Merced diabetics often forced to choose between food and medication

The idea of choosing between food and medication sounds like an issue faced by people far away, years ago – not a decision people living in one of the wealthiest states of one of the most developed countries have to make today.

But the issue is closer to home than most of us would like to imagine. And the health implications that can come with it are worrisome.

On Wednesday, I met Esperanza Gonzalez, a 59-year-old Planada resident who has been struggling with diabetes for 10 years. She was one of 12 women at Golden Valley Health Center’s “Healthier Living” morning workshop.

The clinic’s six-week program targets people with chronic conditions and their caregivers. It aims to provide education on nutrition as well as disease and medication management.

Gonzalez is hopeful the workshops will help her. She shared that living with diabetes has limited her in many ways. Her activity level has gone down, she has to carry medication with her everywhere and has trouble sleeping. This has caused her to feel frustrated and depressed. She also has arthritis, adding physical pain.

Every month, she spends about $280 on insulin. She has no medical insurance, so everything must be paid out of pocket. To be able to afford her medication, she works jobs that many times require her to wake up at 4 a.m. and stand for long hours.

But she’s always been accustomed to tough labor, she said. She was a field worker in Fresno for more than 20 years. Overworking her knees, wrists and shoulders, she believes, could have contributed to her arthritis. She worked in tomato and onion fields, as well as in plum and peach orchards.

Ironically, she picked some of the produce she could not afford to put on the dinner table for her own family.

“They were too expensive,” she said. “We ate them only when they were on sale.”

But Gonzalez is not alone.

The concept that people in agricultural regions, many times those who grow our fruits and vegetables, suffer from poor health made worse by not being able to afford nutritious food, is not new.

Kennoris Bates, director of education at Golden Valley Health Centers, explained that people living in rural communities, composed in big part of low-income field workers, have a harder time properly managing their chronic conditions. They don’t have close access to large grocery stores or farmers markets. Instead they have small corner stores that sell high-fat, high-sugar foods.

People with chronic conditions living in rural communities are often faced with the “groceries vs. medication” dilemma.

Most will decide to buy cheaper foods in an attempt to save money for medication. These “cheap” foods – prepackaged or canned items, high in calories and salt content – actually come at a high cost. “They don’t realize the long-term impact that these choices will have on their diabetes,” Bates said.

A big concern is that a number of people will purposely underuse their medication to “make it stretch.” They take less than the recommended dosage to make it last longer. But this can defeat the purpose of the treatment, Bates explained.

Dr. Gerardo Moreno, an assistant professor at UCLA, conducted a study that looked at the health-related outcomes among Latinos with diabetes living in rural agricultural communities.

The study took a look at 250 adult Latinos with Type 2 diabetes. The adults were patients from Golden Valley Health Centers in Merced and Stanislaus counties.

The study found that 52 percent of the patients were “food insecure,” meaning more than half of the people in the study did not have consistent access to adequate food because of a lack of money or resources.

Food insecurities are linked to not having a good control of diabetes and to not receiving recommended health care services, Moreno explained. It is also linked to underusing medication due to cost.

While the financial burden might be the biggest obstacle for the area’s diabetics in obtaining adequate nutrition, Moreno believes, education is also a factor. Awareness of the state’s CalFresh programs and workshops such as Golden Valley’s also need a boost.

“We can make recommendations of healthy eating and healthy diets, that can help, but if patients can’t afford it, then no improvements will be made,” Moreno said.

Moreno, who grew up in Atwater and is familiar with the San Joaquin Valley, said the problem is ironic, and one that needs to be addressed promptly.

“Agriculture is multibillion-dollar industry and major driver of California’s economy, but yet people in agricultural regions of the state suffer from social and health disparities,” Moreno noted in his study.

These findings don’t surprise Gonzalez, but she is making the effort to lead a healthier lifestyle – at least as much as she can afford to.

This story was originally published July 10, 2015 at 5:57 PM with the headline "Merced diabetics often forced to choose between food and medication."