A diagnosis of prediabetes may be unwelcome, but it may be the single most important piece of information you ever get from your doctor. Knowing that you have prediabetes gives you a chance to improve your blood sugar control and prevent or delay type 2 diabetes.
Being healthy and avoiding complications is certainly a motivation for preventing type 2 diabetes, but there are other reasons. For one thing, managing diabetes is more intensive than managing prediabetes, since it may include and medications such as oral pills and injectable insulin. Another major concern for people with diabetes in the US is the cost of insulin. The insulin cost per month is high enough to be an unaffordable burden to many.
Insulin and Your Blood Sugar
Insulin is a hormone that is critical to blood sugar regulation and related to the development of prediabetes and type 2 diabetes. Its role is to help blood glucose (or blood sugar) get from your bloodstream to cells in your body for fuel or energy storage.
Beta cells, which are insulin-producing cells in the pancreas, release insulin when your blood sugar is high. This occurs after you have a meal, snack, or beverage with carbohydrates, and the carbohydrates are turned into blood sugar during the digestion process. Under normal circumstances, insulin helps lower blood sugar by letting it get into muscle, fat, and other types of cells in your body.
Insulin's Function Gone Awry
Why does insulin always come up when talking about diabetes? The trouble starts, years or decades before you may learn that you have prediabetes or diabetes, when insulin resistance begins to develop. As the term implies, cells in your body become resistant to the effects of insulin and they need more insulin to do the same job. A series of events can occur.
First, the insulin-producing cells in the pancreas increase insulin production to keep up with the demands of your body's cells. At this point, blood sugar levels stay normal.
Next, insulin production cannot keep up with demand. Blood sugar levels start to rise, and prediabetes or diabetes can be diagnosed.
Finally, the insulin-producing cells in the pancreas may get fatigued ("beta-cell exhaustion") and reduce their production of insulin. This usually occurs when diabetes has progressed.
This progression is different than in type 1 diabetes, which makes up only 5 to 10% of diabetes cases and happens as the result of an autoimmune response that destroys the beta cells, or insulin-producing cells in your pancreas. All individuals with type 1 diabetes need to take insulin.
The Need for Insulin in Type 2 Diabetes
You will probably be prescribed medications if you develop type 2 diabetes, since the Centers for Disease Control and Prevention (CDC) report that 85% of individuals with the condition report taking medications for it. While half of patients are taking only oral blood glucose-lowering medications, 31% of patients with type 2 diabetes take insulin, with or without another diabetes medication.
"Taking insulin" is not so simple. It can be fast-acting, medium-acting, or slow-acting, and you may need a combination of one or more of these varieties. You may get your insulin using a pump or syringe. You may need to administer it once or multiple times a day, and your dose and timing may need to change if you change what or when you eat.
Cost of Insulin
Suppose that you would not mind measuring your blood glucose a few times a day and taking one or more diabetes medications, such as insulin, if you got diabetes. Here is a question: can you afford to take insulin? The cost of insulin per month is prohibitive and rising. [3, 4]
In 2016, the average monthly cost for insulin was $450 per patient. The average cost of the top four insulin medications has tripled in the past 10 years, and out-of-pocket costs have doubled. If you have health insurance with prescription drug coverage, you are still almost sure to pay hundreds of dollars or over $1,000 per year.
The cost of insulin per month is clearly beyond easy reach for people with diabetes in the U.S. A shocking 1 in 4 diabetes patients skip or cut back on doses of insulin due to the high cost of insulin per month. The results can include
Cutting back on food, heat, or luxuries to afford insulin.
More diabetes complications because of higher blood sugar due to inadequate insulin.
Are Insulin Costs Avoidable?
If you have prediabetes or are at risk for type 2 diabetes, one choice is to do nothing and hope you will not get type 2 diabetes. Most people with prediabetes eventually develop diabetes if they do nothing.
The other option is to lower your risk for type 2 diabetes by managing prediabetes. You may be able to delay the onset of diabetes, prevent it entirely, or even reverse prediabetes. Medication is one option, but there is something that is easier, healthier, and nearly twice as effective: lifestyle changes. A lifestyle change program, such as the CDC Diabetes Prevention Program (DPP), has been proven to lower diabetes risk by 58% without any medications.
The DPP is a year-long program to prevent or delay diabetes. Over 1,800 providers offer a CDC-approved DPP. Each program has a curriculum that focuses on losing weight and increasing physical activity, but some programs go beyond. For example, Lark DPP delivers the CDC's PreventT2 curriculum for weight loss and exercise, and also provides coaching on additional behaviors that are linked to lower diabetes risk. These include healthy food choices, better sleep habits, and stress management techniques.
The Affordability of a Healthy Lifestyle
I can't afford to eat healthily! How many times have you said that, or at least noticed that healthy food is more expensive than junk food? You may have even used that as an excuse not to lose weight!
It is true that healthy food can be more expensive if you think only about the cost when you make your purchase. For example, you could spend $3 for 2 slices of a pepperoni pizza and a bottle of soda with a total of 830 calories, 22 grams of fat, and 140 grams of carbohydrates, while a salad with grilled chicken and water totaling 280 calories, 12 grams of fat, and 7 grams of carbs may cost twice that amount.
However, what happens when you consider the long-term cost of eating poorly? What if eating the cheapest available food contributes to the development of type 2 diabetes? Once you start thinking about the cost of insulin, the cost of living healthy suddenly seems low.
The following table provides just one example of how you culd
What Can You Do with $450 (If You Are Not Spending It on Insulin)?
60 lb. of fruit and vegetables (1/2 lb. extra per day for each member of a family of four)
A spa treatment such as a massage or facial
Contribute to a family vacation or home improvement fund
A pair of workout shoes or an outfit
Healthy pantry staples, such as dried beans, spices, whole grain pasta, canned tomatoes and tuna, and olive oil
The above table may put things into perspective: insulin is expensive, and healthy living‚Ä¶not so much.
If you are concerned about diabetes and are looking for motivation to take action, the cost of insulin per month may be what you need. At a cost of up to $450 per month, insulin is expensive enough that it may be a deterrent, on its own, against welcoming diabetes into your life. In addition, while preventing diabetes is one goal, it is important to realize that each month that you can delay diabetes has its financial benefits, too.
Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32 Suppl 2(Suppl 2):S151-6.
National Center for Health Statistics. Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997–2011. Centers for Disease Control and Prevention. Reviewed November 19, 2013. https://www.cdc.gov/diabetes/statistics/meduse/fig2.htm
Luo J, Kesselheim AS, Greene J. Strategies to improve the affordability of insulin in the USA. The Lancet Diabetes and Endocrinology. February 08, 2017DOI:https://doi.org/10.1016/S2213-8587(17)30041-4.
Luo J, Avorn J, Kesselheim AS. Trends in Medicaid Reimbursements for insulin from 1991 through 2014. JAMAIntern Med. 2015;175(10):1681-1687. doi:10.1001/jamainternmed.2015.4338
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. February 7, 2002. N Engl J Med. 2002; 346:393-403. DOI: 10.1056/NEJMoa012512 https://www.nejm.org/doi/full/10.1056/NEJMoa012512
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