Diabetes Self-Management Blog

My blog colleague Eric apparently ponders things. Things like "time spent checking blood glucose," which he figures to be "a month and a half every decade," as he wrote in the comments section of my December 18 blog entry ("Jan Cleans Out Files, Comes Up With Blog Entry").

I, on the other hand, am more likely to ponder how much something costs. Eric might, for example, multiply his salary by the time he spends checking his blood glucose, which could be part of the indirect cost of diabetes, which is defined by the American Diabetes Association as “lost workdays, restricted activity days, mortality, and permanent disability due to diabetes.” A “month and a half every decade” would certainly add up to some lost workdays, although if you have a job that requires thinking, I suppose you could think and check at the same time.

Eric also wonders how many drops of blood that amounts to, asking: “How much blood? Buckets?”

This I asked my brother, the engineer. Who finked out by saying the online conversion chart he was using didn’t list “drop” as one of the selections. “Just be grateful,” I told him, “that I didn’t ask you how many tears it would take to cry me a river.”

As it happens, one U.S. drop is, officially, 1/60 of a teaspoon, or 1/360 of a U.S. fluid ounce. One U.S. bucket holds 80 cups, or about 640 ounces. Therefore, 360 drops per ounce times 640 ounces per bucket equals 230,400 drops per bucket.

Divide that by the number of times Eric checks per day (10), then by the number of days in a year (365) and you find that it will take him about 63 years to fill a bucket.

“How many strips,” he goes on to ask, “and what if you lined them up end to end?” The number of strips is easy, at 10 strips per day multiplied by however many days you want to count. In one year, he would use 3,650 strips—at an annual cost of $2,920 at 80 cents a strip.

As for distance, that depends on the brand of strip. A LifeScan OneTouch Ultra strip, for example, is 1 inch long, while an Accu-Chek Aviva strip is 1.5 inches long. There are 63,360 inches in one mile. So, while it would take 63,360 Ultras to stretch for one mile, you’d only have to lay down 42,240 Aviva strips to go the same distance.

It would take Eric about 11.5 years to go one mile with Aviva strips, but a little more than 17 years if he uses an Ultra. It would kind of be like a race between a tortoise and a snail. Either way, he wouldn’t get very far in a lifetime, and one year’s worth would only be (pardon me) a drop in the bucket.

For cost, I checked the Fifty50 Pharmacy Web site, which lists 50 Ultra strips for $42.50 and 50 Aviva strips for $38.95, or $53,856 per mile (plus shipping, handling and, possibly, taxes) for the Ultra and $32,904.96 (plus shipping, etc.) per mile for the Aviva strips.

Sometimes I just shake my head and think of all the things I could do that I really wanted to do if I didn’t have diabetes. I do frequently give thanks that we have good insurance and can afford for me to have diabetes, but I’d really rather be traveling.

If you think strips are expensive, try insulin. Hoo-boy! For this one, I called my local Walgreens, which quoted me a cash price of $96.99 a vial for Humalog (insulin lispro) and $39.99 per vial for Humulin Regular. Let’s call it $97 and $40, respectively.

Just the cost per vial seems like a lot, but I (er, my brother) converted it into gallons so you can get a good idea of the cost in terms of a measurement familiar to most of us. There are 378.5 10-milliliter vials of insulin in one gallon of liquid. Which would be $36,714.50 per gallon for Humalog and $15,140 for Regular.

And you thought $3 a gallon for gasoline was expensive.

So you’ve got your strips and maybe you have insulin or an oral medicine or two (or three). I went to www.drugstore.com to get some costs on orals. I chose metformin (brand name Glucophage), pioglitazone (Actos), and glimepiride (Amaryl) for the meds, which add up to about $170 a month if you take 1,000 mg of metformin and the minimum amount of pioglitazone and glimepiride per day.

Do you take exanatide (Byetta)? That’s $225 or so per 10-microgram pen. I have no idea how long one of those pens lasts. (I tried it and it didn’t work for me.) Pramlintide (Symlin), which does work for me, is listed at $116 per vial. Maybe it will cost more when the company manages to get it out in pens. Who knows?

Now, add to that the other meds many of us take to thwart off diabetes-related complications: blood pressure pills, cholesterol-lowering drugs, antidepressants

We also need to eat healthy—and fresh fruits and vegetables and lean meats and fish cost a bit more than boxed macaroni and cheese.

Have I mentioned all of those extra doctor’s visits yet? The endocrinologist, ophthalmologist, and maybe others, depending on your individual circumstances?

What to do about it? Don’t be afraid to tell your health-care provider that your finances may not be up to affording what is being prescribed. He or she may understand more than you’ll know. A friend of mine who is a doctor and currently without insurance e-mailed me recently to ask if I had some spare strips. As it happens, I used to use the same meter that he does now and did have a couple of boxes to give him.

Ask if the older, less expensive drugs will work as well as the newer, more expensive ones. Ask if the pharmaceutical company that manufactures your drug has an assistance program. I still use Regular insulin on occasion, particularly when I’m running low on what I normally use or need insulin when I’m away from home. It works more slowly than rapid-acting insulin, but it doesn’t require a prescription, and it’s less than half the cost of the newer insulin analogs.

Does your community have an Angel Food Ministries site? The not-for-profit, nondenominational organization offers healthy foods for less than half the cost of what you’d pay at the grocery store.

In fact, ask for a consultation with a social worker. They generally have a good handle on what’s available in your community.

My original intent was to make this a fun post. Somewhere in the middle, however, it became less fun and more…well, I hate to say depressing, but I guess that’s what it is.

Today, I’m very fortunate, but I’ve also been a single mother living on popcorn and potatoes so I could feed my child a healthy diet. On the plus side, I didn’t have diabetes then (that I know of).

In this new year, let us all vow to take care of ourselves to the best of our abilities, and to help those who aren’t as fortunate take care of themselves, too.

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Comments
  1. I ws diagnosed on Dec. 5, 2007, with Type II Diabetes. Up until then, bills came first. Now, though, my health comes first. I currently weigh 316, am 6′1″ and have no health insurance. I have to offset other bills, i.e., mortgage and power, when there is a medical item to pay for. Most people I work with understand that. One of my goals for 2008 = lose weight / get insurance / get better control of my diabetes. IT CAN BE DONE!

    Posted by d_baeuerle |
  2. I use the Control AST meter from U.S. Diagnostics (available at Fifty 50) for $19.95 (50/box) and test for only $20,224 per mile! My meter is easy to use and very accurate.

    Posted by J Johnson |
  3. Please check out WalMart Pharmacy. Metformin and glimepiride are listed in their $4.00 prescriptions. For the last year I have been getting both my medications for $8.00 a month.

    Posted by challey |
  4. Thank you Jan Chait for your funny and informative article. It does make a person think about the costs of so many things, diabetic or otherwise.

    I’m familiar with the Angel Food Ministries and highly recommend it to anyone seeking help with finances

    The Angel Food Ministries is a godsend for families trying to afford groceries. Check their website at to find a location near you.

    Posted by Kuini |
  5. I was diagnosed about 2 years ago with diabetes (age 46). Oral meds did not seem to get control of the situation, so I was put on insulin within a month of the diagnosis. I was not overweight, got exercise regularly, and ate a fairly good diet. They finally ran the test to find that my body barely makes insulin at all. With a self-employed husband, and me working part-time, we had obtained insurance on our own about 9 years ago. Each year the premiums would go up, so we would have to increase our deductible to keep our monthly premiums lower. (Who can afford $800-900 a month premiums for the best coverage?)By the time we had increased the deductible to the highest amount is when I was diagnosed. I also have $1000 pharmacy deductible that I have to meet. So each year, I start off paying full price for insulin and test strips until that deductible is met, which is like having a car payment Jan-April. At least I know I will soon meet that and then the co-pay amounts kick in. With the economy struggling, my husband is having to dissolve his company and go back to work for a company. I had hoped to go back to full-time work when our youngest headed to college in a few years, but we will no longer have that luxury.(Which means it will be more difficult for me to find the time to exercise adequately). We have always lived conservatively, never spending more than we could afford: no vacations, continuing to drive older, paid-for vehicles (and not the big gas guzzlers that are so prominent in our culture), and denying our kids many of the fancier items that most other kids have. In the end I feel like my diabetes has robbed my family of any breathing room we previously had worked so hard for. I have often wondered what is the cost to the pharmaceutical company to manufacture a 5pack of Novolog pens and Levemir pens (yes, I have to take TWO insulins)…Just needed to vent…..

    Posted by Cynthia |

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