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Casi lo fue. Atencio y sus hijos durmieron durante años en los sofás de amigos o en casa de familiares, sin poder alquilar un apartamento debido a su mal historial de crédito. Una de las principales razones, dijo, fue la deuda médica.

Atencio sufrió un ataque al corazón a los 19 años, desencadenado por una afección congénita no diagnosticada. Las deudas por su atención devastaron su crédito. “Siempre sentí que no podía salir adelante”, dijo, recordando una vida de trabajos sin futuro y préstamos con intereses altos mientras trataba de mantenerse al día con los cobradores de deudas.

A los 25 años, tuvo que declararse en quiebra.

En todo el país, la deuda médica obliga a legiones de estadounidenses a hacer sacrificios dolorosos. Muchos recortan gastos en alimentos, asumen trabajos adicionales o agotan sus ahorros para la jubilación. Para millones como Atencio, el sistema de atención médica amenaza sus propios hogares.

Esto ha resultado ser especialmente devastador en comunidades como Denver, donde los precios de las viviendas se han disparado, volviéndose inaccesibles para muchos residentes, alimentando una crisis que ha dejado a miles de personas sin hogar y durmiendo en las calles.

En Community Economic Defense Project, o CEDP, una organización sin fines de lucro de Denver que ayuda a las personas que enfrentan el desalojo o la ejecución hipotecaria de sus hogares, aproximadamente dos tercios de los clientes tienen deuda médica, según una encuesta informal realizada por KFF Health News y la organización.

Cerca de la mitad de las casi 70 personas encuestadas dijeron que la deuda médica desempeñó un papel en su problema de vivienda, y aproximadamente una de cada 6 dijo que fue un factor importante.

“Todo el día escucho sobre la deuda médica”, dijo Kaylee Mazza, defensora de inquilinos que trabaja en una clínica legal de CEDP en el tribunal de Denver que ofrece ayuda a los inquilinos que enfrentan procesos de desalojo. “Está en todas partes”.

A nivel nacional, alrededor de 100 millones de personas tienen alguna forma de deuda de atención médica. De ellos, aproximadamente una de cada 5 dijo que las deudas los obligaron a cambiar su situación de vida, incluyendo mudarse con amigos o familiares, según una encuesta de KFF de 2022.

Un creciente cuerpo de investigaciones muestra que la vivienda estable es fundamental para el bienestar físico y mental. Algunos sistemas médicos importantes, incluyendo varios en Colorado, incluso han comenzado a invertir en viviendas asequibles en sus comunidades, citando la necesidad de abordar los llamados determinantes sociales de salud.

Pero a medida que los hospitales y otros proveedores médicos dejan a millones en deuda, socavan inadvertidamente la salud de la comunidad, dijo Brian Klausner, médico en una clínica que atiende a pacientes sin hogar en Raleigh, Carolina del Norte.

“Muchos de los hospitales en todo el país que ahora públicamente se comprometen a abordar las inequidades en salud y eliminar las barreras para la salud están contribuyendo simultáneamente a crear estos mismos problemas”, dijo Klausner. “A nadie le gusta el elefante en la habitación, pero la realidad es que hay miles de estadounidenses enfermos que probablemente están sin hogar, y enfermos, debido a la deuda médica”.

Efecto dominó

La deuda médica puede socavar la seguridad de la vivienda de varias maneras. Para algunos, debilita su crédito, lo que dificulta alquilar o solicitar una hipoteca. El año pasado, aproximadamente uno de cada 8 consumidores estadounidenses con un informe de crédito tenía una deuda médica en él, según el Urban Institute, una organización sin fines de lucro.

Los pacientes con condiciones médicas crónicas pueden atrasarse en el pago del alquiler o de las cuotas de su hogar mientras luchan por mantener bajo control las deudas médicas para preservar el acceso a la atención médica. KFF Health News encontró que muchos hospitales y otros proveedores rechazan a pacientes con cuentas pendientes.

Denise Beasley, quien también ayuda a clientes en CEDP en Denver, dijo que muchas personas mayores, que normalmente dependen más de los médicos y los medicamentos, creen que deben pagar sus cuentas médicas y de farmacia antes que cualquier otra cosa. “Están aterrados”, dijo.

Para otros, esta deuda puede aumentar las dificultades financieras provocadas por un accidente o una enfermedad inesperada que los obliga a dejar de trabajar, poniendo en peligro su cobertura de salud o su capacidad para pagar la vivienda.

En Seattle, los investigadores encontraron una deuda médica generalizada entre los residentes de campamentos de personas sin hogar. Y aquellos con este tipo de deudas tendían a experimentar la falta de vivienda durante dos años más que los residentes de campamentos sin deuda.

En términos más generales, las personas con deuda médica tienen más probabilidades de decir que la deuda les ha impedido rentar o avanzar con una hipoteca, en comparación con las personas que tienen préstamos estudiantiles o de tarjetas de crédito, según una encuesta nacional de 2019 realizada por la empresa de bienes raíces Zillow entre inquilinos, compradores de viviendas y dueños de propiedades.

Para Atencio, quien dejó su hogar a los 16 años, sus problemas con la deuda médica comenzaron con el ataque al corazón. Estaba trabajando en una gasolinera y viviendo en Trinidad, una pequeña ciudad en el sur de Colorado cerca de la frontera con Nuevo México.

Fue llevado de urgencia a un hospital local, donde fue sometido a una cirugía. Las facturas, que superaban los $50,000, no estaban cubiertas por su plan de salud porque había acudido a un proveedor fuera de la red sin saberlo, contó. “Luché lo más que pude, pero no podía pagar un abogado. Estaba atrapado”.

Atencio, quien es transgénero, tiene el pelo oscuro corto y un gran tatuaje en su antebrazo derecho en memoria de dos amigos que murieron en un accidente automovilístico. Sentado en un sofá viejo en un apartamento con rejas en las ventanas, es filosófico acerca de su largo periplo desde esa crisis médica a través de años de deuda e inseguridad de vivienda. “Hemos salido adelante”, dijo. “Pero tuvo un costo”.

Cuando su crédito bajó a cerca de 300, la calificación más baja, había pocos lugares a los que recurrir en busca de ayuda. La relación de Atencio con sus padres, quienes se divorciaron cuando él tenía 2 años, había sido tensa durante años. Atencio se casó a los 18, pero él y su esposo rara vez tenían suficiente para llegar a fin de mes. “Recuerdo pensar, ‘¿Qué tipo de comienzo de mi vida adulta es este?'”.

Finalmente, fueron acogidos por la madre de su esposo. “Si no fuera por ella, habríamos estado sin hogar”, dijo. Pero salir de la deuda fue agonizante.

“Terminas en este ciclo”, dijo. “Te endeudas. Luego tomas préstamos para tratar de pagar parte de la deuda. Pero luego está todo ese interés”. Con un mal historial de crédito, Atencio en ocasiones dependía de prestamistas a los que hay que devolver el dinero pronto, cuyas altas tasas de interés pueden aumentar drásticamente lo que deben los prestatarios.

Además, muchos empleadores también verifican los puntajes de crédito, lo que dificultaba que Atencio encontrara algo más que trabajos mal remunerados.

El trabajo en el refugio fue un paso adelante, y este año Atencio obtuvo el apartamento, que está reservado para familias monoparentales en riesgo de quedarse sin hogar. (Atencio se separó de su esposo el año pasado).

Desafíos de vivienda en Colorado

Las luchas de vivienda de Atencio están lejos de ser únicas. Jim y Cindy Powers, quienes viven en Greeley, una pequeña ciudad al norte de Denver, vieron colapsar sus propios sueños de vivienda después de que a Cindy se le diagnosticara una afección potencialmente mortal que requirió múltiples cirugías y dejó a la pareja con más de $250,000 en deuda médica.

Cuando los Powers se declararon en quiebra, el acuerdo protegió su hogar. Pero su hipoteca fue vendida y el nuevo prestamista rechazó el plan de pago. Perdieron la casa.

Lindsey Vance, de 40 años, quien se mudó a Denver hace cinco años en busca de viviendas más asequibles que en el área de Washington, DC, de donde es originaria, aún no puede comprar una casa debido a deudas médicas. Ella y su esposo tienen un ingreso de seis cifras, pero las facturas médicas por incluso atención de rutina que ha luchado por pagar desde sus 20 años han afectado su crédito, dificultando la obtención de un préstamo. “Estamos atrapados en un punto muerto”, dijo.

En Denver y sus alrededores, funcionarios electos, líderes empresariales y otros se han mostrado cada vez más preocupados por la deuda médica mientras buscan formas de abordar lo que muchos ven como una crisis de vivienda.

“Son cosas profundamente conectadas”, dijo Sarah Parady, miembro del Concejo Municipal de Denver. “A medida que los precios de la vivienda han subido y subido, he visto a más y más personas, especialmente personas con problemas médicos y deudas, perder la seguridad en la vivienda”.

Parady, quien se postuló para el cargo el año pasado para abordar la asequibilidad de la vivienda, está liderando un esfuerzo para que la ciudad compre y cancele la deuda médica de los residentes de la ciudad.

Impulsado por los precios disparados y las tasas de interés en aumento, el costo de comprar una vivienda en Denver se más que duplicó desde 2015 hasta 2022, según un análisis reciente. Y con los alquileres también aumentando, los desalojos están en alza luego del paréntesis de los dos primeros años de la pandemia.

Tal vez en ningún lugar la crisis de Denver es más visible que en las calles. El centro de la ciudad está lleno de tiendas de campaña y campamentos, incluido uno que se extiende por varias cuadras cerca del refugio y la clínica donde Atencio solía trabajar. Según un conteo, la población sin hogar del área metropolitana de Denver aumentó casi un 50% desde 2020 hasta 2023.

CEDP, que fue fundado para ayudar a los residentes con desafíos de vivienda desencadenados por la pandemia, se unió este año a otros defensores de consumidores y pacientes de Colorado para presionar a la legislatura en busca de protecciones más sólidas para los pacientes con deuda médica.

Y en junio, Colorado promulgó una ley pionera que prohíbe que la deuda médica se incluya en los informes de crédito de los residentes o se tenga en cuenta en sus puntajes crediticios, una medida que colocó al estado a la vanguardia de los esfuerzos a nivel nacional para ampliar las protecciones contra las deuda para los pacientes.

Algunos otros estados están considerando medidas similares. Y en Washington, DC, defensores de consumidores y pacientes están presionando para que se tomen medidas federales para limitar las facturas médicas en los informes de crédito. En la mayoría de los estados, incluyendo muchos con las tasas más altas de deuda médica, los pacientes aún no tienen tales protecciones.

Por su parte, Atencio espera que el nuevo apartamento marque un punto de inflexión.

El hogar es modesto, una pequeña unidad en una vieja torre de concreto. Hay un guardia de seguridad en la puerta principal y pasillos largos pintados de azul y marrón institucional.

La familia de Atencio se está instalando, junto con cuatro ratas mascotas: Stitch, Cheese, Peach y Bubbles, que viven en una jaula grande en la sala de estar. “Esto se siente como libertad”, dijo Atencio.

Ha tratado de darles a sus hijos, de 5 y 11 años, una sensación de seguridad: comidas caseras y espacio para jugar o pasar el rato en sus propios dormitorios. Como todos los padres, se preocupa por el tiempo que pasan frente a las pantallas y frunce el ceño cuando critican lo que hay para cenar. (No les gustaron las papas que puso en un asado al horno).

Todos son estudiantes a tiempo completo: Atencio, que dejó su trabajo en el refugio, está cursando una maestría en trabajo social. Su hijo acaba de empezar el jardín de infantes y su hija está en la escuela media. “Tengo grandes planes y grandes objetivos”, dijo.

Y con varios miles de dólares de deuda médica aún por pagar, agregó que tiene cuidado de no llevar a sus hijos a un hospital o médico fuera de la red. “No cometeré ese error de nuevo”, dijo.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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eagues wrote in Cureus. “Despite this disparity, concerns persist regarding the potential transmission of the disease through tear samples, even when obvious ocular signs and symptoms

It nearly was. Atencio and his children for years slept on friends’ couches or stayed with family, unable to rent an apartment because of poor credit. A big reason, he said, was medical debt.

Atencio had a heart attack at 19, triggered by an undiagnosed congenital condition. The debts from his care devastated his credit score. “It always felt like I just couldn’t get a leg up,” he said, recalling a life of dead-end jobs and high-interest loans as he tried to stay ahead of debt collectors. By 25, he’d declared bankruptcy.

Across the country, medical debt forces legions of Americans to make painful sacrifices. Many cut back on food, take on extra work, or drain retirement savings. For millions like Atencio, the health care system is threatening their very homes.

That’s proven particularly devastating in communities like Denver, where skyrocketing prices have put housing out of reach for many residents and fueled a crisis that’s left thousands homeless and sleeping on the streets.

At the Community Economic Defense Project, or CEDP, a Denver nonprofit that helps people facing eviction or home foreclosure, about two-thirds of clients have medical debt, an informal survey by KFF Health News and the organization suggests. Close to half of the nearly 70 people surveyed said medical debt played a role in their housing issue, with about 1 in 6 saying it was a major factor.

“All day long I hear about medical debt,” said Kaylee Mazza, a tenant advocate who staffs a CEDP legal clinic at the Denver courthouse that offers aid to tenants going through eviction proceedings. “It’s everywhere.”

Nationwide, about 100 million people have some form of health care debt. Of those, about 1 in 5 said the debts have forced them to change their living situation, including moving in with friends or family, according to a 2022 KFF poll.

A growing body of evidence shows that stable housing is critical to physical and mental well-being. Some major medical systems — including several in Colorado — have even begun investing in affordable housing in their communities, citing the need to address what are sometimes called social determinants of health.

But as hospitals and other medical providers leave millions in debt, they inadvertently undermine community health, said Brian Klausner, a physician at a clinic serving homeless patients in Raleigh, North Carolina.

“Many of the hospitals across the country that are now publicly vowing to address health inequities and break down barriers to health are simultaneously helping to create these very problems,” Klausner said. “Nobody likes the elephant in the room, but the reality is that there are thousands of sick Americans who are likely homeless — and sick — because of medical debt.”

A Downward Spiral

Medical debt can undermine housing security in several ways. For some, it depresses credit scores, making it difficult to get a lease or a mortgage. Last year, about 1 in 8 U.S. consumers with a credit report had a medical debt listed on it, according to the nonprofit Urban Institute.

Patients with chronic medical conditions may fall behind on rent or home payments as they scramble to keep medical debts in check to preserve access to health care. Many hospitals and other providers will turn away patients with outstanding bills, KFF Health News found.

Denise Beasley, who also assists clients at CEDP in Denver, said many older people, who typically depend most on physicians and medications, believe they must pay their medical and pharmacy bills before anything else. “The elderly are terrified,” she said.

For others, such debt can compound financial struggles brought on by an accident or unexpected illness that forces them to stop working, jeopardizing their health coverage or ability to pay for housing.

In Seattle, researchers found widespread medical debt among residents in homeless encampments. And those with such debt tended to experience homelessness two years longer than encampment residents without it.

More broadly, people with medical debt are more likely to say the debt has caused them to be turned down for a rental or a mortgage than people with student loans or credit card debt, according to a 2019 nationwide survey of renters, homebuyers, and property owners by real estate company Zillow.

For Atencio, who left home at 16, his struggles with medical debt began with the heart attack. He was working at a gas station and living in Trinidad, a small city in southern Colorado near the New Mexico border.

Rushed to a local hospital, he underwent surgery. The bills, which topped $50,000, weren’t covered by his health plan because he’d unknowingly gone to an out-of-network provider, he said. “I fought it as hard as I could, but I couldn’t afford a lawyer. I was stuck.”

Atencio, who is transgender, has close-cropped dark hair and a large tattoo on his right forearm memorializing two friends who died in a car accident. Sitting on an aging couch in an apartment with bars on the windows, he’s philosophical about his long journey from that medical crisis through years of debt and housing insecurity. “We’ve pulled ourselves out of this,” he said. “But it took a toll.”

When Atencio’s credit score dipped close to 300, the lowest rating, there were few places to turn for help. Atencio’s relationship with his parents, who divorced when he was 2, had been strained for years. Atencio got married at 18, but he and his husband rarely had enough to make ends meet. “I remember thinking, ‘What kind of a start to my adult life is this?’”

They were ultimately taken in by Atencio’s mother-in-law. “If it wasn’t for her, we would have been homeless,” he said. But getting out from the debt was agonizing.

“You end up in this cycle,” he said. “You get into debt. Then you take out loans to try to pay off some of the debt. But then there’s all this interest.” With poor credit, Atencio relied at times on payday lenders, whose high interest rates can dramatically increase what borrowers owe. Many employers also check credit scores, which made it difficult for Atencio to land anything but low-wage jobs.

The job at the shelter was a step up, and Atencio this year got the apartment, which is reserved for single-parent families at risk of being homeless. (Atencio separated from his husband last year.)

Colorado’s Housing Challenges

Atencio’s housing struggles are hardly unique. Jim and Cindy Powers, who live in Greeley, a small city north of Denver, saw their own housing dreams collapse after Cindy was diagnosed with a life-threatening condition that required multiple surgeries and left the couple with more than $250,000 in medical debt.

When the Powers declared bankruptcy, the settlement protected their home. But their mortgage was sold, and the new lender rejected the payment plan. They lost the house.

Lindsey Vance, 40, who moved to Denver five years ago seeking more affordable housing than the Washington, D.C., area where she was from, still can’t buy a house because of medical debts. She and her husband have a six-figure income, but medical bills for even routine care that she’s struggled to pay since her 20s have depressed her credit score, making it difficult to get a loan. “We’re stuck in a holding pattern,” she said.

In and around Denver, elected officials, business leaders, and others have become increasingly concerned about medical debt as they look for ways to tackle what many see as a housing crisis.

“These things are deeply connected,” Denver City Council member Sarah Parady said. “As housing prices have gone up and up, I’ve seen more and more people, especially people with a medical issues and debts, lose housing security.” Parady, who ran for office last year to address housing affordability, is helping lead an effort to get the city to buy and retire medical debt for city residents.

Fueled by skyrocketing prices and rising interest rates, the cost of buying a home more than doubled in Denver from 2015 to 2022, according to one recent analysis. And with rents also surging, evictions are rocketing upward after slowing during the first two years of the pandemic.

Perhaps nowhere is Denver’s crisis more visible than on the streets. The city’s downtown is dotted with tents and encampments, including one that stretches over several blocks near the shelter and clinic where Atencio used to work. By one count, metro Denver’s homeless population increased nearly 50% from 2020 to 2023.

CEDP, which was founded to help residents with housing challenges sparked by the pandemic, this year joined other Colorado consumer and patient advocates to push the legislature for stronger protections for patients with medical debt.

And in June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores, a move that put the state at the forefront of efforts nationally to expand debt protections for patients.

A few other states are considering similar steps. And in Washington, D.C., consumer and patient advocates are pushing for federal action to limit medical bills on credit reports. In most states — including many with the highest rates of medical debt — patients still have no such protections.

For his part, Atencio is hoping the new apartment marks a turning point.

The home is modest — a small unit in an aging concrete tower. There’s a security guard by the front door and long, linoleum corridors painted institutional blue and brown.

Atencio’s family is settling in, along with four pet rats — Stitch, Cheese, Peach, and Bubbles — who live in a large cage in the living room. “This feels like freedom,” said Atencio.

He’s tried to give his children, who are 5 and 11, a sense of security: home-cooked meals and the space to play or hang out in their own bedrooms. Like parents everywhere, he frets over their screen time and rolls his eyes when they critique what’s for dinner. (They didn’t like the potatoes he put in a pot roast.)

They are all full-time students: Atencio, who left his job at the shelter, is working on a master’s in social work. His son just started kindergarten, and his daughter is in middle school. “I have big plans and big goals,” he said.

And with several thousand dollars of medical debt still to pay off, Atencio said he’s careful not to take his kids to an out-of-network hospital or physician. “I won’t make that mistake again,” he said.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Santo Domingo.- The clinical symptoms of dengue can be confused with other diseases ranging from leptospirosis to hepatitis, which is why it is important to perform a comprehensive medical evaluation of the patient and laboratory tests.

This is what the infectologist Elianet Castillo, from the Centro Médico de Diabetes, Obesidad y Especialidades (CEMDOE) warns when referring to the current epidemic outbreak of dengue that is affecting the country and that is leading to a high demand for medical attention.

The specialist explained that it is important to know that dengue is characterized by symptoms of fever, headache, retro ocular pain, general malaise, rash, joint pain and muscle pain.

These symptoms and signs, he said, can be confused with other diseases that are also part of the country’s local epidemiology, such as malaria, chikungunya, zika and leptospirosis,” he explained.

He explained that when the patient with dengue presents alarm signs such as nausea, persistent vomiting and abdominal pain it could represent a challenge because it could also be confused with other infectious diseases affecting the gastrointestinal system such as hepatitis or inflammation of specific organs such as the gall bladder (cholecystitis) and the appendix (appendicitis).

Malaria and Leptospirosis

Castillo pointed out that in the case of malaria, chikungunya and zika, they also present with fever. “Generally, compared to dengue, they do not cause as many alterations at the hematological level and do not usually cause as much morbi-mortality.”

He said that leptospirosis, which usually increases its incidence after heavy rains and floods, can present symptoms very similar to dengue, and being a bacterial disease requires treatment with antibiotics to prevent progression to its terminal stage called Weil’s syndrome where severe kidney and liver damage occurs, reaching a 50% mortality rate.

This shows, added the specialist, the importance of a comprehensive medical evaluation and the performance of the necessary laboratories to reach an accurate diagnosis and thus speed up the appropriate treatment of the patient.

INSULIN therapy often is an important part of diabetes treatment. It helps keep one's blood sugar under control and prevents diabetes complications. It works like the hormone insulin that the body usually makes.

The role of insulin in the body

Insulin comes from an organ in the stomach area called the pancreas. The main role of insulin is to ensure that sugar from nutrients in food is correctly used or stored in the body.

If your body can make enough insulin, you don't have diabetes. In people who don't have diabetes, insulin helps to:

*Control blood sugar levels. After you eat, your body breaks down nutrients called carbohydrates into a sugar called glucose. Glucose is the body's main source of energy; it's also called blood sugar. Blood sugar goes up after you eat.

When glucose enters the bloodstream the pancreas responds by making insulin. Then insulin allows glucose to enter the body's cells to give them energy.

*Store extra glucose for energy. After you eat, insulin levels are high. Extra glucose is stored in the liver. This stored glucose is called glycogen.

Between meals, insulin levels are low. During that time the liver releases glycogen into the bloodstream in the form of glucose. This keeps blood sugar levels within a narrow range.

If you have diabetes:

Your blood sugar levels keep rising after you eat. That's because there's not enough insulin to move the glucose into your body's cells. With type 1 diabetes the pancreas stops making insulin. With type 2 diabetes, he pancreas doesn't make enough insulin. And in some people with diabetes, insulin does not work well.

If you don't get treatment for diabetes, high blood sugar can lead to health problems over time. These conditions include:

Heart attack or stroke

Kidney disease, leading to kidney failure

Eye problems, including blindness

Nerve damage with nerve pain or numbness, called diabetic neuropathy

Foot problems that may lead to surgery to remove the foot

Dental issues.

Goals of insulin therapy

Insulin therapy keeps your blood sugar within your target range. It helps prevent serious complications.

If you have type 1 diabetes you need insulin therapy to stay healthy. It replaces the insulin your body doesn't make.

If you have type 2 diabetes insulin therapy might be part of your treatment. It's needed when healthy-lifestyle changes and other diabetes treatments don't control your blood sugar well enough.

Insulin therapy also is sometimes needed to treat a type of diabetes that happens during pregnancy which is called gestational diabetes. If you have gestational diabetes you might need insulin therapy if healthy habits and other diabetes treatments don't help enough.

Types of insulin

Any type of insulin helps treat diabetes. Each type varies in how quickly and how long it controls blood sugar. You may need to take more than one kind of insulin. Factors that help determine which types of insulin you need and how much you need include:

The type of diabetes you have

Your blood sugar levels

How much your blood sugar levels change during the day

Your lifestyle.

The main types of insulin therapy include:

Long-acting, ultralong-acting, or intermediate-acting insulins. When you're not eating, your liver releases glucose so your body has energy. Long-, ultralong- or intermediate-acting insulin prevent blood sugar levels from rising without eating.

Examples of these insulins are glargine (Lantus, Basaglar, others), detemir (Levemir), degludec (Tresiba) and NPH (Humulin N, Novolin N, others). Intermediate-acting insulin lasts about 12 to 18 hours while long-acting insulin works for about 24 hours and ultralong-acting insulin lasts about 36 hours or longer.

Rapid-acting or short-acting insulins. These insulins are ideal for use before meals. If taken with a meal they can help bring blood sugar back down to the baseline; they also blunt the sugar spikes after you eat. They start to work much faster than long-acting or intermediate-acting insulins do, and sometimes rapid-acting insulins begin working in as few as 5 to 15 minutes. But, they work for a much shorter time. Rapid-acting insulin lasts about 2 to 3 hours. Short-acting insulin lasts about 3 to 6 hours.

Examples of these insulins include ultrafast-acting aspart (Fiasp) and lispro (Lyumjev); rapid-acting aspart (NovoLog), glulisine (Apidra), and lispro (Humalog, Admelog); and short-acting, regular (Humulin R, Novolin R).

Sometimes insulin-makers combine two types of insulin; this is called pre-mixed insulin. It can be helpful for people who have trouble using more than one type of insulin. Pre-mixed insulin often starts to work in 5 to 60 minutes. It can keep working for 10 to 16 hours.

Be aware that different preparations of insulin vary in terms of when they start working and how long they last. Be sure to read the instructions that come with your insulin and follow any directions from your health-care team.

Ways to take insulin

Insulin doesn't come in pill form as the digestive system would break the pill down before it had a chance to work. But there are other ways to take insulin. Your health -are team can help you decide which method fits best for you.

Choices include:

Shots or pens. You can inject insulin into the fat just below the skin with a syringe and needle or you can inject it with a pen-like device. Both types of devices hold insulin with a needle attached. How often you need to use an insulin pen or shot depends on the type of diabetes you have; it also depends on your blood sugar levels and how often you eat and exercise. You may need to take insulin shots or use insulin pens multiple times a day.

Insulin pump. An insulin pump gives you small, steady amounts of rapid-acting insulin throughout the day; this works like using a shot of long-acting insulin. A pump also can give a rapid burst of insulin, often taken with food; this works like using a shot of rapid-acting insulin. The pump pushes the insulin into a thin tube placed beneath the skin.

Several different kinds of insulin pumps are available.

Inhaled insulin (Afrezza). This type of insulin is rapid-acting; you breathe it in through a device that goes in your mouth, called an inhaler. You take this type of insulin at the start of each meal. People who smoke should not use inhaled insulin, nor should people who have lung problems such as asthma or chronic obstructive pulmonary disease.

Sometimes, using insulin therapy can be a challenge but it's an effective way to lower blood sugar. Talk to a member of your health-care team if you have any trouble with your insulin routine. Ask for help right away if at-home glucose tests show that you have very low or very high blood sugar as your insulin or other diabetes medicines may need to be adjusted. With time you can find an insulin routine that fits your needs and lifestyle and that can help you lead an active, healthy life.

If you take many doses of insulin a day, ask your health-care provider if there's a way to make the routine simpler. Adding non-insulin medicines to your treatment plan might lower the number of insulin shots you need each day. And if you take fewer insulin shots you'll need to check your blood sugar less often. Certain non-insulin medicines have other health benefits too. Some can help control weight and lower the chances of heart attack or stroke, heart failure, and kidney failure. Some people with type 2 diabetes can stop taking insulin completely after they start taking non-insulin medicines. But it's important to keep taking your insulin as prescribed until your health-care provider tells you it's OK to stop.

This article first appeared on the Mayo Clinic website. Read more at mayoclinic.org

Earlier this year, several labs around the world released pre-print studies that had not been peer-reviewed, describing their development of early human embryo-like structures.

But now one group's research has been published in the peer-reviewed journal Nature, describing how they coaxed human embryonic stem cells to self-organise into a model resembling an early embryo.

The research was welcomed by some scientists as an "impressive" advance that could help unlock secrets about the precarious early stages of pregnancies, when failure is most common.

The work will however renew debate on the need for clearer ethical rules on development of lab-grown human embryo models.

The researchers, led by Palestinian scientist Jacob Hanna at Weizmann Institute in Israel, harnessed the power of embryonic stem cells, which can become any kind of cell.

They produced embryo models up to 14 days old, which is the legal limit for human embryo lab research in many countries and the point at which organs like the brain begin to develop.

The researchers say their work differs from those of other teams because it uses chemically rather than genetically modified embryonic stem cells and produces models more like real human embryos, complete with yolk sac and amniotic cavity.

These similarities could make the models more useful for research into conditions like miscarriage, birth defects and infertility, said James Briscoe of Britain's Francis Crick Institute.

The model "seems to produce all of the different types of cells that form tissues at this early stage of development", said Briscoe, principal group leader and associate research director at the biomedical research charity.

The research "is a step towards opening a window on the period of human development where many pregnancies fail and which has been really difficult to study up until now".

Both the researchers and scientists not involved in the work emphasised that the models should not be considered human embryos.

The structure "highly resembles but (is) not identical to the in utero situation", the research notes.

The success rate on generating the models was also low, with the stem cells organising correctly just a small percentage of the time.

Still, "in contrast to similar studies published earlier this year, these embryo-like structures contained most of the cell types found in developing embryos", said Darius Widera, an expert in stem cell biology at the UK's University of Reading.

The research and other recent work show "that models of human embryos are getting more sophisticated and closer to events that occur during normal development".

This highlights "that a robust regulatory framework is more needed than ever before", he added.

In Britain, Cambridge University has begun developing the country's first governance framework for stem cell-based human embryo models.

British law prohibits the culturing of human embryos in labs beyond the 14-day mark, but because the structures derived from stem cells are formed artificially, they are not explicitly covered by existing regulations.

Still, most researchers have adopted voluntary limits on their work at this stage.

The Weizmann Institute research did not develop its models beyond 14 days and does not involve transferring the models into a human or animal womb.

A newly published Mayo Clinic study puts numbers on that cost: an estimated US$1.8 billion in lost work time and US$26.6 billion when medical expenses are added, in the US alone.

"The takeaway for employers is that there is a critical need to address this issue for women in the workplace," says lead author Stephanie Faubion, medical doctor and director of Mayo Clinic Women's Health.

Menopause occurs at a mean age of about 52 years. Given that mid-life women make up a sizeable proportion of the global workforce, the impact of menopause symptoms on worker absenteeism, productivity, increased direct and indirect medical costs, and lost opportunities for career advancement are significant.

To evaluate the impact of menopause symptoms on women in the workplace, Mayo Clinic researchers invited 32,469 women aged 45 to 60, who are receiving primary care at Mayo Clinic, to participate in a survey study. Just over 5,200 women responded (16.1 per cent) and of those, 4,440 women were currently employed and included in the study.

The findings, published in Mayo Clinic Proceedings, identified an association between menopause symptoms and adverse work outcomes, including lost work productivity, with the severity of menopause symptoms strongly predicting the odds of an adverse work outcome. According to the 'Proceedings' article, the findings highlight a critical need to improve medical treatment provided to women and present an opportunity to make the workplace environment more supportive for women experiencing menopause symptoms.

"A full 13 per cent of the women we surveyed experienced an adverse work outcome related to menopause symptoms, and about 11 per cent were missing days of work because of these symptoms," Dr Faubion says. "We also found some racial and ethnic differences on a sub-analysis of the results, though more research is needed in this area in larger and more diverse groups of women."

The article estimates the annual economic impact, based on lost workdays, at US$1.8 billion. Dr Faubion, the study's first author, says that when direct medical costs are included the cost is about US$26.6 billion annually.

The survey was conducted from March 1, 2021 through June 30, 2021, and symptoms were assessed by the Menopause Rating Scale (MRS). The mean total MRS score was 12.1, indicating moderate menopause symptom burden. The mean age of the 4,440 participants was 53.9 years, with the majority being white (93 per cent), married (76.5 per cent), and educated (59.3 per cent with college degree or more).

A total of 597 women (13.4 per cent) reported at least one adverse work outcome due to menopause symptoms, and 485 women reported missing one or more days of work in the preceding year due to symptoms.

"Adding to the complexity of women's experience of menopause is that the topic has been taboo, particularly in the workplace, which potentially adds to the psychological burden of symptoms," says senior author Ekta Kapoor, assistant director of Mayo Clinic Women's Health. "Women often fear bias, discrimination and stigmatisation, and therefore may be reluctant to disclose their menopause symptoms to their workplace managers and others. Recognising these concerns and creating a safe workplace environment for women to discuss their health-care needs may help address this."

Dr Faubion and Dr Kapoor also are co-authors of an article to be published in the May edition of Mayo Clinic Proceedings on the association between migraine and vasomotor symptoms. Vasomotor symptoms, such as hot flashes and night sweats, are hallmark symptoms of menopause and are experienced by a majority of women during the menopause transition.

"Our research suggests a critical need to address this issue for women in the workplace," Dr Faubion says. "Clinicians need to ask women about menopause symptoms and offer guidance and treatment, and employers need to create and implement workplace strategies and policies to help women navigate this universal life transition."