From the hand-wavey way he was talking it sounds like those levels are commonplace lately, but he only concretely admitted to the one most recent reading. His bit about passing out often does lend credence to it all though. He also mentions that he tends to start talking in circles when his blood sugar is in the stratosphere.
People can adapt to running with a CBG in the 300s all the time, so much so that if their CBG goes down to 150 they feel like they're low and start sweating and shivering. Jake might be see-sawing from high to low (or normal) or he might just be unlucky. I mean to say, Jake would be lucky not to adapt to extended high blood glucose,
if that drove him to treat his diabetes.
Someone like Lou Gags is always stupid and aggressive, which can be a side effect of hyperglycemia, but it doesn't bother him any and he ignores his diabetes until he loses visual field or a toe.
Either way the damage is happening; Jake is just noticing it and not enjoying it.
This sounds extremely plausible to me. Is he going to die because he couldn't just send the goddamn email for an insulin refill?
Usually pharmacies will call/text/email with "your refill is due but your Rx is expired; want us to contact your doctor?" and do it for you. So much of this is automated, which doesn't make it foolproof but sure helps.
I wonder if Jake has 100 unopened text messages, a full voicemail box and a big stack of physical envelopes by his door.
One other thing it could be (this is speculation) is a formulary change. If his insurance decided their long-acting insulin of choice was going from Tresiba to Lantus, and Jake had a Tresiba prescription, he'd have more of a chance to fall into a crack. Usually this is no problem--the doctor changes the prescription, unless you've got proof you can't tolerate the formulary med and then the doctor has to affirm that you need to stay on the old one--but Jake can't say the
reason they won't fill his prescriptions.
The pharmacy tech telling Jake "hey your insurance won't cover X, can you contact your doctor and ask them to change it to Y" might have just sounded like dive alert klaxons and flashing red lights inside Jake's head and now he'd rather die than sit down and look at paperwork and stay on hold for a long time. They could have told him
anything where he had to do a simple step, and it just went into the big "DDOSed" inbox in Jake's head.
Looking through some Connecticut documentation, metformin is listed as "step therapy" (i.e. you have to have tried something else first) and a bunch of his meds have "quantity limits" (without a doctor's authorization). But I don't see how any of that would apply given that he has a doctor prescribing it. The laziness theory is gaining ground.
Metformin is old and super cheap, so the doc probably just had to say Jake failed diet and exercise.
Again, he could buy this off-insurance for under $10. GLP-1s are new and expensive and insulin takes some paperwork to get cheap, but this is
metformin. Dude.
A tiny fraction of the effort Jake spends on his "transition" (and I know that's not much) would get help for his diabetes.
