Health or Wealth? Tough Choice for Diabetics

Nov. 19, 2008— -- Despite being diagnosed with diabetes just a few months ago, Perdue University graduate student Kristen Imboden, 22, is already disobeying doctor's orders.

Diabetics are encouraged to check their blood glucose levels several times a day to stay healthy. But Imboden admitted, "I've found myself testing [glucose levels] less frequently, so I don't run out of testing strips."

Imboden is not trying to rebel; rather, she is trying to budget. She is currently able to afford her medication under her parents' insurance plan, but will be dropped from this coverage on her 23rd birthday. Then, Imboden said, "I'll be transferring my supplies under my grad student insurance, which covers next to nothing."

As Imboden is quickly learning, being a diabetic can be very costly. A report released Tuesday by the Associated Press estimates that diabetes costs the United States $218 billion a year in medical bills, lost productivity and disability. And while some of these costs are only indirectly borne by those with the condition, the American Diabetes Association estimates that diabetics spend more than $20 billion of this sum on medical supplies alone.

Doctors recommend that glucose levels be checked up to 12 times a day for insulin dependent, Type 1 diabetics. One glucose test strip must be used for each of these checks. Without insurance; strips can cost consumers an average of 70 cents each, adding up to $3,000 annually for a person who checks as often as doctors recommend.

In total, health care expenses can cost each American diabetic more than $6,500 a year -- an expense more than twice what the average non-diabetic incurs -- according to the American Diabetes Association.

In addition to her prescription charges, "I wasn't fully prepared for the sudden increase in costs [with] doctor's visits, labwork, medicine, etc.," Imboden said. "I got a rebate for a phone I just bought. ... I thought maybe I could put it towards clothes ... but, instead, I thought, 'no, I have a refill coming up.'"

Stretching to the Limit

So what happens when diabetics are forced to choose between rent and refills? Many seek alternative ways to make ends meet, turning to generous doctors and foreign vendors if they have inadequate insurance coverage or funds.

Juanita Tharp, 74, of Fort Worth, Texas, said she has fallen into a "doughnut hole" in her Medicare coverage and must now pay out of pocket for her insulin.

"I've had a little help from my doctor giving me samples," she said, "because each vial of insulin costs nearly $100, and I use three a month."

Though Tharp's testing supplies are covered by Social Security and Medicare, the enormous cost of her insulin alone has forced her and her husband to dip into their savings.

"Any extras or ... trips or anything like that, no -- we just have to use this just to pay our bills and our medications," she said.

Tharp's situation has also led her to the increasingly popular Canadian market. There, insulin is "anywhere from $21 a vial to $43 a vial, plus your shipping -- which is still half the cost," she explained.

Paying the Price

A more extreme method for making supplies last is to eat less. For most diabetics, injections are given several times a day in relation to the amount of sugar and carbohydrates consumed. By consuming fewer carbohydrates, less insulin is needed.

Though this may seem like a great way for some to slim their waistline and save their wallets, spreading resources thin may also mean testing the body's limits.

For good health, "the objective is to keep your blood sugars as close to normal as possible and do whatever you need to get that done," said Dr. Keith Campbell, a certified diabetes educator and professor in diabetes care at the Washington State University College of Pharmacy.

Using medicine appropriately "will save so much money in the long run," Campbell said. "You know how much a kidney transplant is or a leg amputation is?"

There are immediate effects of poor diabetes management, as well. Unattended glucose levels can bring about diabetic comas. In addition, the disorienting effects of low blood sugar levels have been known to account for auto accidents and injuries on the job.

"If people don't take their medication, the care they get is suboptimal because the [emergency room] is supposed to just be for emergencies," Campbell said.

Stateside Solutions

Some companies are beginning to pick up the slack, at least when it comes to medications. American pharmacies, such as Wal-Mart and CVS, offer discount programs for those who qualify, some offering generic drugs for as low as $4.

At both Wal-Mart and CVS, lower prices apply to Metformin and Glipizide, drugs for Type 2 diabetics. Still, these discounts do not apply to brand name insulins commonly used by those with Type 1 diabetes.

"I am using some of the newest insulin, which is the most expensive, of course, and there is not a generic form," said Tharp, who takes the highly prescribed Humalog insulin.

But those with diabetes often find themselves a long way from making ends meet. And high costs are not only an issue for those in retirement, but also for those preparing to enter the work force.

"None of my friends on a grad student's budget have to struggle with a lifelong disease, so I'm the one that has to budget," Imboden said.

When discount pharmacy programs are not enough, charitable organizations, like IPUMP.org, can often lend a helping hand

IPUMP is one of many organizations providing supplies to those who could not otherwise afford them. CEO and founder Lahle Wolfe knows the financial hardships of chronic disease from personal experience. The mother of two diabetic children and a diabetic herself, Wolfe lost her home four years ago to pay off medical debt.

Since its inception, her organization has helped more than 6,000 diabetics afford health care necessities. She receives letters and phone calls each day from others in need. Some of the correspondence is particularly difficult: "[Some ask], 'Do I feed my other children, or do I give insulin to my diabetic child?'" Wolfe said.

Test strips and insulin pump materials are among the organization's most requested supplies. Insulin pumps are small, electronic devices that continually administer insulin via a catheter. They are widely considered to be the pinnacle of diabetes management. However, pumps come with a hefty price tag, which prevents many from using the new technology.

Once diabetics have used this device, Wolfe said, "[they] are desperate to stay on their pumps; it's much more expensive than shots [and] it's the first luxury in diabetes [they must] give up."

Choices like these plague diabetics who want to maintain good health but cannot always afford the most effective treatment. And until financial conditions improve, many of the nation's 17 million diabetics may have to continue to reach outside the box to stay within their means.