Diabetes Costs and Long Term Implications

Diabetes can be an expensive illness. Whether one is following a low carbohydrate approach, taking medications, or testing limited amounts a day – the costs can quickly add up and impact our overall budget. Unfortunately, many of these costs come out of the pocket of the person with diabetes because of limited assistance and health care coverage.

Why is this? Well, there are a few reasons:

Lack of diabetes awareness

Many people, including our lawmakers and some medical professionals, lack understanding of the seriousness of diabetes (both type 1 and type 2) and its potential complications, as well as a patient’s needs. They then FAIL to make the proper legislation, or recommendations to overarching organizations. They might think “It’s no big deal, if you just change your diet and move a little more, you’ll be just fine. You don’t need to test your blood glucose, see a nutritionist, or go to an endocrinologist.” This is a serious oversimplification of diabetes, because diabetes is serious condition leading to more deaths every year than breast cancer and AIDS combined. It can negatively impact every other health condition we have, and a person with diabetes needs to have access to proper tools, specialists (doctors who understand diabetes in more depth than your average practitioner), as well as education, in order to make the right changes.

Patient blame

Because of this serious lack of diabetes awareness, many in the industry see a person with diabetes as ‘to blame’ for their decisions that lead to a diagnosis, and therefore lack empathy for the patients. In mainstream media, diabetes is a popular scapegoat of the healthcare crisis (though this crisis is complicated and would still be there without diabetes). The fact is that ALL of our every day health decisions contribute to illness – and sometimes, we are more likely to get certain conditions by virtue of family history, age, taking certain medications, or simply having other illnesses. “Blame” is counterproductive to understanding how a society as a whole should change in order to improve overall health in communities. Sadly, this blame often results in health organizations and government agencies wanting to limit what they are willing to pay for patients – negatively impacting the overall health of the population at large.

High cost of diabetes every day management

Organizations base most of their decision making on the immediate impact they see on their bottom line: testing strips are expensive, many oral medications are expensive, many of the newer insulins are very expensive, and some of the costs of special gadgets for continuous glucose monitoring as well as insulin delivery can be prohibitive. (Especially for something ‘you gave yourself,’ right?) Some of these agencies would like for patients to be ‘the most frugal’ in their approach to managing diabetes and to not utilize things that go ‘above and beyond’ what the patient might need. In some respects, this is not an unwise position. The problem is that often, these folks do not understand what would be the BASIC need for a person with diabetes, and what would be ‘above and beyond.’ Giving a person with type 2 diabetes one strip a week, and pretending for them to be effective at glucose management with this is unwise, and ill-informed. A person with type 2 diabetes should be testing 2-4 times a day, even if they are not taking any medications. A person who is taking medications, such as oral agents or insulin, should test from 6-10 times a day.  We simply will NOT know what our blood glucose is doing in response to foods, times of the day when we test, and medications, if we do not test. Just ‘guessing’ that we made the right choice without proper knowledge is not acceptable – and should not be acceptable.

Skewed perspective

The costs of diabetes management are expensive, yes – especially if a patient were to test properly in order to tightly manage glucose control. But how does one balance ‘above and beyond’ with the even MORE expensive costs of long term complications? It might be tricky, but not difficult, for an insurance company to see the difference between the costs invested in a well-managed and tightly controlled person with diabetes, versus one who has had poor control over the long term (especially if due to a lack of access to testing tools or more effective insulins and management gadgets). Some insurance companies, for example, will put the cart before the horse by demanding that a patient be ‘in good control’ before they will approve an insulin pump or a continuous glucose monitoring system that would actually help to achieve that good control.

Anyway it’s diced, though, the number one most effective way to manage diabetes and to reduce its costs is to test, and that's something government should invest in<. There is simply no other way around it. One cannot make appropriate dietary changes to manage glucose levels in blood without testing. When we test more, we have tighter glucose numbers and a higher likelihood of hitting target HbA1c goals, we see a reduction in need for medications or insulin, we see a reduction in complications, as well as surgical interventions like amputations, and even gastric bypasses. The future might hold non-invasive glucose monitoring devices, but who knows what approaches industry might hold to ‘replace’ the cash cow of test strip profits. For now, though, places like big box retailers and online auction sites will continue to be sources of affordable strips for many – even if they are less reliable, or came from a black market.

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