A big problem for diabetics

I’ve written quite a bit about diabetes here and at my old blog, and I’ve explained to you how controlling blood pressure and cholesterol in diabetics prevents macrovascular disease, such as heart attack and stroke. I’ve also explained how controlling blood sugar prevents microvascular disease such as kidney failure and blindness. In type II diabetics, controlling blood sugar prevents disability and sometimes death. In type I diabetics, controlling diabetes with insulin is the only way to prevent a swift and painful death. Most non-diabetics, however, don’t know the details of how we control blood sugar.

Let’s take an example. A typical type I diabetic, who is completely dependent on insulin, will take a long acting (basal) insulin to keep glucose levels down between meals, and will also take a short acting insulin at meals to account for the extra glucose load. In order to know how much short-acting insulin to take, a diabetic has to insert a test strip into their glucometer, prick their finger with a small needle, and touch the drop of blood to the test strip. This is usually done (at least) on waking, before every meal, and at bedtime—at least four times per day. Thankfully, blood glucose monitors are quite inexpensive and last a long time. Test strips, however, are expensive and disposable. How expensive? Depending on the brand of meter being used, and how many times you need to test, $30-$200 per month. These strips are usually not covered by insurance.

To give a comparison, good medical treatment for coronary heart disease, which usually requires about four medications, costs around $16/month. Older forms of insulin are also rather inexpensive (but the newer ones are costly). Without insulin, diabetics die—fast. Without test strips, diabetics don’t know how much insulin to use.

In my private practice, most of my patients either can afford test strips, or have a Medicare plan that pays for them. In my residents’ hospital-based clinic, not so much. One of the biggest impediments to diabetes care for patients with little money is the inability to purchase test strips. Short of a single-payor health care system, what are we to do?

This issue couldn’t be more important, and can’t wait for health care reform. Diabetics need their test strips—yesterday. I don’t have a solution in mind yet, but I’m thinking. Should we agitate to make this a required benefit for all health plans? That won’t help the uninsured. Should we have a “diabetic care plan” for all diabetics, a sort of “diabetes insurance” that everyone who can pays into, and helps diabetics pay for life-saving insulin and test strips?

Ideas? Anyone?


Write your reps!

Dear [congressperson],

Diabetes is a serious disease affecting more than 20 million Americans. Part of the treatment of diabetes is the regular testing of blood glucose levels. In order to do this, diabetics must purchase glucometer test strips, which cost around a dollar a piece, and are usually not covered by insurance. For diabetics, especially those who have financial difficulties, the cost of test strips, which can be up to hundreds of dollars per month, makes diabetic treatment impossible.

I respectfully request that you look into potential solutions for this very serious problem, and bring this to the attention of your colleagues.