Diabetes is an expensive disease. Over a lifetime, people with diabetes spend a lot of money and time on self-management. For many, diabetes care is unaffordable and hard to access. As a result, they turn to other ways to get medicine and supplies. For example, people may trade, donate, borrow and buy their medicines through unauthorized channels. In a recent study, people with diabetes responded to an online survey exploring difficulty purchasing diabetes medications and supplies and “underground” exchange activities. Over half of the participants used these underground networks to meet their needs. There was no link between blood sugar levels and trading, purchasing, or borrowing diabetes medications and supplies. We know that in both urgent and nonurgent situations people with diabetes frequently donate, trade, borrow, and buy medications and supplies with online strangers as well as relatives and friends. These underground activities highlight a failure of the U.S healthcare system.