No place to store insulin if living on the street, limited access to required refrigeration, temptation to sell syringes. High cost of oral medications restricts availability, particularly for indigent clients. Glucometers and supplies for self-monitoring are difficult to obtain, particularly for uninsured patients. Medicaid may not cover monitor for all beneficiaries. Glucometers are often stolen in shelters.
Test strips are expensive and hard to come by.
Restricts capacity to adhere to any treatment regimen. Alcoholism exacerbates hyperglycemia. Interrupts continuity of care, particularly for diabetic persons discharged from jails without medication or treatment record. Despite these formidable challenges, clinicians interviewed reported creative strategies to meet many of them.