February 23, 2009

Diabetes on a Budget

Diabetes is expensive. Test strips, drugs, and food that doesn't raise your blood sugar all cost money, but for a lot of us, the money to pay for these necessities has become hard to find. If you are finding yourself in a crunch here are a few ideas that may help.

Test Strips
If you don't have insurance coverage test strips are obscenely expensive and the cost is getting worse every month. Still, used properly they can be the most powerful tool you have in the battle to avoid blindness, amputation, and kidney failure--all of which have been linked to blood sugars that stay above 140 mg/dl for a few hours each day.

You can often find deals on brand name strips online. Amazon features several merchants offering Test Strip Deals. From the customer feedback it appears that these are legitimate, though you may receive strips that are a few months from their expiration date. This should not make any difference in how they function.

Some people have found good test strip deals on eBay. Avoid ordering strips when it is very hot, as they may be damaged by sitting in a very hot truck.

The Relion brand meters and strips sold at Wal-mart are much cheaper than the name brand strips. In my experience they do not appear to as accurate as the Ultra meters, but they are similar to the Accu-Cheks. Meter accuracy is a whole nother topic which we won't go into here. If you are not using insulin to achieve very tight control, the Relion meters are fine. If you are, you might want to pay a bit extra for the name brand strips.

The drug store generic brand strips I used to recommend though slightly less expensive than the name brand strips have become much more expensive. I no longer recommend them.

To cut down on how many strips you use, make it a policy to ask yourself, before you test, "What action will I take based on the reading I am about to see?" If you do not plan to use your test result to make a specific change in your food intake or drug dose, don't test. It is easy to get into the habit of testing and to test because you are curious, rather than because the result you see will cause you to take action.

If money is really tight and you cannot afford test strips, you may be able to extract useful information from the urine test strips that measure glucose in urine. These come in packs of 50 and should not cost more than $10. You can use a scissors to cut each strip into 3 or 4 thinner strips without affecting the strip's function. How useful these strips will be for you depends on your own personal "renal threshold for glucose." This is the blood sugar level at which you start to dump glucose in your urine.

How high this level might be varies from person to person. At one extreme, there are people who will see glucose in their urine when their blood sugar is slightly over 140 mg/dl (7.7 mmol/L). At the other, there are people like me who only see glucose in their urine when their blood sugar goes over 250 mg/dl (13.8 mmol/L). Few people will fall at these extremes. Most people will spill a detectable amount of glucose in their urine when their blood sugar exceeds 160 - 180 mg/dl (8.9 - 10 mmol/l) for more than a short time. It is important to understand that it takes time for high blood sugars to translate into high glucose in urine. So a high result on a urine test strip tells you that your blood sugar was high 2 or 3 hours before.

If you have some blood sugar test strips and your money is running low, it might be a good idea to buy some urine test strips and to see if you can determine how high your renal threshold for glucose is. Test your urine with a strip two hours after you see a high value on your blood sugar meter test strip. If your threshold is not too high, you may be able to use the urine test strips to confirm that you are avoiding dangerous highs.

Many people who developed Type 1 diabetes in the 1930s and 1940s were able to maintain their long term health long term without access to reliable testing. If you use whatever strips you can afford to determine how high a set amount of carbohydrtae raises your blood sugar, and scrupulously avoid eating more than the amount that pushes your blood sugar over your chosen blood sugar targets, you can preserve your health too.

Type 2 Diabetes Drugs

Though doctors are much too quick to prescribe the newest, most expensive diabetes drugs there is little evidence that these new expensive drugs are any more effective than the older drugs that are available as generics. With most pharmacies and supermarkets selling generic drugs for $4 a prescription, you can afford these effective diabetes drugs.

The best drug for most people with Type 2 diabetes is Metformin. Plain Metformin and Metformin ER, the extended release form that is easier on the stomach, are both available as generics. Some generic brands appear to be stronger than others, so if you aren't happy with the results you are getting with one brand, ask the pharamacist to try another, or if that isn't a possibility, switch your prescription to another pharmacy that dispenses a different generic brand. The pharmacist will tell you which brand they dispense if you ask.

Amaryl is also available as a generic. It is a sulfonylurea drug. Though this is not a drug I recommend to people who have a choice of medications, if you don't have a choice and it lowers your blood sugar, Amaryl is a lot better than nothing. Avoid glipizide as its potential for causing heart attack appears to be higher than that of Amaryl, though its effect on blood sugar is similar.

If you do not have health insurance coverage you will find the analog insulins most doctors prescribe obscenely expensive. These include Lantus, Levemir, Humalog, Novolog and Apidra. Fortunately there are older, insulins that are much cheaper which you can use instead. These cheap insulins are sold only at Wal-mart and are the Relion Novolin R, a faster acting insulin, and the Novolin NPH, which is a longer acting insulin. (Other pharmacies may sell NPH and R but they sell them at a much higher price.)

These insulins have different activity curves than do the analogs. Read Dr. Bernstein's Diabetes Solution for complete instructions on how to figure your doses with these insulins. The R insulin works best with a lower carbohydrate intake. NPH can be made to act as a basal insulin if you use it very cautiously and understand that it does have a peak.

If you cannot make these insulins work, ask your doctor to file the paperwork to get you insulin via one of the hardship programs that help people who are insulin dependent. If he can't, call the largest regional hospital in your area and ask to speak to a social worker about how to sign up for one of these programs.

Here is another useful resource if you are low income:


Thanks to Bamagal for contributing this link.

If you have been eating a low(er) carb diet you may have come to rely on expensive meats and fresh vegetables and fear that it is not possible to control your blood sugar on cheaper fare. This is not true. There are long discussion threads on how to eat a very low carb diet on a budget HERE.

A crockpot is a worthwhile investment as you can use it to turn tough, cheap cuts of meat into delicious stews. Shop carefully and only buy meat on sale. You can often find good deals on meats like pork chops and roasts (pork chops have been selling for $2 a lb in my region recently.) Often the better quality meat on sale is much cheaper than hamburger or other ground meat which people think of as bargain fare. Chicken thighs and mixed parts are often on sale at very cheap prices. Even chicken breast goes on sale from time to time at $2 a lb. Fresh ground store brand sausage may also be a good, cheap, filling choice.

Frozen vegetables are as nutritious as fresh and can be bought in cheaper larger sizes.

Cheese may seems expensive when you look at the per pound cost, but you can get high quality nutrition from eating only a few ounces. Cheese, too, goes on sale from time to time and you can stock up when your favorites are on sale.

Eggs continue to be a great food bargain. Omelets or fritattas made with cheese and/or frozen veggies are low carb and very good for you.

If you have tips to help others manage diabetes on a budget, please post them in the comments section. (Click on the "n comments" link immediately below this message to get to the comments section.)


Anonymous said...

Alan has some excellent ideas on saving money and testing


IME testing a lot initially pays dividends over the long term, now I have worked out what I can and cannot eat an different times of day I can test a lot less and be confident in my results. The upfront cost is more than worth it for the long term savings.

I'm one for whom carbs beget carb cravings which beget carb eating. So breaking out of that cycle liberates more money which can be spent on more nutritious food. Yes, fresh veg and decent meat is expensive compared to processed foodlike substances, but if you eat less of it your food bill will reduce, or at least not increase so much.

Again there's a long term gain, what you spend now on decent food will (hopefully) be repaid in spades in lower medical bills in future years.

You don't have to look far to see the result of the alternative, ever increasing medication bills, expensive surgical procedures and most importantly a total lack of quality of life.

Agreed though it's a difficult equation to balance in a world where a 40 speed DVD burner costs less than a week's supply of vegetables. As expensive things get cheaper so cheap things get expensive. :(

Anonymous said...

Groceries in most parts of the country put out circulars once a week. In our area they can be found in the Wednesday local paper. If you are on a budget this is an essential. There is almost always meats, fruit, and veggies of some sort on deep discount. As an example last week they had broccoli and cauliflower under a dollar a pound. New York Steaks, with a little bone and gristle were $2.34 a pound - if you bought 10 pounds or more. I repackage and freeze at home. And oh yes, 6! Romaine lettuce hearts in a pack for $2. RobLL

Anonymous said...

Find coupons in the Sunday paper for the Contour meter from Bayer. About 2 - 4 times a year I find them in the Sunday paper coupon section. Generally you can find this meter on sale at Walgreens and Walmart so your end cost is tax. This meter comes with 10 strips. The coupon generally is for the Breeze also but only buy the Contour. One strip will be used with the control so you are left with 9 strips. Buy *several* papers and get the coupon section from friends and family who get the Sunday paper. Generally there will be another coupon or more of products you use so the cost of the paper should be covered.
It turns out to be like having an 80% strip coverage for insurance. My insurance does not cover strips unless you are on insulin.
This one I am testing this week along with my official blood draw (so it may not be a tip). The Reli On brand at Walmart has a home A1c test kit for $9 + tax (includes an envelope to send the sample to be tested) if it is accurate it would be a good way to have an idea of how you are doing between appointments. If you have tested the foods you generally eat and are mildly diabetic you may not need to test with test strips very often. Use the test strips sparingly and then off-set it with the home A1c test. This way you can use the money you would be spending on testing for food that doesn't raise your blood sugar.

BamaGal said...

Partnership for Prescription Assistance is a good place to look for help getting your scripts. Here's the link to their webpage.

Welcome to PPARx.org

this is from their website

The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

Anonymous said...

I recently went looking for another meter when I suspected that my Reli-on meter was not giving accurate results. I found the disposable Sidekick meter with 50 strips for $19.99 Walmart. So far I'm impressed.

Harold said...

In the low range I have found the ReliOn strips and meter as good as several others that I compared it to.
I stay out of the higher levels so can't say about that. I can say that it does not make much difference if you are high (above 150) as you are too high and no matter what you will will need to test again when you are coming under control and the meter will be accurate then. In other words accuracy in the high levels is not important but accuracy in the low level is!. You just need to know that you are high and start getting down. The lower cost of ReliOn is worthwhile.

Anonymous said...

I'd like to just re-iterate Jenny's point about unnecessary testing.

Once you've established your good habits, there's no point in wasting a strip when you already know what it's going to say!
Leave the testing for when you're trying something novel and what to see what effect it has.

Another tip to save money is to live in a country that has some form of socialised medicine!
(OK, if you don't already, the transition cost might be considerable...)
(Test strips here are AUD0.06ea, subsidised by the NDSS, National Diabetes Services Scheme.)

Sara said...

Thanks for this; there are a lot of good ideas here. In particular, it had never occurred to me to check Amazon for strips -- I see that I can get the strips from my Accu-Check Aviva (which I got free, also thanks to you) at a price very comparable to the strips for the Reli-On, and I think my Aviva is a touch more accurate (or at least, it's more self-consistent, which Dr. Bernstein identifies as a marker of accuracy) than my Reli-On, so this is great.

Anonymous said...

My company no longer provides a copay health plan. I am pretty much on my own up to a $5200 deductible. So I have quit using my meter (which was given to me free) due to cost of test strips. Why? Jenny asks the right question: What are you going to DO as a result of your test result? Otherwise, it is the equivalent of hopping on the weight scale 10times a day, seeing an appalling result, and then wringing your hands about it. I decided I really already know what sends my sugar up, I know the symptoms without testing for it, and I know what to do (or not to do). I'm now relying on quarterly A1Cs and common sense in the meantime. Also good carb avoidance means you don't have to spend money on insulin, Byetta, Januvia or all the other (expensive) stuff the "health" business depends on you to buy.

Anonymous said...

Good point, now I can *feel* when my BG has gone high or low and often the test just confirms it.

Excellent point about the coupons too. Here the discounts are mainly for crap but there are often two for the price of one and other discounts in store, and spend £30 and get £5 off coupons, spend £40 and get money off fuel etc. so you can save money by buying bulk stuff every couple of weeks.

Where I used to work we had a choice of two supermarkets, and two more where I lived. In general prices were similar overall but by shopping around you could save a bit as some things were cheaper in each one, and hey! the exercise will do you good if you have the time to spare. Sometimes fresh foods are cheaper as well as better quality in the small specialist shops where you'd think they would be more costly - but not always.