stop lying to yourselves and face the facts

Must I go through this again? Fine. FINE. You guys are working my nerves today. You want to talk about facing the facts? Let's face the fucking facts.

In 2022, the US market cap of the weight loss industry was $75 billion [1, 3]. In 2021, the global market cap of the weight loss industry was estimated at $224.27 billion [2]. 

In 2020, the market shrunk by about 25%, but rebounded and then some since then [1, 3] By 2030, the global weight loss industry is expected to be valued at $405.4 billion [2]. If diets really worked, this industry would fall overnight. 

1. LaRosa, J. March 10, 2022. "U.S. Weight Loss Market Shrinks by 25% in 2020 with Pandemic, but Rebounds in 2021." Market Research Blog. 2. Staff. February 09, 2023. "[Latest] Global Weight Loss and Weight Management Market Size/Share Worth." Facts and Factors Research. 3. LaRosa, J. March 27, 2023. "U.S. Weight Loss Market Partially Recovers from the Pandemic." Market Research Blog.

Over 50 years of research conclusively demonstrates that virtually everyone who intentionally loses weight by manipulating their eating and exercise habits will regain the weight they lost within 3-5 years. And 75% will actually regain more weight than they lost [4].

4. Mann, T., Tomiyama, A.J., Westling, E., Lew, A.M., Samuels, B., Chatman, J. (2007). "Medicare’s Search For Effective Obesity Treatments: Diets Are Not The Answer." The American Psychologist, 62, 220-233. U.S. National Library of Medicine, Apr. 2007.

The annual odds of a fat person attaining a so-called “normal” weight and maintaining that for 5 years is approximately 1 in 1000 [5].

5. Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A.T., & Gulliford, M.C. (2015). “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” American Journal of Public Health, July 16, 2015: e1–e6.

Doctors became so desperate that they resorted to amputating parts of the digestive tract (bariatric surgery) in the hopes that it might finally result in long-term weight-loss. Except that doesn’t work either. [6] And it turns out it causes death [7],  addiction [8], malnutrition [9], and suicide [7].

6. Magro, Daniéla Oliviera, et al. “Long-Term Weight Regain after Gastric Bypass: A 5-Year Prospective Study - Obesity Surgery.” SpringerLink, 8 Apr. 2008. 7. Omalu, Bennet I, et al. “Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004.” Jama Network, 1 Oct. 2007.  8. King, Wendy C., et al. “Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery.” Jama Network, 20 June 2012.  9. Gletsu-Miller, Nana, and Breanne N. Wright. “Mineral Malnutrition Following Bariatric Surgery.” Advances In Nutrition: An International Review Journal, Sept. 2013.

Evidence suggests that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function [10].

10. Tomiyama, A Janet, et al. “Long‐term Effects of Dieting: Is Weight Loss Related to Health?” Social and Personality Psychology Compass, 6 July 2017.

Prescribed weight loss is the leading predictor of eating disorders [11].

11. Patton, GC, et al. “Onset of Adolescent Eating Disorders: Population Based Cohort Study over 3 Years.” BMJ (Clinical Research Ed.), 20 Mar. 1999.

The idea that “obesity” is unhealthy and can cause or exacerbate illnesses is a biased misrepresentation of the scientific literature that is informed more by bigotry than credible science [12]. 

12. Medvedyuk, Stella, et al. “Ideology, Obesity and the Social Determinants of Health: A Critical Analysis of the Obesity and Health Relationship” Taylor & Francis Online, 7 June 2017.

“Obesity” has no proven causative role in the onset of any chronic condition [13, 14] and its appearance may be a protective response to the onset of numerous chronic conditions generated from currently unknown causes [15, 16, 17, 18].

13. Kahn, BB, and JS Flier. “Obesity and Insulin Resistance.” The Journal of Clinical Investigation, Aug. 2000. 14. Cofield, Stacey S, et al. “Use of Causal Language in Observational Studies of Obesity and Nutrition.” Obesity Facts, 3 Dec. 2010.  15. Lavie, Carl J, et al. “Obesity and Cardiovascular Disease: Risk Factor, Paradox, and Impact of Weight Loss.” Journal of the American College of Cardiology, 26 May 2009.  16. Uretsky, Seth, et al. “Obesity Paradox in Patients with Hypertension and Coronary Artery Disease.” The American Journal of Medicine, Oct. 2007.  17. Mullen, John T, et al. “The Obesity Paradox: Body Mass Index and Outcomes in Patients Undergoing Nonbariatric General Surgery.” Annals of Surgery, July 2005. 18. Tseng, Chin-Hsiao. “Obesity Paradox: Differential Effects on Cancer and Noncancer Mortality in Patients with Type 2 Diabetes Mellitus.” Atherosclerosis, Jan. 2013.

Fatness was associated with only 1/3 the associated deaths that previous research estimated and being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories [19].

19. Flegal, Katherine M. “The Obesity Wars and the Education of a Researcher: A Personal Account.” Progress in Cardiovascular Diseases, 15 June 2021.

Studies have observed that about 30% of so-called “normal weight” people are “unhealthy” whereas about 50% of so-called “overweight” people are “healthy”. Thus, using the BMI as an indicator of health results in the misclassification of some 75 million people in the United States alone [20]. 

20. Rey-López, JP, et al. “The Prevalence of Metabolically Healthy Obesity: A Systematic Review and Critical Evaluation of the Definitions Used.” Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 15 Oct. 2014.

While epidemiologists use BMI to calculate national obesity rates (nearly 35% for adults and 18% for kids), the distinctions can be arbitrary. In 1998, the National Institutes of Health lowered the overweight threshold from 27.8 to 25—branding roughly 29 million Americans as fat overnight—to match international guidelines. But critics noted that those guidelines were drafted in part by the International Obesity Task Force, whose two principal funders were companies making weight loss drugs [21].

21. Butler, Kiera. “Why BMI Is a Big Fat Scam.” Mother Jones, 25 Aug. 2014. 

Body size is largely determined by genetics [22].

22. Wardle, J. Carnell, C. Haworth, R. Plomin. “Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment” American Journal of Clinical Nutrition Vol. 87, No. 2, Pages 398-404, February 2008.

Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index [23].  

23. Matheson, Eric M, et al. “Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals.” Journal of the American Board of Family Medicine : JABFM, U.S. National Library of Medicine, 25 Feb. 2012.

Weight stigma itself is deadly. Research shows that weight-based discrimination increases risk of death by 60% [24].

24. Sutin, Angela R., et al. “Weight Discrimination and Risk of Mortality .” Association for Psychological Science, 25 Sept. 2015.

Fat stigma in the medical establishment [25] and society at large arguably [26] kills more fat people than fat does [27, 28, 29].

25. Puhl, Rebecca, and Kelly D. Bronwell. “Bias, Discrimination, and Obesity.” Obesity Research, 6 Sept. 2012. 26. Engber, Daniel. “Glutton Intolerance: What If a War on Obesity Only Makes the Problem Worse?” Slate, 5 Oct. 2009.  27. Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22(1), 68–78. 28. Chastain, Ragen. “So My Doctor Tried to Kill Me.” Dances With Fat, 15 Dec. 2009. 29. Sutin, Angelina R, Yannick Stephan, and Antonio Terraciano. “Weight Discrimination and Risk of Mortality.” Psychological Science, 26 Nov. 2015.

There's my "proof." Where is yours?

[diabetickidneydiseasehealth]

What are the effective treatment for diabetic kidney disease?

Diabetes is a chronic metabolic disorder characterized by insufficient or ineffective insulin, leading to elevated blood glucose levels. Normally, insulin, a hormone, facilitates the conversion of blood sugar into energy. However, in individuals with diabetes, this process is disrupted, resulting in high blood sugar.

Diabetes is divided into two main types: Type 1, often caused by the immune system attacking insulin-producing beta cells in the pancreas, and Type 2, involving insufficient insulin production or poor cellular response to it.

Elevated blood sugar can lead to various health issues, including cardiovascular diseases, kidney disease, and eye problems.

Therefore, the management of diabetes typically involves adjustments to diet, medication, and lifestyle. Timely diagnosis and effective control are crucial to slowing down or preventing the development of complications.

The treatment of diabetic kidney disease involves a multifaceted approach. The optimal approach to treating diabetes typically involves a comprehensive, personalized plan that combines medication and lifestyle adjustments.

Blood Glucose Control:

Tight control of blood glucose levels is crucial. This often involves a combination of medications (insulin or oral hypoglycemic agents) and lifestyle modifications, including a well-balanced diet and regular exercise.

Blood Pressure Management:

Controlling hypertension is vital to slowing the progression of diabetic kidney disease. Medications like angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are commonly prescribed to help manage blood pressure and reduce proteinuria.

Medication Management:

Medications may be prescribed to address specific symptoms or complications associated with diabetic kidney disease, such as medications to control high cholesterol levels.

Dietary Changes:

A dietitian may recommend a diet low in sodium, saturated fats, and cholesterol. Protein intake may also be monitored, as excessive protein can strain the kidneys.

Weight Management:

Maintaining a healthy weight is important. Weight loss, if necessary, can help improve insulin sensitivity and reduce the risk of complications.

Regular Exercise:

Engaging in regular physical activity can help control blood glucose levels, manage weight, and contribute to overall cardiovascular health.

Smoking Cessation:

Quitting smoking is crucial, as smoking can exacerbate kidney disease and increase the risk of cardiovascular complications.

Regular Monitoring and Follow-up:

Regular check-ups and monitoring of blood pressure, blood glucose levels, and kidney function are essential. Adjustments to the treatment plan may be made based on these assessments.

Treatment of Complications:

Prompt treatment of complications, such as urinary tract infections or other infections, is important to prevent further kidney damage.

Kidney-Friendly Medications:

Some medications need adjustment or avoidance in individuals with kidney disease. It's important to consult with healthcare providers to ensure that prescribed medications are kidney-friendly.

Renal Replacement Therapy:

In advanced stages of diabetic kidney disease, when kidney function is severely impaired, renal replacement therapy such as dialysis or kidney transplantation may be considered.

[wellhealthhub]

Diabetes Medicine: An In-depth Guide to Managing Diabetes

Looking for detailed information on diabetes medicine? This extensive article covers all aspects of effective diabetes management, including a wide range of treatments and medications. Gain insights from experts and real-life experiences. Introduction: Recognizing the Vitality of Diabetes Medicine Diabetes, a pervasive chronic condition afflicting millions worldwide, arises from impaired blood…

[medicinemane]

From what I can tell my mom also decided not to season the stir fry today... so cool... that's nice

[kahin]

DO NOT SCROLL, URGENT CAMPAIGN.

[pt: Do not scroll, urgent campaign.]

I am making this post to clear up some confusion regarding Momen's campaign that may have prevented people from donating because it made them sceptical about its legitimacy. This confusion is most likely caused by the failures of machine translation.

Momen is attempting to evacuate ten family members, with the cost of evacuation for each being €7,000. So far, the amount raised is only enough for two. The family members are:

Father (suffers from hypertension, heart disease, and diabetes)

Mother (suffers from hypertension)

Three brothers

Two sisters

Ahmed's (the eldest brother) children, Malak (newborn) and Muhammad (who has Polio)

Reham's (eldest sister) newborn, Amir

Their newborn babies are suffering from a number of respiratory issues. One of the younger members of his family contracted Hep C due to water contamination (and I apologise for spreading misinformation, as I truly did think it was his child, but it isn't). His hopes are to get his family evacuated so they can all receive urgent medical attention.

Momen is only 24 years old. He is bearing an unimaginable weight on his shoulders. He's essentially been begging for several months now since the campaign's creation to an uncountable number of strangers who have bared little to no heed to his campaign. His campaign has struggled to receive any traction. His blogs have been banned and suspended, over and over and over again. And honestly? Even with all this information in mind, I still don't know what it takes to get you people to donate.

Is it the lack of money? Well, that's not it! You people help raise thousands for AO3 yearly. Is it that you think he's a scammer? He's been vetted as number 125 on that spreadsheet, so that's probably not it unless you think Palestinians are scammers by default. Why are you letting yourself become desensitised to their pain? Why does every facet of their misery need to be posted for you to care, and even still you won't?

The campaign is behind on its short term goal. Severely behind, only €854/3724. The deadline is the end of tomorrow, and if we don't reach it then God help us, because then it will take even longer to fill the gap for the funds for each member's evacuation. Every campaign is urgent. Even the ones that don't list it as such. They're undergoing bombing, they're forced to evacuate from place to place while ill and terrified. You think they want to live another minute of this? Another day?

Every amount helps. I feel like a broken record saying this. Just donate. However, you much you can. 1, 20, 5, if that's the most you can. Share as much as you can.

[pt: Every amount helps. I feel like a broken record saying this. Just donate. However, you much you can. 1, 20, 5, if that's the most you can. Share as much as you can.]

Do not tag as ANYTHING if you're reblogging this post. No tags whatsoever. No "long post", or any organisational tags.

blog tags under the cut.

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[familydocblog]

The Power of Prevention: The Benefits of Routine Preventive Screening

As we age, our health becomes an increasingly important aspect of our lives. Preventive care and routine screenings play a pivotal role in maintaining our well-being and ensuring a high quality of life.

Introduction:As we age, our health becomes an increasingly important aspect of our lives. Preventive care and routine screenings play a pivotal role in maintaining our well-being and ensuring a high quality of life. In this blog post, we will explore the purposes and benefits of regular preventive screening appointments for middle-aged and older adults. By staying proactive and engaging in…

[cripplecharacters]

Disabilities that You Should Consider Representing in Your Writing More… part 1

[large text: Disabilities that You Should Consider Representing in Your Writing More… part 1]

While all disabilities are underrepresented in basically all sorts of media, it’s hard to not notice the trend in what disabilities make up the majority of representation. It’s especially visible when having a blog like this, where we can see what disabilities writers even consider including in their writing, and which ones never come up.

One in four people are disabled. With eight billion people alive it means there’s a lot of disabled people, and a lot of reasons why they are disabled in the first place - but this diversity is rarely represented, even on this blog, and anyone who has been following for a while has probably noticed that fact.

To be blunt: there are disabilities other than “amputee” and “(otherwise invisibly disabled) mobility aid user”. Does that mean that it’s wrong to write either of those? Of course not, and we don’t want to imply that it is. Does it mean that either of these have a ton of good representation? Hell no. Does it mean that when you are deciding on what to give your character, you should think beyond (or along! people can be multiply disabled!) just those two? Absolutely. Disability is a spectrum with thousands of things in it - don’t limit yourself for no reason and embrace the diversity that’s built into it instead. 

This is, simply, a list of common disabilities. This is just a few of them, as this is part one of presumably many (or, at least three as of right now). By “common” we rather arbitrarily decided on “~1% or more” - so at least 1 in 100 people has the disabilities below, which is a lot. Featuring!: links that you should click, sources of the % that are mostly just medical reports and might be hard to read, and quick, very non-exhaustive explanations to give you a basic idea of what these are. 

Intellectual disability (about 1.5%) Intellectual disability is a condition we have written about at length before. It’s a developmental disability that affects things such as conceptualization, language, problem-solving, or social and self-care skills. ID can exist on its own or be a part of another condition, like Down Syndrome, Congenital Iodine Deficiency, or Fetal Alcohol Spectrum Disorders. This post covers a lot of basic information that you might need. We have an intellectual disability tag that you can look through!

Cancer survivors (5.4% in the US, about 0.55% worldwide) A cancer survivor is a pretty self-explanatory term. There is a lot of types of cancer and some of them are very common while others are very rare, which makes this a very diverse category. Cancers also have different survival rates. While not every survivor will have disabling symptoms, they definitely happen. Most of the long-term side effects are related to chemotherapy, radiation, and other medication, especially if they happened in children. They can include all sorts of organ damage, osteoporosis, cognitive problems, sensory disabilities, infertility, and increased rate of other cancers. Other effects include removal of the affected area, such as an eye, a spleen, breasts, or the thyroid gland, each of which will have different outcomes. Cancer, and cancer treatments, can also result in PTSD.

Diabetes (about 8.5%, ~95% of that are type 2) Diabetes is a group of endocrine conditions that cause hyperglycemia (high blood sugar) for various reasons depending on the type. The vast majority of people have type 2 diabetes, which can cause fatigue, poor healing, or feeling thirsty or hungry. A diabetic person will use insulin when needed to help manage their blood sugar levels. There are many complications related to diabetes, from neuropathy, to retinopathy, and chronic kidney disease, and there's a lot of disabilities that coexist with diabetes in general! You might want to check out the #how to write type 1 diabetes tag by @type1diabetesinfandom!

Disabling vision loss (about 7.5%) Blindness and low vision are a spectrum, ranging from total blindness (around 10% of legally blind people) to mild visual impairment. Blindness can be caused by countless things, but cataracts, refractive errors, and glaucoma are the most common. While cataracts cause the person to have a clouded pupil (not the whole eye!) blind eyes usually look average, with strabismus or nystagmus being exceptions to that fairly often (but not always). Trauma isn't a common cause of blindness, and accidents are overrepresented in fiction. A blind person can use a white cane, a guide dog or horse, or both. Assistive solutions are important here, such as Braille, screenreaders, or magnifying glasses. We have a blindness tag that you can look through, and you might want to check out @blindbeta and @mimzy-writing-online.

Psoriasis (about 2-4%) Psoriasis is a chronic skin condition with multiple subtypes; it can cause intense itching, pain, and general discomfort, and often carries social stigma. It’s an autoimmune and non-contagious disability that affects the skin cells, resulting in raised patches of flaky skin covered with scales. It often (30%) leads to a related condition, psoriatic arthritis, which causes joint pain, tenderness, and fatigue, among other things.

Stroke survivors (0.5-1%) A stroke survivor is a person who has survived any kind of stroke (ischemic, hemorrhagic, etc.). While the specific symptoms often depend on the exact location on where the stroke happened, signs such as hemiplegia, slurred speech, vision problems, and cognitive changes are common in most survivors to some degree. When someone has a stroke as a baby, or before they are born, it can result in cerebral palsy, epilepsy, and other disabilities. We have a brain injury tag that you can look through!

Noonan Syndrome (about 0.1-1% - mild is 1%, severe 0.1%) Noonan Syndrome is a disability that is almost never mentioned in any context, but certainly not around the topic of writing disabled characters. It’s a congenital condition that can cause cardiomyopathy, chronic joint pain, hypermobility, short stature, facial differences such as ptosis, autism, and various lymphatic problems among other things. Some people with Noonan Syndrome might use mobility aids to help with their joint pain.

Hyperthyroidism (about 1.2%) Hyperthyroidism is a condition of the endocrine system caused by hormone overproduction that affects metabolism. It often results in irritability, weight loss, heat intolerance, tremors, mood swings, or insomnia. Undertreated hyperthyroidism has a rare, but extremely dangerous side effect associated with it called a thyroid storm, which can be fatal if untreated.

Hypothyroidism (>5%) Hypothyroidism is an endocrine condition just as hyperthyroidism is, and it causes somewhat opposite symptoms. Due to not producing enough thyroid hormones, it often causes fatigue, depression, hair loss, weight gain, and a frequent feeling of being cold. It’s often comorbid with other autoimmune disabilities, e.g. vitiligo, chronic autoimmune gastritis, and rheumatoid arthritis. Extreme hypothyroidism can also be potentially fatal because of a condition known as Myxedema coma (or “crisis”), which is also rare.

Deafblindness (about 0.2-2%) Being DeafBlind is often considered to be an extremely rare disability, but that’s not really the case. DeafBlindness on its own isn’t a diagnosis - it can be caused by a wide range of things, with CHARGE syndrome (congenital), Usher syndrome (born deaf, becomes blind later in life), congenital rubella, and age-related deafness and blindness being some of the most common reasons. DeafBlindness is a wide spectrum, the vast majority of DeafBlind people aren’t fully blind and deaf, and they can use various ways of communication. Some of these could be sign language (tactile or not), protactile, the deafblind manual, oral speech (aided by hearing aids or not), the Lorm alphabet, and more. You can learn more about assistive devices here! Despite what various media like to tell you, being DeafBlind isn’t a death sentence, and the DeafBlind community and culture are alive and thriving - especially since the start of the protactile movement. We have a DeafBlindness tag that you can look through!

It’s probably worth mentioning that we have received little to no asks in general for almost all the disabilities above, and it’s certainly not due to what mods answer for. Our best guess is that writers don’t realize how many options they have and just end up going for the same things over and over.

Only representing “cool” disabilities that are “not too much while having a particular look/aura/drama associated” isn’t what you should aim for. Disabled people just exist, and all of us deserve to be represented, including those whose disabilities aren’t your typical “cool design” or “character inspo”. Sometimes we are just regular people, with disabilities that are “boring” or “too much”, and don’t make for useful plot points.

mod Sasza (with huge thank yous to mod Sparrow, Rot, and Virus for their contributions with research and data!)

[mostlysignssomeportents]

What the fuck is a PBM?

TOMORROW (Sept 24), I'll be speaking IN PERSON at the BOSTON PUBLIC LIBRARY!

Terminal-stage capitalism owes its long senescence to its many defensive mechanisms, and it's only by defeating these that we can put it out of its misery. "The Shield of Boringness" is one of the necrocapitalist's most effective defenses, so it behooves us to attack it head-on.

The Shield of Boringness is Dana Claire's extremely useful term for anything so dull that you simply can't hold any conception of it in your mind for any length of time. In the finance sector, they call this "MEGO," which stands for "My Eyes Glaze Over," a term of art for financial arrangements made so performatively complex that only the most exquisitely melted brain-geniuses can hope to unravel their spaghetti logic. The rest of us are meant to simply heft those thick, dense prospectuses in two hands, shrug, and assume, "a pile of shit this big must have a pony under it."

MEGO and its Shield of Boringness are key to all of terminal-stage capitalism's stupidest scams. Cloaking obvious swindles in a lot of complex language and Byzantine payment schemes can make them seem respectable just long enough for the scammers to relieve you of all your inconvenient cash and assets, though, eventually, you're bound to notice that something is missing.

If you spent the years leading up to the Great Financial Crisis baffled by "CDOs," "synthetic CDOs," "ARMs" and other swindler nonsense, you experienced the Shield of Boringness. If you bet your house and/or your retirement savings on these things, you experienced MEGO. If, after the bubble popped, you finally came to understand that these "exotic financial instruments" were just scams, you experienced Stein's Law ("anything that can't go forever eventually stops"). If today you no longer remember what a CDO is, you are once again experiencing the Shield of Boringness.

As bad as 2008 was, it wasn't even close to the end of terminal stage capitalism. The market has soldiered on, with complex swindles like carbon offset trading, metaverse, cryptocurrency, financialized solar installation, and (of course) AI. In addition to these new swindles, we're still playing the hits, finding new ways to make the worst scams of the 2000s even worse.

That brings me to the American health industry, and the absurdly complex, ridiculously corrupt Pharmacy Benefit Managers (PBMs), a pathology that has only metastasized since 2008.

On at least 20 separate occasions, I have taken it upon myself to figure out how the PBM swindle works, and nevertheless, every time they come up, I have to go back and figure it out again, because PBMs have the most powerful Shield of Boringness out of the whole Monster Manual of terminal-stage capitalism's trash mobs.

PBMs are back in the news because the FTC is now suing the largest of these for their role in ripping off diabetics with sky-high insulin prices. This has kicked off a fresh round of "what the fuck is a PBM, anyway?" explainers of extremely variable quality. Unsurprisingly, the best of these comes from Matt Stoller:

https://www.thebignewsletter.com/p/monopoly-round-up-lina-khan-pharma

Stoller starts by pointing out that Americans have a proud tradition of getting phucked by pharma companies. As far back as the 1950s, Tennessee Senator Estes Kefauver was holding hearings on the scams that pharma companies were using to ensure that Americans paid more for their pills than virtually anyone else in the world.

But since the 2010s, Americans have found themselves paying eye-popping, sky-high, ridiculous drug prices. Eli Lilly's Humolog insulin sold for $21 in 1999; by 2017, the price was $274 – a 1,200% increase! This isn't your grampa's price gouging!

Where do these absurd prices come from? The story starts in the 2000s, when the GW Bush administration encouraged health insurers to create "high deductible" plans, where patients were expected to pay out of pocket for receiving care, until they hit a multi-thousand-dollar threshold, and then their insurance would kick in. Along with "co-pays" and other junk fees, these deductibles were called "cost sharing," and they were sold as a way to prevent the "abuse" of the health care system.

The economists who crafted terminal-stage capitalism's intellectual rationalizations claimed the reason Americans paid so much more for health care than their socialized-medicine using cousins in the rest of the world had nothing to do with the fact that America treats health as a source of profits, while the rest of the world treats health as a human right.

No, the actual root of America's health industry's problems was the moral defects of Americans. Because insured Americans could just go see the doctor whenever they felt like it, they had no incentive to minimize their use of the system. Any time one of these unhinged hypochondriacs got a little sniffle, they could treat themselves to a doctor's visit, enjoying those waiting-room magazines and the pleasure of arranging a sick day with HR, without bearing any of the true costs:

https://pluralistic.net/2021/06/27/the-doctrine-of-moral-hazard/

"Cost sharing" was supposed to create "skin in the game" for every insured American, creating a little pain-point that stung you every time you thought about treating yourself to a luxurious doctor's visit. Now, these payments bit hardest on the poorest workers, because if you're making minimum wage, at $10 co-pay hurts a lot more than it does if you're making six figures. What's more, VPs and the C-suite were offered "gold-plated" plans with low/no deductibles or co-pays, because executives understand the value of a dollar in the way that mere working slobs can't ever hope to comprehend. They can be trusted to only use the doctor when it's truly warranted.

So now you have these high-deductible plans creeping into every workplace. Then along comes Obama and the Affordable Care Act, a compromise that maintains health care as a for-profit enterprise (still not a human right!) but seeks to create universal coverage by requiring every American to buy a plan, requiring insurers to offer plans to every American, and uses public money to subsidize the for-profit health industry to glue it together.

Predictably, the cheapest insurance offered on the Obamacare exchanges – and ultimately, by employers – had sky-high deductibles and co-pays. That way, insurers could pocket a fat public subsidy, offer an "insurance" plan that was cheap enough for even the most marginally employed people to afford, but still offer no coverage until their customers had spent thousands of dollars out-of-pocket in a given year.

That's the background: GWB created high-deductible plans, Obama supercharged them. Keep that in your mind as we go through the MEGO procedures of the PBM sector.

Your insurer has a list of drugs they'll cover, called the "formulary." The formulary also specifies how much the insurance company is willing to pay your pharmacist for these drugs. Creating the formulary and paying pharmacies for dispensing drugs is a lot of tedious work, and insurance outsources this to third parties, called – wait for it – Pharmacy Benefits Managers.

The prices in the formulary the PBM prepares for your insurance company are called the "list prices." These are meant to represent the "sticker price" of the drug, what a pharmacist would charge you if you wandered in off the street with no insurance, but somehow in possession of a valid prescription.

But, as Stoller writes, these "list prices" aren't actually ever charged to anyone. The list price is like the "full price" on the pricetags at a discount furniture place where everything is always "on sale" at 50% off – and whose semi-disposable sofas and balsa-wood dining room chairs are never actually sold at full price.

One theoretical advantage of a PBM is that it can get lower prices because it bargains for all the people in a given insurer's plan. If you're the pharma giant Sanofi and you want your Lantus insulin to be available to any of the people who must use OptumRX's formulary, you have to convince OptumRX to include you in that formulary.

OptumRX – like all PBMs – demands "rebates" from pharma companies if they want to be included in the formulary. On its face, this is similar to the practices of, say, NICE – the UK agency that bargains for medicine on behalf of the NHS, which also bargains with pharma companies for access to everyone in the UK and gets very good deals as a result.

But OptumRX doesn't bargain for a lower list price. They bargain for a bigger rebate. That means that the "price" is still very high, but OptumRX ends up paying a tiny fraction of it, thanks to that rebate. In the OptumRX formulary, Lantus insulin lists for $403. But Sanofi, who make Lantus, rebate $339 of that to OptumRX, leaving just $64 for Lantus.

Here's where the scam hits. Your insurer charges you a deductible based on the list price – $404 – not on the $64 that OptumRX actually pays for your insulin. If you're in a high-deductible plan and you haven't met your cap yet, you're going to pay $404 for your insulin, even though the actual price for it is $64.

Now, you'd think that your insurer would put a stop to this. They chose the PBM, the PBM is ripping off their customers, so it's their job to smack the PBM around and make it cut this shit out. So why would the insurers tolerate this nonsense?

Here's why: the PBMs are divisions of the big health insurance companies. Unitedhealth owns OptumRx; Aetna owns Caremark, and Cigna owns Expressscripts. So it's not the PBM that's ripping you off, it's your own insurance company. They're not just making you pay for drugs that you're supposedly covered for – they're pocketing the deductible you pay for those drugs.

Now, there's one more entity with power over the PBM that you'd hope would step in on your behalf: your boss. After all, your employer is the entity that actually chooses the insurer and negotiates with them on your behalf. Your boss is in the driver's seat; you're just along for the ride.

It would be pretty funny if the answer to this was that the health insurance company bought your employer, too, and so your boss, the PBM and the insurer were all the same guy, busily swapping hats, paying for a call center full of tormented drones who each have three phones on their desks: one labeled "insurer"; the second, "PBM" and the final one "HR."

But no, the insurers haven't bought out the company you work for (yet). Rather, they've bought off your boss – they're sharing kickbacks with your employer for all the deductibles and co-pays you're being suckered into paying. There's so much money (your money) sloshing around in the PBM scamoverse that anytime someone might get in the way of you being ripped off, they just get cut in for a share of the loot.

That is how the PBM scam works: they're fronts for health insurers who exploit the existence of high-deductible plans in order to get huge kickbacks from pharma makers, and massive fees from you. They split the loot with your boss, whose payout goes up when you get screwed harder.

But wait, there's more! After all, Big Pharma isn't some kind of easily pushed-around weakling. They're big. Why don't they push back against these massive rebates? Because they can afford to pay bribes and smaller companies making cheaper drugs can't. Whether it's a little biotech upstart with a cheaper molecule, or a generics maker who's producing drugs at a fraction of the list price, they just don't have the giant cash reserves it takes to buy their way into the PBMs' formularies. Doubtless, the Big Pharma companies would prefer to pay smaller kickbacks, but from Big Pharma's perspective, the optimum amount of bribes extracted by a PBM isn't zero – far from it. For Big Pharma, the optimal number is one cent higher than "the maximum amount of bribes that a smaller company can afford."

The purpose of a system is what it does. The PBM system makes sure that Americans only have access to the most expensive drugs, and that they pay the highest possible prices for them, and this enriches both insurance companies and employers, while protecting the Big Pharma cartel from upstarts.

Which is why the FTC is suing the PBMs for price-fixing. As Stoller points out, they're using their powers under Section 5 of the FTC Act here, which allows them to shut down "unfair methods of competition":

https://pluralistic.net/2023/01/10/the-courage-to-govern/#whos-in-charge

The case will be adjudicated by an administrative law judge, in a process that's much faster than a federal court case. Once the FTC proves that the PBM scam is illegal when applied to insulin, they'll have a much easier time attacking the scam when it comes to every other drug (the insulin scam has just about run its course, with federally mandated $35 insulin coming online, just as a generation of post-insulin diabetes treatments hit the market).

Obviously the PBMs aren't taking this lying down. Cigna/Expressscripts has actually sued the FTC for libel over the market study it conducted, in which the agency described in pitiless, factual detail how Cigna was ripping us all off. The case is being fought by a low-level Reagan-era monster named Rick Rule, whom Stoller characterizes as a guy who "hangs around in bars and picks up lonely multi-national corporations" (!!).

The libel claim is a nonstarter, but it's still wild. It's like one of those movies where they want to show you how bad the cockroaches are, so there's a bit where the exterminator shows up and the roaches form a chorus line and do a kind of Busby Berkeley number:

https://www.46brooklyn.com/news/2024-09-20-the-carlton-report

So here we are: the FTC has set out to euthanize some rentiers, ridding the world of a layer of useless economic middlemen whose sole reason for existing is to make pharmaceuticals as expensive as possible, by colluding with the pharma cartel, the insurance cartel and your boss. This conspiracy exists in plain sight, hidden by the Shield of Boringness. If I've done my job, you now understand how this MEGO scam works – and if you forget all that ten minutes later (as is likely, given the nature of MEGO), that's OK: just remember that this thing is a giant fucking scam, and if you ever need to refresh yourself on the details, you can always re-read this post.

The paperback edition of The Lost Cause, my nationally bestselling, hopeful solarpunk novel is out this month!

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/09/23/shield-of-boringness/#some-men-rob-you-with-a-fountain-pen

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

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