Uninsured + Diabetic = Catastrophe?

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Permalink Reply by Melissa Padilla on February 15, 2008 at 2:41pm

Hi Mike,

I'm in your same boat, no insurance. I pay for everything out of my own pocket. It's expensive!!! Especially the test strips! My insulins and pills, I can deal with. All $4 a peice at Walmart. But those test strips. UGH! I too have a wonderful Endo who keeps in mind my financial and insurance state and does all he possibly can to keep my costs as low as possible. But, he can only do so much.

News on your insulin. At Walmart you can buy the "ReliOn" brand for like $21.95 a vial. It's actually Novolin. Walmart and Novolin went in together and have a "co-branded" insulin. They sell all the Novolin insulins .... R, N (NPH) and 70/30. Of course, you'd have to purchase syringes, which the ReliOn brand of those run around $12.95 I think. But it's MUCH cheaper than the pens!

You don't even need a prescription for either the insulin or the syringes. Well, the syringes, you might need on. That's a per state thing. Most states you don't need one though. But still, you can ask your doc for that, if needed.

At least until you can get yourself some insurance, it's the cheapest way to go. We gotta do, what we gotta do, to keep our costs down as much as possible, yanno!

Good Luck!

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Permalink Reply by Kimberly on February 15, 2008 at 3:35pm

Unfortunately, your title is totally on the money. You are now that person with a "pre-existing" condition and insurance companies hate that. You won't be able to (from what I know) get individual insurance, so you are left to find a job that offers group plans. Once you get that (face it - you gotta get a job to get the health insurance b/c this diabetes thing is more expensive than you know), you'll have to wait the requisite 60-90 days before it kicks in. When it does, take full advantage and get an endo (and get some testing done to determine if you're Type 1 or Type 2; no need to be on the met and glip if your pancreas just sputtered out). If you are Type 1, you'll be able to get fancy toys like a pump or CGMS.

For now, go to the ADA website and check out the info they have on the left side of the screen. There are ways to defray the cost of things that are so prohibitively expensive. You didn't mention test strips - they are almost priceless in managing diabetes but yet not so much b/c they're close to $1 per strip. The ADA may have info on how to get reduced-cost strips or something like that.

Good luck.

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Permalink Reply by Michelle on February 16, 2008 at 8:14am

It is possible to get an individual insurance policy while having diabetes. I've had type 1 for 22 years and for the past few years I've had a BCBS of MI individual insurance policy. When I got it I did have to wait for some time (don't remember how long) before they would pay for anything diabetes related. However, the policy is extremely expensive and still doesn't cover everything (no doctor appointments, diabetes-related or not) so I'm not sure a policy like this would be very cost effective.

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Permalink Reply by Sara Ludwig on March 19, 2008 at 9:14pm

I am currently at the point of being uninsured and have done some research. I saw a company that offered health insurance called HumanaOne. I haven't committed to anything yet, but they had a plan that covered all my prescriptions, doctor visits, and hospitalization. It's definately worth checking out their web site (HumanaOne.com) if you want more information.

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Permalink Reply by Jenny on February 15, 2008 at 4:59pm

You can use Novolin insulin which is $22 per 100 ml vial containing 1000 units at Wal-Mart instead of Novolog. These are the older insulins.

If your doctor writes you a prescription for needles the generics are $17 for 100, I believe.

The 70/30 mix is not a very good insulin to use because it is a mixture of slow and fast insulins that doesn't let you match the shot to meals. A much better way of using insulin is to dose the slow insulin morning and night and the meal insulin to match your carbs at meal times.

You could buy Novolin N which is a longer lasting insulin and Novolin R which starts to act in 45 minutes to an hour and is out of your system by about 3 hours.

What size doses are you using of the insulin? If they are very small I'd wonder if you are a Type 2.

If you aren't Type 1, you can probably control very well with a low carb diet and not need pills. But you look pretty young and skinny to be
a Type 2.

I liked R a lot more than the analogs because it is a bit slower, so if you get the dose wrong you get time to correct.

I'd urge you to read the Dr. Bernstein's Diabetes Solution book, which might give you a better understanding of how to use insulin whateer kind of diabetes you have.

With a limited carb input and the cheap Novolin insulins you might be able to get by just fine.

Also, if you cut your carbs way down, you will get better blood sugars using Novolin R instead of the more expensive stuff as R works a lot better with a lower carb intake than Novolog.

BTW, if you are able to, you can move to MASSACHUSETTS and buy insurance with no need to have a job and no exclusion for preexisting condition. If you are young it is quite affordable. I'll probably be stuck in MA for the rest of my life since it's the only place i can be sure of getting real insurance that covers everything.

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Permalink Reply by Scott Strumello on February 15, 2008 at 6:18pm

I don't understand the concept of pre-mixed insulins, but the first recommendation I would say is as Jenny noted, dump the overpriced analogue mix.

Contrary to all that proponents claim, not one insulin analogue can claim to deliver superior glycemic control over the tried-and-true varieties. Your doctor may give you free samples of a Novolog Mix 70/30 which is an analog mix, but when you have to pay for them out-of-pocket, analogues cost about 50% more. Instead, consider a pre-mix of the older varieties, such as Novolin Mix 70/30 or Humulin 70/30. Novolin sells for a lower price at Wal-Mart under the brand name Reli-On Novolin 70/30. Pens are nice and convenient, but also much more expensive. Plain syringes are far cheaper, and if you need to dose on the run, consider buying a Wright Pre-Filled Syringe Case that's about the size of a ballpoint pen (OK, maybe a little bigger) for $20 which you can reuse forever! Another note: if you use a Novopen (not the disposable pen, but the pen that you place an insulin cartridge into), you CAN refill the empty insulin cartridges, simply go from a vial of the same type of insulin, and fill the syringe, and insert it into the rubber stopper of the empty cartridge. Each cartridge holds 300 units, so you'll need to repeat the process several times.

Do not feel bad about asking your doctor for an older insulin variety -- it is not bad for your health. You can note that several meta-analyses have examined this, including Germany's Institute for Quality and Efficiency in Health Care (IQWiG) report, as well as another study undertaken in Canada last year by the the Canadian Agency for Drugs and Technology in Health (CADTH) and both reached the same conclusion: glycemic control is NO better with insulin analogs, yet, not surprisingly, costs as much as 50% more.

Also, although it is not recommended, you CAN safely re-use insulin syringes. A small study undertaken at the University of Alabama found that re-use by the same patient in a generally clean environment did not pose any health risks. Keep in mind, though, that the syringe (particularly the needle) does wear down and the lubricants which ease injections can wear off after a few uses, so you may wish to limit the number of times you consider doing that. BTW, I re-use pen needles until I have to replace the insulin cartridge, and have never had a problem, and I've used pens (except for 3 years when I wore an insulin pump) since 1992.

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Permalink Reply by Jenny on February 16, 2008 at 5:36am

Scott,

I've got a question for you about reusing syringes. I reuse pen needles with no problem, except that I found that if I leave the needle on the pen a lot of insulin oozes out and I get a lot fewer doses from the pen. I also find that air gets in and I have to do more air shots. So I end up wasting a huge amount of insulin So for now I'm recapping the needle and removing the needle after each dose when I reuse it.
I haven't noticed a difference in pain with reused needles, though eventually I always end up bending them.

But I wondered about Dr. Bernstein's claim that if you inject air into the vial with a reused needle old bits of insulin will serve as seeds for crystallization. I only use a few units per shot, so I should theoretically be able to use a 10 ml vial for 250 doses, but that never happens. The insulin always starts to weaken and eventually after 2 months max it gets tiny crystals even though I don't reuse needles.

Any ideas here?

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Permalink Reply by Melissa Padilla on February 16, 2008 at 7:45am

I'm not Scott, but, I do re-use my syringes, usually two, sometimes three times. I've never had that issue with the crystalization. Now, my N Insulin doesn't last me but about 3 weeks, but my R Insulin, lasts me about 6 months or so. No issues. One thing I do, is, I will pull air into my syringe and then push it out into the air, to get any little drop of insulin that may be in there (happens sometimes), before I put air into the vial. I don't always put air into the vial either. I watch the rubber stop, to see if it's going concave or not. I've also had my insulin out of the fridge since about November, when it started to really cool down, and my home is rarely above 72 degrees. In the summertime, I leave it in the fridge at all times, as the room I'm in here, can get quite warm, if I don't have the A/C unit turned on.

I've no idea about your situation with the crystalization, for no apparent reason. Which kind of insulin is this, Jenny?

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Permalink Reply by Scott Strumello on February 20, 2008 at 5:37pm

I would have to agree with Melissa; although I don't reuse regular syringes, I do reuse pen needles mainly for convenience (having to change it on the run is a hassle). I will say that reusing needles does wear them out, so you may not get as much life as we did with lower-guage (sp?) syringes and needles, as the finer needles bend more easily and don't last as long. The key is to ensure the needle is completely empty, and that means squeezing the last drop out before using the needle again. I'm not sure if that helps, but hopefully it does!

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Permalink Reply by Jenny on February 21, 2008 at 1:21pm

The biggest problem with those pen needles is that I bump them into things and bend them! But the don't seem to lose their painlessness any more than the lancets I use for months.

The crystallization happens with vials of Wal-mart R insulin, but it usually happens after I've used the one vial for a couple shots a day for about two months. It happens even when I don't reuse needles. I have been keeping my Novolog pens in the fridge, but not the R vials.

One thing I've noticed about the Wal-mart R is that they have been selling me insulin from the same lot for the last 4 months. I wonder how long the insulin has been sitting in their fridge and how the continual opening and shutting of the fridge affects it. I don't get the impression they sell much R.

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Permalink Reply by Neal on February 21, 2008 at 1:33pm

For the crystallization or "polymerization" as Dr Bernstein calls it you can try rinsing out the syringes with sterile saline solution before/after each shot so the old insulin will be discharged. This seems to work for me. Right now I just use the same solution for contact cleansing but you could also get a prescription for vials of saline solution which are still pretty cheap.

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Permalink Reply by Melissa Padilla on February 21, 2008 at 2:36pm

hmmm

That's what I use too, the ReliOn R and N varieties. And, as I said, I use ONE vial of R for over 6 months. Clear as a bell, no crystals or anything.

I would bring it up to the pharmacist at Wal-Mart. There could be some issue with that lot, or something!?

It is doing it's job properly though, right?

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