The Hidden Costs of Diabetes

Diabetes is expensive.

This is true even if you have "good" healthcare coverage. Either the monthly premiums cost a lot, or the monthly copays are pricey. And since there's no skipping care with a chronic condition, there's no easy way to get around the expense.

Type 2 diabetes and hard decisions

However, diabetes extracts costs beyond just the price of health insurance and copays. It also demands hidden costs in the form of the tough choices people living with diabetes too often face.

The job trap: Sacrificing career for healthcare

Many of us receive health insurance coverage through our employer. Our health insurance coverage is tied to having a job. Healthcare benefits vary from company to company, as well as location and job position.

Changing jobs or companies puts our health insurance coverage at risk. There is no guarantee that we'll maintain comparable coverage or even a similar out-of-pocket cost in a new job. If we move to a small company, we might not have access to company-sponsored health insurance, leaving us to pay the full premiums.

As a result, some people stay in a job primarily because of their healthcare benefits, even when the job is no longer a good fit or limits their career advancement. Having that proverbial bird in hand stifles job mobility and career growth.

The geographic gamble: State-specific health coverage

For those of us using government-sponsored health insurance, the state we live in determines the coverage and cost of Medicaid and some parts of Medicare. What is and isn't covered and the copays vary widely from state to state – along with which healthcare providers are considered in-network.

Some people feel stuck living in a state where they can get better healthcare coverage. Having better access to health insurance trumps considerations like moving closer to family, to a job, or to educational opportunities elsewhere.

The quandary: Family planning with type 2 diabetes

At first, I was shocked to hear a friend tell me that she and her husband decided against starting a family because of her diabetes. As I thought about it, their logic became more apparent to me.

Pregnancy with diabetes or prediabetes is considered high risk for both the mother and the child. Extra care and monitoring are needed throughout the pregnancy and possibly after birth. Serious complications are more commonly expected. And not all the ill effects go away at birth. Starting a family with diabetes comes with emotional costs as well as financial ones. Diabetes adds additional layers of stress and concern about the odds of having a bad outcome.

The missed moments: Social isolation

Spontaneous social events, celebratory meals, and even well-planned group travel can bring a mix of joy and anxiety. While spending time with friends and family can feed the soul, these gatherings can also disrupt our well-established diabetes self-care routines.

So much goes into daily diabetes management: monitoring glucose levels, taking medication, managing exercise, diet, rest, and stress. Any disruption can lead to a spiral of out-of-range glucose levels and other symptoms.

When considering participating in most social events, trade-offs will be considered. What if they don't have the food I'm used to? Or what if I miss a dose of medicine? What if I need medical attention while I'm away?

The very thought of a disruption to our diabetes self-care routines can leave us fraught with worry. It can leave us wondering if it's worth the risks, creating a barrier to participation and reinforcing social isolation.

Ironically, wanting to ensure we maintain the routines that keep us healthy can keep us from experiencing the social and emotional support needed to live our best lives.

Balancing the emotional and financial tolls of diabetes

Life with diabetes includes constantly having to make choices and wondering if we made the right ones. Some of the choices affect our pocketbooks. Others take a toll on our mental health. In trying to maintain our physical health, sometimes we pay a steep price, either in dollars or with our emotional well-being. Everyone should be able to live a happy, healthy life, not just those with deep pockets.

Have you experienced any of these hidden costs of diabetes? What changes would you like to see to minimize the toll these costs take?