No matter how long you’ve had diabetes, managing your self-care can be a difficult balancing act: With a meticulous approach toward controlling your blood glucose level, you risk episodes of hypoglycemia (low blood glucose); but relax a little too much, and your level can shoot through the roof. For many people with diabetes, this balancing act also applies to the cost of managing their condition. Sure, everyone wants to save money — but not when trimming the budget now could increase the risk of developing burdensome and expensive complications later on.
This article reviews ways to save on education, drugs, supplies, food, and exercise, while also pointing out some strategies that yield more risk than savings.
Since knowledge about diabetes and its care is constantly expanding and changing, education is the gateway to improving all aspects of your self-care. While medical professionals are a critical source of guidance, people with diabetes who get their information from a variety of sources are more likely to know what questions to ask and how to make the best use of visits to their health-care team.
With this in mind, seek lots of education with a focus on value: the quantity and quality of information received compared to its price. Personal medical attention is, of course, irreplaceable; it gives you the most direct, personally relevant information of any source. Group education, however, is an excellent complement to one-on-one visits. Not only does it offer interaction with a professional at a lower cost, but it also gives you an opportunity to interact with and learn from other people with diabetes. Many hospitals and clinics offer both group and individual sessions with Certified Diabetes Educators (CDEs), which most insurance plans cover for a set number of hours.
Written materials can also be a great way to get information and expand your knowledge. The American Diabetes Association Complete Guide to Diabetes, for example, is a good general reference on diabetes. The Diabetes Self-Management Answer Book is full of in-depth tips to help you take charge of your diabetes.
If you like Web-based resources, scores of diabetes-related Internet blogs exist, including the ones on our own Web site (www.diabetesselfmanagement.com). Although many are decidedly not authoritative sources of information, diabetes blogs offer a ready supply of potentially useful ideas, experiences, and musings. But don’t change your self-care regimen solely because of something you read on a blog or in the news. Each person’s diabetes is different and requires an individualized approach. Speak to your health-care provider about new products or ideas you read about.
Educating children about their diabetes can be particularly challenging. Fortunately, numerous materials have been developed for this purpose. Some of the products with especially positive consumer ratings include the CD-ROM “Diabetes Education for Kids” by dbaza, inc. (for PC only) and the workbook It’s Time to Learn About Diabetes by Jean Betschart Roemer. Reviews of other materials for children, with links to buy them online, are available at the Web site Children With Diabetes (www.childrenwithdiabetes.com) in the “Products” section. Another helpful resource is the “Kids Online” Web site of the Juvenile Diabetes Research Foundation (http://kids.jdrf.org).
Prescription medicines impose a heavy financial burden on many people with diabetes, and depending on your income and insurance coverage, it may be difficult to reduce this expense substantially. A number of options can, however, generate at least some savings. One is using a mail-order pharmacy; many insurance companies offer reduced co-pays for this service, and the actual cost of the drug is likely to be lower, too. This will benefit you directly if your insurance plan has restrictions on the total cost of covered prescriptions within a time period (as does Medicare Part D), or if you are paying for the drug yourself.
If you do not have insurance coverage for prescription drugs, you may be tempted to use an online Canadian mail-order pharmacy. While this can cut costs, it is technically illegal under federal law, and the US Food and Drug Administration (FDA) plays no role in the oversight of non-US pharmacies. Nevertheless, several states, including Illinois, Kansas, Missouri, Vermont, and Wisconsin, have authorized programs through which their residents can order medicines from select foreign pharmacies. (No insurance companies recognize these programs.)
If you have insurance that covers prescription drugs, check to see if the policy has its own mail-order program. If you decide to look for a mail-order pharmacy online by yourself, look on the site for the VIPPS (Verified Internet Pharmacy Practice Site) seal. (Only US pharmacies are eligible for this certification.) Make sure to check any drugs received by mail, especially insulin, for spoilage before using them. Medicines from all pharmacies should look the same; if you have any doubt that a prescription you receive by mail is the correct one, do not use it until you have checked it out with the pharmacist or your doctor.
When selecting either a traditional or a mail-order pharmacy, look for the lowest total cost of all your prescriptions. Mixing and matching pharmacies may save a little bit of money, but buying all of your drugs from one place allows pharmacists to check for potentially dangerous drug interactions.
If you cannot or would rather not change the source of your prescriptions, or if doing so doesn’t save you enough money, you may want to consider changes in the drugs you take themselves. Ask your doctor whether an older, less expensive medicine might work instead; new drugs are not always more effective. (You can read about good drug values at Consumer Reports Best Buy Drugs, www.crbestbuydrugs.org.) If you are taking a brand-name medicine that has a generic equivalent, ask your doctor if you can switch; with just a handful of exceptions, generic drugs are just as safe and effective as their more expensive brand-name counterparts. You may also be able to cut the cost of certain drugs through pill-splitting, since pills with a higher drug content are often no more, or only slightly more, expensive than pills with a lower drug content. Not all pills can safely be split, however, so it is necessary to discuss this option with your doctor.
If you have a relatively low income and none of these options offer enough savings, consider applying for a patient assistance program, under which drug companies offer substantial discounts. Several Web sites exist for this purpose, including RxAssist (www.rxassist.org), BenefitsCheckUp (www.benefitscheckup.org), and the Partnership for Prescription Assistance (www.pparx.org).
No matter what your financial situation is, never alter the dose of a drug without first talking to your doctor. It may be possible over time, however, to lower the doses of some drugs or even eliminate them from your regimen through regular exercise and weight loss, since both of these can reduce insulin resistance.
There is some overlap in techniques for saving on drugs and for saving on other diabetes supplies, but some differences are worth noting. Older, potentially cheaper forms of supplies, if available at all, are seldom the wise choice, since technological improvements have made newer products more accurate and often much easier to use, lowering the chances of user error and wasted supplies. Because of this, smart cost-cutting is usually limited to finding ways to save on the supplies you already use. Buying in bulk is one way to do this; the savings can be significant, but make sure not to buy more of any item than you’ll use before its expiration date.
Some supplies, such as lancets and syringes, may be safely reused. With good hygiene, it is usually acceptable to use the same lancet throughout a 24-hour period, although you should check with your doctor first. One syringe can be used multiple times throughout a day, as well, unless you have a history of infections or are ill or immune-compromised. Make sure to recap the needle after each use, and don’t use alcohol on it, since this can damage its protective coating. After injecting insulin, force out any insulin that remains in the needle; if left there it can form clogs that, when the needle is reinserted into the bottle, may accelerate spoilage of the insulin. Again, check with your doctor if you are considering reusing syringes.
Ordering supplies by mail (on the Internet or by phone) is often, but not always, the most cost-effective way to buy them. If you need assistance with a new blood glucose meter or other equipment, it may be difficult to get help from a mail-order pharmacy, whereas most local pharmacies offer free assistance. Also, since the amount of time a supply lasts can vary, many insurance companies require personal initiation of each mail-order shipment (as opposed to automatically shipping supplies on a predetermined schedule). If you think you might forget to reorder before you run out completely, it’s probably best to stick with local suppliers.
No matter how pressured you are financially, skipping necessary monitoring is not a good way to save money; the cost of monitoring is practically nothing compared to the potential cost of complications.
A healthy diet doesn’t have to cost any more than an unhealthy one — in fact, it may cost considerably less with the right approach. One of the keys to saving money while maximizing nutrition is to plan meals well in advance. This means you can buy and prepare ingredients in larger quantities, focusing on the bigger nutrition picture and saving preparation time while cutting grocery-store costs. When shopping, note that precooked, presliced, and individually wrapped items are usually more expensive than their raw, whole, and unportioned equivalents. However, if you’re short on time for food preparation, a meal composed of prepared items from the grocery store may still be less expensive and more nutritious than a restaurant meal. A healthy microwave dinner once in a while is fine, too — but in general, try to buy items that are processed as little as possible while still convenient. Not only will it save you money, but you will also have greater control over what goes into your mouth.
Although less-expensive store-brand items may be noticeably different from their famous-brand equivalents, don’t dismiss them without trying them first. Also, if a grocery item is available in bulk and can be used before it spoils, it may be a good choice — but consider whether having such a ready supply of the item might lead you to increase portion sizes. Finally, read the labels carefully on reduced-fat, reduced-sugar, or other specially formulated “dietetic” foods. Although these items may have some advantages over the regular versions, they may still be high in calories and are likely to be expensive. If you need a snack, consider having some unsalted nuts, low-fat dairy products (which don’t tend to cost more than higher-fat dairy products), fruits, and vegetables; these foods pack a nutritious punch relative to their cost.
Expense is seldom, if ever, a real barrier to exercise; all you need to reap the most important benefits are a pair of shoes and some regular household items. Walking or jogging is one of the simplest and most affordable ways to be active, with potentially enormous health benefits. However, if you’ve had diabetes-related foot complications, talk to your doctor about safe forms of exercise for you. Do not use complications as an excuse for being inactive unless it is a medical necessity; the health benefits of exercise, including weight control, can help offset many potential complications in the long run.
In addition to aerobic activities such as running or walking, work some resistance exercises into your routine, even if very light ones are all that are feasible. (Aerobic exercise supports heart and lung health; resistance exercise promotes bone and muscle strength.) You can use items such as soup cans or bottles of water for this purpose, or you might want to buy inexpensive rubber exercise bands, which often come with instructions for use. Stretching regularly to maintain flexibility is another important part of physical fitness, and it costs nothing.
If you’re thinking about purchasing exercise equipment, first be realistic: Only buy something if you’re sure you’ll use it regularly. If you decide that buying equipment is the right choice for you, do some research to make sure that what you might purchase is durable. Buy used if possible — you can look in classified ads, used equipment stores, and Internet listings. (Remember that there will probably be shipping costs for online purchases.) Never buy an exercise video at its retail price unless you know it is exactly what you want. Some online stores, such as Collage Video (www.collagevideo.com), offer short, instant previews that may be helpful. It is far more cost-effective, though, to borrow videos from your public library, to buy them for pennies at a garage sale, or to record them from your TV. (Check your local TV listings; you may be surprised to see what you’re already paying for.)
With a little bit of initial exploration, it is possible to come up with a plan for exercise, just as for education, drugs, supplies, and food, that reflects your health needs and aspirations while limiting your expenditures. Although it requires some effort and commitment, investing wisely in your health can lead to both tangible and immeasurable returns on your money.