Phoenix Diabetes and Endocrinology has compiled this information to help our patients manage their diabetes in the event they have lost their health insurance or have a very limited budget and cannot afford preferred therapies. Many type II diabetics can maintain good blood sugar control if they focus on diet, weight management and exercise as the primary therapy and use these cheaper medications discussed below when additional therapies are needed.
Type I or insulin deficient diabetes patients will have a much harder time controlling their blood sugars with cheaper medications. Several insulin manufacturers have programs for diabetics without any health insurance to provide insulin at no charge. The forms for these programs are found at our needymeds link.
For the type II diabetics:
Some types of diabetes medications do not have generic alternatives. These include Byetta and Januvia as well as many of the modern insulin. These medications may need to be discontinued.
Older insulins such as Novolin N and Regular human insulin work differently and will require more blood sugar monitoring to be used safely. Therefore, understand that these recommendations are based on cost considerations rather than obtaining optimal diabetes control while your financial resources are limited.
Additionally, realize ignoring diabetes is not wise either. One ER visit for dehydration or infection due to poorly controlled blood sugars will be very expensive.
Therefore, these recommendations are intended to help control costs, not replace needed medical care.
Lab work
There are many places where discounted lab work is available at less than half the cost of traditional labs. One such place is Lab Express 602-273-9000. A comprehensive metabolic panel cost $45 and hemoglobin A1c costs $65. I believe at a minimum every diabetic should monitor electrolytes, liver and kidney functions annually which a comprehensive metabolic panel will accomplish.
Medication
Glimepiride and metformin are excellent oral medications for diabetes. They are affordable at about $5 monthly and probably will treat most type II diabetics that do not yet need insulin. Additionally, really limiting calories especially carbohydrates will help diminish your diabetes costs.
Preferred basal insulins are Lantus and Levemir. These 2 insulins are expensive, costing about $100 a vial. For those that cannot afford these preferred insulins, consider Novolin N as an alternative, which costs about $25 per vial at Walmart.
Novolin N is an effective alternative, but be aware of the following considerations:
Lantus and Levemir start working in about 2 hours and continue to work without a peak of action for up to 24 hours. Novolin N will require 2 injections and peaks 6-8 hours after it is given. It generally will stay in the body for about 12 hours but one needs to watch for low blood sugars 6-8 hours after it is given. It is very important to time Novolin N with eating. Novolin N is much harder to use for this reason. However, it is half the cost. Some patients on Lantus and Levemir do very little home glucose monitoring because the risks of low blood sugars are small. This is not the case with Novolin N so be very careful. Make sure you have a working glucose monitor and test strips before starting Novolin N.
Novolin N insulin and syringes should be available in Arizona without a prescription. To switch from Lantus or Levemir to Novolin N insulin can be difficult but in general, this is what we recommend:
Calculate your total daily dosage of Levemir or Lantus. For example, say it is 100 units daily. Take 80% of this number which in this case is 80 and then divided in 2. Take half of it or 40 units at bedtime with a snack. Remember this drug peaks in 6-8 hours so plan on eating when you get up in the morning. You can take a second dosage in the morning but again do not skip meals.
Home Glucose Monitoring
On the basis of cost, Wal-Mart’s home glucose monitor Reli On appears to be the most affordable product. This also does not require a prescription if you are not going through your insurance.
If you were going to use Novolin N insulin, plan on monitoring at least 2-3 times daily. Low blood sugars can happen unexpectedly with Novolin N insulin so always carry a source of glucose with you. This is especially important when driving. This insulin is more affordable and depending on how many vials of insulin you require monthly, this insulin maybe much more affordable, but Novolin N will require much more glucose monitoring. Using a more affordable test strip and meter really makes sense.
Again this information is provided to our patients who may have lost their health insurance and are cannot afford preferred therapies. This information is not intended to replace our in-office diabetes care but to help our patients cut some of their medical costs.
