Managing Diabetes on a Budget

Diabetes is usually one of the most expensive diseases we could get. But it doesn’t have to be.

If we didn’t have diabetes, the amount that we would have to spend for healthcare would be a lot less. Specifically, diabetes costs us about 2.3 times as much in medical expenditures as it does for people who don’t have it, according to the American Diabetes Association. And that doesn’t even consider the lost income from losing work because of diabetes.

But that’s money under the dam. We’ve got diabetes and we’ve got to figure out how to live with it within our means.

The trick is to manage our diabetes so it doesn’t manage our life. Easier said than done, of course, but it’s certainly possible.

Still, no one will decide to manage his or her diabetes just to save money. We can weigh the costs of uncontrolled diabetes against how much it costs to manage it, but I doubt if anyone will do that. The budgetary savings are just good side effects of saving our health.

After Writing and Titling this Article, I Discovered that the ADA Published a Book with Exactly the Same Title Back in 1996. It is Currently Budget-Priced at $0.01, But May be a Bit Out of Date

Once we decide that the discipline of managing our diabetes is worth the effort that we have to put into it, we have to face the facts that everything we do has financial consequences. Some are immediate and some may or may not come until years down the pike. I’m thinking of the financial consequences of the many complications of diabetes to say nothing of the consequences that these complications could have for our health and happiness if we encourage those consequences by not managing our diabetes now.

Of all the diseases that we could get, diabetes is the most insidious. Diabetes itself is no big deal.

Oh, we have some relatively unimportant symptoms. If it’s type 1, we may notice frequent urination, being especially thirsty, hungry, tired, or irritable, or losing weight with no apparent reason. When we get type 2, we can have any of those symptoms and also get repeated infections, slow healing of cuts or bruises, tingling or numbness in our hands or feet, and even blurred vision.

These symptoms are usually enough for us to take notice and are bad enough. But they are nothing compared with the complications that come with years of high blood sugar.

“Diabetes causes nothing,” as Dr. Bill Polonsky says. Poor management causes the complications of diabetes.

Good management of our diabetes takes all the self-control, discipline, and maturity we have. I’m talking here about delayed gratification. Being able to plan for a better future is a sign of maturity.

Studies show that children who don’t delay gratification have behavioral problems later in life. When we eat the marshmallows that the children in some of these studies were encouraged to postpone, then we will have both behavioral and health problems.

We can either invest in a healthy future now or pay the piper later. Most of what we have to pay now is the emotional cost of exercising self-control. Some of the cost, however, is financial.

Management of our diabetes has three or four cornerstones. The typical four cornerstones are medication, diet, physical activity, and stress management. By far the most expensive of these is diabetes medication.

The Medication Cornerstone
If you have type 1 diabetes, insulin injections are essential. But different varieties of insulin sell for vastly different amounts. One diabetes specialist told me that for her patients on a tight budget she prescribes an older 70/30 NovoLog or Humulin insulin instead of the standard basal insulins.

Most of us who have type 2 diabetes aren’t taking any type of insulin. But the overwhelming proportion of us take one of the many oral medications, some much more expensive than others. By far the least expensive oral is metformin, which also happens to be the best tested for safety and for working well.

In addition to diabetes medication, the second part of this cornerstone is blood sugar testing. Any meter that we can get to test our level is better than none. No one has yet invented a completely accurate meter, so why not get one that costs very little and — even more importantly — has inexpensive test strips? As much as I dislike shopping at Wal-Mart, their ReliOn meter and strips are about the least expensive out there.

We also need to consider the many types of financial aid that are available to help cover the costs of this medication cornerstone. Ever since 2003 I have been maintaining a directory of Financial Aid we may be eligible for. If you check it out, you may be pleasantly surprised.

The Diet Cornerstone
A few of us are able to avoid taking any injections or oral medication. The only way that I know how to manage diabetes without drugs is to severely limit the amount of carbohydrates in our diet to no more than about 50 grams per day. I’ve been doing that myself since 2007 and find that as the years go by this gets easier and more effective.

But I had to invest in more expensive food. Anyone who follows a low-carb diet will have to spend more upfront on quality fats and protein than people who subsist on the cheap starch in grains, like wheat, and tubers, like potatoes. Even here, however, the cost doesn’t have to be high when we chose less expensive fish and meat.

We don’t need Copper River king salmon when regular sockeye or coho is available. We don’t need filet mignon when we can get inexpensive cuts of meat like roasts, 70 percent hamburger, or chicken. We don’t need to shop in more expensive natural, organic, or health food stores, when our common supermarkets stock some real food along with the preponderance of fast or junk food.

We especially don’t need nearly as much protein as most people seem to think we do. I simply can’t see why anyone who is not a vegan or a vegetarian would go to the expense and trouble of buying and drinking one of the many protein powder drinks that fill up the aisles of our natural food stores.

Like other men, I need just 56 grams of complete protein per day, according to the Food and Nutrition Board of the Institute of Medicine. Most adult women need 46 grams, according to the Food and Nutrition Board of the Institute of Medicine. Pregnant women and nursing mothers need 71 grams. The Food and Nutrition Board defines complete protein as “Protein from animal sources such as meat, poultry, fish, eggs, milk, cheese, and yogurt provide all nine indispensable amino acids, and for this reason are referred to as ‘complete protein.’”

Most Americans get far more protein than this. Most of us — even those who follow a very low-carb diet — can save money by reducing the amount of protein in our diet and improving our health in the bargain. A surplus of protein turns into glucose, which means higher blood sugar levels. Low-carb means high fat — not high protein.

The Physical Activity Cornerstone
One of the least expensive cornerstones of diabetes management is physical activity. For most of us all that it takes is a good pair of walking or hiking shoes or boots. Most of us already have more than enough of these in our closets. Even a set of dumbbells costs very little. Exercise machines are considerably more expensive and unless you are a lot more disciplined than I am, you probably won’t give them and yourself the workout you need.

The Stress Management Cornerstone
Managing the stress of daily living might not be easy but it certainly is the least expensive. It just means for us to slow down, and unlike with a motor vehicle we won’t burn out any brake linings when we do.

My preferred stress reduction is meditation. I often think of the takeoff on encouraging us to respond, “Don’t do something! Just sit there!”

Ironically, this is just the opposite of the physical activity we also need. Or maybe it isn’t. Maybe just sitting on the couch is the opposite. But watching TV not only doesn’t give us any of the physical activity we need but it also doesn’t help to reduce our stress.

Learning how to meditate is easy. You don’t need a lot of instruction to do so, but if you don’t have anyone to help you, I can highly recommend a book that I got years ago and still refer to. Wherever You Go There You Are by Jon Kabat-Zinn will set you back less than $10 and will save you much more than than as your life becomes free of heavy stress.

Each of these cornerstones of diabetes management carries some cost now. Think of them as investments in a long happy and healthy future.

This article is based on an earlier version of my article published by HealthCentral.