14-year-old Kate Eilderts ’26 walked into what seemed like a normal doctor’s checkup — only to leave her local hospital with an unexpected, life-altering diagnosis of Type 1 diabetes.

Eilderts is one of 830 million individuals worldwide who has diabetes, a chronic condition that occurs when the body is unable to produce a sufficient amount of insulin — a hormone designed to maintain balanced blood sugar levels — or cannot use it effectively to regulate blood sugar levels.

Impacting people of all ages, both Type 1 and Type 2 diabetes prevent glucose from reaching the body’s cells due to the lack or ineffective use of insulin. However, Type 1 diabetes is an autoimmune disease developed by the body’s immune system attacking healthy, insulin-producing beta cells within the pancreas. Although the exact cause of Type 1 diabetes remains unknown, researchers believe environmental toxins for those with a genetic predisposition play a role in the triggering or acceleration of the condition. Without adequate insulin, blood glucose is prevented from reaching the body’s cells and fails to generate energy, resulting in high blood sugar — also known as hyperglycemia.

Eilderts underwent a series of labs checking for various conditions when her blood appeared unusual. Before her diagnosis, Eilderts explains she experienced fatigue and dehydration — symptoms later attributed to a condition called diabetic ketoacidosis, in which a buildup of acids, also known as ketones, can accumulate in the bloodstream due to insulin deficiency, leading to physical symptoms.

“There were a lot of warning signs I didn’t realize, but it was definitely a while leading up to [the diagnosis]. Once we got it figured out, all those problems went away,” Eilderts said.

Eilderts had no prior indications that her symptoms may be linked to diabetes, considering autoimmune diseases such as Type 1 diabetes often emerge abruptly.

“I was the only one in the family that didn’t have any health problems, and then — bam — I got it. A lot of people in my family have an autoimmune disorder of some sort, so it shows in different ways,” Eilderts said.

To combat the effects of diabetes, continuous glucose monitors were devices traditionally utilized by diabetics to track blood sugar levels. With its long-term health benefits, CGMs have significantly revolutionized healthcare by allowing for better daily management of diabetes. Today, CGMs have become progressively widespread, enhancing patient outcomes for millions around the world.

Jamie Pitlick is a professor of pharmacy practice and chair of the College of Pharmacy and Health Sciences Department at Drake University, as well as a clinical pharmacist at Iowa Diabetes. Pitlick explains how technological advancements have not only assisted diabetics, but provided non-diabetic adolescents with ways to effectively regulate glucose levels during physical exercise.

“In the wellness and fitness world, CGM use is increasing. That’s actually why companies like Abbott and Dexcom released over-the-counter models, to capture that population [but] it’s a balance. If you’re using it for overall wellness and not overanalyzing everything, there can be benefits,” Pitlick said. “Part of that has to do with the research being done on sensors and CGMs. They’ve proven that even people not using insulin get benefits from them. The sensors give immediate feedback showing whether you made a good or bad decision with your food or exercise that day. It’s instant accountability: ‘I had too many carbs,’ and you can see that reflected,” Pitlick said.

The Food & Drug Administration’s approval of over-the-counter CGMs, which no longer require a prescription, was intended for reading updates every five minutes and regular monitoring of glucose levels over several days. The technological advancements of CGMs have improved patient outcomes by improving glycemic control and reducing medical costs. According to the National Institutes of Health, approximately 12.3% of Type 2 diabetics are utilizing CGM systems today.

“When I first started working with patients using CGMs, they had to be on three or more insulin injections a day — that was the government rule, and private insurance companies followed suit. Now, for government insurance, it’s down to just one injection a day; for commercial insurance, you don’t even have to be on insulin, just diabetes medicine,” Pitlick said. “I still run into coverage gaps on different plans where I have to do a prior authorization and work with insurance [companies] to prove why a patient needs it. But it’s way easier than it was five years ago.”

Alka Walter, a family medicine physician and clinical associate professor at the University of Iowa Hospitals and Clinics, also credits the increased use of these devices to their widespread availability in recent years.

“Insurance companies used to only cover [Dexcom CGM sensors] for Type 1 diabetes. It’s expensive, and not everybody can afford it, but [now] more insurance companies are covering it for [all] people who need to monitor their sugars,” Walter said.

Type 2 diabetes is more common and results from the body being unable to use insulin properly, leading to high blood sugar levels accumulating in the bloodstream. Historically, insurance companies primarily restricted coverage of diabetes medical devices to limited purposes; however, they now provide broader coverage for Type 2 diabetics who take any type of insulin.

“Devices used to be available mainly for patients who had Type 1 diabetes, where it really is important for their blood sugars to be tracked closely throughout the day, but most people have Type 2 diabetes and find it very difficult to control their blood sugars,” Walter said. “[These devices] can be helpful, but people should be focusing more on healthy lifestyle changes like eating a balanced diet, exercising regularly, getting enough sleep [and] maintaining a healthy weight. Those are the things that prevent diabetes from occuring.”

Expansion of health insurance coverage from government programs such as Medicaid aided 10.9 million Americans between 2013 and 2016 following the enactment of the Affordable Care Act in 2010, which increased health insurance coverage to many who were previously uninsured. According to the Robert Wood Johnson Foundation, this legislation could allow CGMs to progressively become more affordable, with 44 states across the United States now providing some form of coverage.

According to a 2021 Iowa Behavioral Risk Factor Surveillance Survey, 63.1% of Iowans reported not having a personal health care provider and 32.9% reported being unable to have a doctor’s visit within the last 12 months due to financial costs. Access to health care is correlated to the number of diabetes cases detected in Iowa, as more health insurance allows for better health care services. In the same survey, 10.1% of health-insured Iowan residents reported a diagnosis of diabetes, compared to 5.3% of those without health insurance who were aware of having diabetes.

“Anyone with diabetes should be able to get [CGMs]. There’s evidence that CGMs lower blood sugar and help patients improve their eating and lifestyle patterns within the first 90 days,” Pitlick said.

Having health insurance plays a key role in detecting diabetes, allowing for more equitable access to health care.

“One of my current research projects is focused on trying to increase access for patients with state insurance, specifically Medicaid,” Pitlick said. “The goal is to show that anyone with diabetes benefits [from CGMs], not just those on insulin.”

Under Section 514C.18 of the Iowa Code, Iowa law requires insurance coverage for diabetic care when prescribed by a licensed physician or physician assistant, under Chapter 148. This coverage includes equipment and supplies, along with self-management education and training. This provision guarantees that Iowans eligible for a third-party payment insurance contract are protected by certification from the Department of Health and Human Services to receive training and the tools needed to ensure proper management of their diabetes.

Iowa law requires insurance coverage for diabetic care when prescribed by a licensed physician or physician assistant, ensuring that Iowans receive the training and equipment needed for proper management of their diabetes. Eilderts recalls the required instruction and education process she went through before being eligible to self-manage her diabetes using the Tandem Mobi, an automated insulin pump and glucose monitor.

“For the first insulin pump I went on, I had to take a class and pass this test for them to think about approving it. [Now, I can] carry everything on me. I do everything myself, because it’s just easier that way,” Eilderts said.

Diabetic education is covered through an outpatient program — insured by Iowa Medicaid — for once in a lifetime for each member, providing the educational aspects for diabetes care. However, the purpose of the program does not include coverage for medically necessary services regarding the diabetic’s care.

Having treated patients with diabetes for 15 years, Walter has witnessed how the strides in testing advancements, improved education on diabetes management and the wider variety of medicines have improved their lives.

“Good control of diabetes can make such a difference to a person’s life,” Walter said. “There are so many new, exciting ways to help people with diabetes, given that it’s such a huge health burden in the world right now.”

With recent advances in medications, including Ozempic — a GLP-1 medication widely used by people with Type 2 diabetes — doctors are finding new ways to control blood sugar and reduce long-term complications. Within the last decade, not only have these innovative medicines treated diabetics, but they have also targeted the pathophysiology, or underlying causes, of high sugar levels. In return, these newer medications are improving weight loss, decreasing cardiovascular risk and preventing strokes for patients.

“We’ve increasingly gotten stronger medications that have eased the burden of diabetes,” Pitlick said. “Medicines like the GLP-1s really help the pathophysiology of the disease. Instead of just lowering sugars, they go into the body and address why the sugars are high. That results in weight loss, lower blood pressure and lower cholesterol.”

Although CGMs help track blood sugar levels for both patients and athletes, constantly monitoring data from these over-the-counter devices can lead to poor outcomes, including eating disorders and body image issues among non-diabetic users.

“The majority of the time, I’ve seen it used in healthy ways. But I have had young adult patients [who] refuse CGMs because of past experiences with disordered eating. There’s something called diabulimia, which is a diabetes-specific eating disorder. Some patients avoid CGMs because they’re worried it could trigger old habits,” Pitlick said. “My concern is the potential for overanalysis and obsession among teens around weight and fitness. If you become fixated on numbers, that negatively affects mental health.”

Countering the benefits of CGMs, obsessive tracking of blood sugar patterns may lead to body image issues or trigger diabulimia, an eating disorder that affects Type-1 diabetics who limit their insulin intake in order to lose weight. If left untreated, diabulimia can cause severe long-term complications for individuals, including making them more susceptible to cardiovascular disease, kidney disease and liver disease.

“There’s no such thing as a ‘bad diabetic’ or a ‘good diabetic.’ You’re simply a person who has to manage their blood sugar. You can have diabetes and still eat cake in moderation, as part of a balanced diet,” Pitlick said. “Some days are good eating days, some days are bad eating days. The goal is to have more good days than bad ones, forgive yourself for the bad ones and move on.”

Medical advancements, improved technology and diabetic education have allowed for diabetes to become more manageable while reducing its stigma.

“The understanding of diabetes has improved, but that’s because of the internet, the educational blogs and information out there,” Pitlick said. “There’s still a lot of misinformation [so] I do a lot of reteaching [and] clarifying what patients might have read online.”

From advancements in technology helping combat the risks of diabetes and debunking stigmas or misconceptions surrounding what the different diabetes types entail to to insurance coverage allowing for more access, diabetes care has faced significant breakthroughs within the last decade.

“The world of diabetes research is expanding rapidly. Researchers are constantly exploring compounds that target the root causes of Type 2 diabetes. On the technology side, we’re seeing huge advancements hitting the market,” Pitlick said. “Every new generation of technology gets us closer to replicating the body’s natural response, minimizing sugar spikes after meals. All of this is happening because of ongoing research by pharmaceutical and tech companies.”

This story was originally published on West Side Story on November 21, 2025.