Rafael Perez* (39) woke up in an emergency room confused and terrified. He’d blacked out because his blood sugar had dropped dangerously low. It wasn’t the first time this had happened, and Rafael feared it wouldn’t be the last. He was living with Type 1 diabetes, and although he knew it was poorly controlled, he felt powerless to remedy his situation.

Because of his immigration status, Rafael did not qualify for health insurance. So he went without medical care and the tools that would help him manage his diabetes and resorted to buying insulin off the street. The situation left Rafael trapped in a cycle of blackouts caused by dangerously low blood sugar.

“I was living in constant fear, never knowing when the next blackout would happen,” Rafael recalls. “I was scared I wouldn’t make it through one of them.”

Finding Support and a Path Forward

When Rafael met Ligaya Scarlett, FNP-C and clinical lead of the Mayer B. Davidson, MD Diabetes Management Program at Venice Family Clinic, he knew things were about to change. “She gave me hope from the moment we spoke,” Rafael says. “I knew I was in safe hands.”

Scarlett immediately found the root of the problem: Rafael had been taking the wrong type and dose of insulin – a problem that she quickly remedied by providing a prescription and dosage instructions for the correct medication. Immediately, blackouts became a thing of Rafael’s past.

Life-Changing Technology

Rafael’s health was improving, but Scarlett knew that managing his diabetes required ongoing intervention. She connected him with the Clinic’s dedicated, multidisciplinary team including diabetes health educators
whose work is generously supported by the Leonard M. Lipman Diabetes Management Program. The diabetes health educators provided Rafael with personalized education, nutrition counseling and continuous support to help him manage his condition with confidence.

He also needed a way to monitor his blood sugar continuously to prevent the dangerous drops that jeopardized his health. Scarlett provided Rafael with a Continuous Glucose Monitor (CGM), a small, wearable device that provides information about his blood sugar levels in real-time, so he could leverage the information it provided about trends to avoid yet another trip to the ER. Scarlett also placed Rafael on an automated insulin pump, a device that automatically delivers precise amounts of insulin based on the CGM’s readings. Pairing both tools significantly reduced the risk of human error, allowing Rafael to maintain stable blood sugar levels with less intensive day-to-day management.

For patients at many community health centers, accessing these life-changing tools would mean navigating a lengthy referral process to see an endocrinologist. However, because Rafael is a patient of Venice Family Clinic, he has immediate access to a team of clinicians with training in advanced diabetes management who can provide the specialized care he needs. Having this in-house expertise significantly reduces the barriers our patients face when trying to reclaim their health.

The peace of mind Rafael gained knowing his health was in the hands of such an experienced team and that he could now avoid life threatening episodes marked a turning point.

“The combination of the CGM and pump meant I could focus on my life, not just managing my diabetes,” Rafael says. “With these tools, I feel like I finally have the freedom to pursue what matters most to me without constant worry and interruptions.”

Opening Doors to Better Health

Rafael isn’t alone. More than 5,000 patients at Venice Family Clinic have diabetes. Without comprehensive care, these patients are vulnerable to serious complications, including kidney failure, an increased risk for heart disease, nerve damage and blindness. Poorly managed blood sugar levels can also lead to amputations and a significantly reduced life expectancy. For patients like Rafael, access to the right tools and support is essential to avoiding these devastating outcomes and living a healthier, more stable life.

In addition to transforming Rafael’s care, the ability to offer both CGMs and insulin pumps marks a major step forward for Venice Family Clinic and the fight for health equity. Although these technologies have been available for years, until recently both have been prohibitively expensive for people on Medi-Cal or living without health insurance. Fortunately, in July 2021, Medi-Cal began covering CGMs for adults living with diabetes. And in May 2022, the program expanded eligibility to include undocumented Californians, making these essential tools accessible to patients like Rafael. As soon as these resources became available, the Clinic worked to ensure our patients could access this life-changing technology.

“A CGM or an insulin pump can change someone’s life, but it takes advanced medical training to program and maintain the technology as well as expert, individualized support for each patient’s unique situation,” says Scarlett. “Our team is here to ensure patients like Rafael have those tools and gain the confidence and skills needs to reclaim their health.”

Looking Forward

What once seemed impossible—access to the same advanced tools that have been common in resourced communities—is now a reality for patients like Rafael. By making this life-changing technology available, Ligaya Scarlett and her team are not only treating diabetes but empowering patients to take back control of their health.

With his CGM and insulin pump, Rafael’s diabetes is under control, and his confidence has returned. The care he receives is about more than managing his diabetes—it’s about finally having the freedom to live. “For the first time, I’m not just surviving—I’m living,” Rafael says. “I feel hopeful about my future.”

*Name changed at our patient’s request.