Living with diabetes: Testing glucose levels without going broke

Most times, I use the tips of my ring fingers.

It's a habit: slip a test strip into my blood glucose meter, prick my skin with a lancet, and touch a drop of blood to the strip. After a five-second countdown, my blood glucose reading pops onto the screen and I'm good to go.

Taking your blood-sugar readings can be one of the most educational (and annoying) parts of having type 2 diabetes. Monitoring your sugars can keep you on top of daily fluctuations and help you uncover any useful patterns (i.e., every time you eat too much fruit, your numbers trend upward). Having numbers in hand can also assist you in taking therapeutic actions such as modifying your diet, your exercise plan, or even your medication (with your doctor's input, of course).

An A1C reading that averages three months of blood-sugar readings is useful, but it's not as precise a measurement for day-to-day living.

But test strips are a part of what makes diabetes an expensive disease. According to a 2012 survey by the American Diabetes Association, the typical person with diabetes spends $13,700 per year on medical costs, with about $7,900 directly attributable to diabetes. The largest expenses are hospital stays, which take up about $3,400, and prescription diabetes medications, at nearly $2,000. Of course, those figures have all gone up since.

According to the same breakdown, about $103 per month goes toward diabetes test strips.

Luckily for me, my test strips and medications are still covered by my insurance for a reasonable co-pay. But that's not the case for everyone. About one in 10 people pay out of pocket for their strips.

"I'm not one who believes that test strips cost too much for people with insurance," said David Kliff, founder of DiabeticInvestor.com. "But it is true that over the years, employers and insurers are increasing deductibles and co-payments."

One reason insurers have raised these co-pays is that unlike people with type 1 diabetes, who must check their sugars several times daily to monitor for possible highs and lows from insulin, there is mixed evidence on how self-monitoring of blood sugar impacts patients with type 2 diabetes.

Some studies show that keeping track improves glycemic control and some do not, said Serge Jabbour, director of the division of endocrinology, diabetes, and metabolic diseases at Thomas Jefferson University.

Yet Jabbour cites one meta-analysis that included patients with type 2 diabetes treated with oral agents or once-daily, long-acting insulin. It showed there was "a larger reduction in A1C (-0.5 percent) with self-monitoring of blood sugars compared with no monitoring, particularly when taking blood sugars [was] combined with patient education and feedback."

Along with regular monitoring, certain circumstances can call for greater vigilance, particularly "whenever blood glucoses can change rapidly," said Jabbour. These factors include stress, which can boost sugars; traveling, when changes in diet and activity can present challenges; exercise, which can lower blood sugar readings; and sickness, which can raise or lower blood sugars, based on stress, gastrointestinal issues, and medications.

Still, what if you can't afford to test regularly?

One option is to work out a schedule with your diabetes educator or doctor for a minimal pattern of testing that will still allow you to keep track of your diabetes. You might test before different meals at various times of day or before or after certain activities, like exercise.

"People may test first thing in the morning and think that's great, but they're ignoring that everything during the day - what they eat, how they exercise, any extra stress, affects their blood sugar," said Monika Shirodkar, an endocrinologist at Jefferson.

"We try to give patients direction," she said. "Maybe they can check Monday first thing and then before dinner, then Tuesday before lunch and bedtime. Or maybe two hours after breakfast or dinner. It's highly individualized, depending on the severity of the diabetes, and what types of medications a patient is on."

Another possibility is to turn to cheaper store brands of meters and test strips. CVS, for example, offers a store-brand meter that uses test strips available online at $22.99 for a box of 100.

There are also a great number of brand-name strips available on eBay, although it's important to make sure that the boxes have not been tampered with and that the expiration date has not passed.

In some cases, said Kliff, patient-assistance programs may help with the cost of strips and co-pays. Two brands - FreeStyle and Contour Next - offer discounts on strips.

Checking your blood sugars regularly won't change your health. Doing that means the hard work of sticking to your meal plan, doing your exercises, and taking your medication. But it will give you greater knowledge about how your body responds to these interventions and greater control over your chronic disease.

mice30@comcast.net

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