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.

Insulin
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:

PPARx.org

Thanks to Bamagal for contributing this link.

Food
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.)