When he was 15, barely old enough to drive, Jeremy Zacks had an insulin problem. But he didn't know it then. No one did—not his mother, who brought him to see his doctor (although she had her suspicions), not his doctor, who advised that there was nothing to worry about, no need to jump to conclusions. It was three more years of worsening symptoms—nagging thirst, stubborn fatigue—before Zacks was diagnosed with type 2 diabetes at 18, just as he flew off for his freshman year at Kwantlen Polytechnic University in British Columbia.
While Zacks studied history and enjoyed college life, first at Kwantlen Polytechnic and then at York University in Toronto, he did what people often do for one reason or another: ignored the reality of his diagnosis, hoping it would go away, and had as much beer and pizza as he wanted, like his friends. “You know what?” said Zacks, who now works as a business advisor at Surescripts. “I don’t have diabetes anymore.”
But it didn’t go away. His body had other plans.
Insulin’s function is to deliver this post-meal message to the body’s cells: “It’s time to clean house.” What needs cleaning is the bloodstream. Glucose is the simplest carbohydrate, a monosaccharide made of one sugar molecule, and it flows abundantly through the bloodstream after eating and drinking. Insulin maintains homeostasis by prompting cells to suck up glucose for energy and stash excess glucose as reserves in the liver, muscle and body fat.
Left to roam the bloodstream unchecked, glucose will wreak havoc on the body and throw homeostasis out of whack. But Zacks didn’t learn any of this after college or even after his first post-graduate job as Jewish Student Liaison at Michigan State University. Zacks moved through major milestones in his life, including a move to Chicago, and then Minnesota to start a family. He didn’t make his health a priority during these years.
At home in Minnesota—now with three young children under his roof—something felt off. He felt sluggish. Finally, at his wife Jennifer’s urging, Zacks went to see the doctor. "Your blood sugars are really bad," he was told. "You have to get on insulin now."
Zacks still had type 2 diabetes after all.
Zacks’ body had acquired a distaste for its own insulin, attacking insulin-producing cells at the source, in the pancreas, or shooting the messenger after a snack or meal. Millions of people are at risk of type 2 diabetes from poor diet and lack of exercise, but not everyone will acquire the condition, and even fewer have the misfortune of acquiring it at such a young age. The symptoms of diabetes became just another part of his life, and he learned to ignore them, despite the consequences.
But diabetes will not be ignored. Thirst, hunger, fatigue, and frequent urination are warning signs of excess glucose. Zacks had all of these, and when he told his doctor about feeling sluggish, his cells weren’t getting the energy they needed. Without a change in diet, lifestyle and medication, Zacks’ longer-term prospects as a husband and father would only get worse. Diabetes, poorly managed, can cause kidney failure, among other complications, including heart attack and stroke.
“That’s when it clicked,” Zacks said. “That’s when I realized I’d have to do something.”
Zacks had tried doing something on and off since 18, but it wasn’t easy learning to eat more greens and whole grains. Or trying fitness classes for the first time. Or figuring out how to get the medication he needed.
“Our solutions for specialty medications would have solved most, if not all, of the problems that I had when getting my Victoza® prescription.”
Zacks’ line of work is fitting. As a business advisor at Surescripts, Zacks works to expand the use of technology to simplify prescribing and fulfillment for specialty medications, like Victoza®, an anti-diabetic medication that lowers blood sugar. He helps electronic health records (EHR) vendors, specialty pharmacies and hubs understand how this technology might fit within their organizations to accelerate the time it takes to get patients like Zacks started on therapy, whose blood sugar needed attention now, not later.
Yet the average patient waits two weeks to get started on a specialty medication.
You don’t know what you don’t know, including Zacks, who, after working for years in healthcare, was well aware of the hoops patients must jump through. It took Zacks eight hours to figure out why his first prescription for Victoza® cost $1,000, when it should have been $100 for a three-month supply. Headaches like these make therapy less affordable—and leave patients untreated. Per the American Diabetes Association, only 69% of diabetic patients are adherent to treatment, and researchers at Yale have found that a full quarter of patients use less insulin than prescribed due to costs.
Zacks came home and told his wife what the doctor told him. He started doing cardio and lifting weights. He started cutting carbs for protein and vegetables. But it still took “hours on end” to manage his medications—not just the first time he got on Victoza®, but for every refill: “I’d call and spend two or three hours on the phone,” Zacks says. “It took a lot.”
Diet and exercise have paid off.
Today, Zacks knows his way around the kickboxing gym, and has lost roughly 70 pounds since moving to Minnesota. He no longer needs the generic insulin his doctor originally prescribed, though he remains on two other medications: a once-a-week shot of Ozempic®, which replaced Victoza®, and the metformin that Zacks has been on for years.
“Be your own advocate,” Zacks says, and explains that as a diabetic, his immune system often takes longer to fight infections. The pandemic didn’t help matters, though it pushed him to finally conquer his type 2 diabetes, not knowing how a COVID-19 infection would pan out. “I have three kids,” Zacks says. “I want to be active and hang out with them. I don’t want to be stuck at home, isolated forever.”
As it happened, Zacks did contract COVID-19, in July 2021, but he was vaccinated and recovered quickly. And he wonders what might have happened if he wasn’t healthier. His mother had always pushed him to take care of himself, to learn how to manage his condition, ever since he was diagnosed. She died in 2015, but now, after more than two decades of living with type 2 diabetes, his blood sugar is at pre-diabetes levels.
“My mom,” he says, “would have been really proud of me.”
Learn more about how Surescripts is remapping the specialty medications journey.