Managing Your Diabetes On A Budget

By Marisela Noorhasan, MD

Prior to starting my second year of training to be a specialist in diagnosing and treating diseases of metabolism, diabetes and nutrition, a “fellowship” that focuses on hormone disorders, I was honored to be the recipient of the Bender Fellowship at the University of Washington. This supported me as I focused on how to help low-income, uninsured persons struggling to maintain their health.

Diabetes, high blood pressure and high cholesterol can affect both quality and quantity of life, if not treated. These conditions do not discriminate – they can affect all age groups and all ethnic groups. Even on a limited income, there are many cost-effective ways to control these conditions, such as increasing physical activity and making better dietary choices and taking a look at the use of various herbs/spices, instead of salt to flavor food.

Managing diabetes on a limited budget

Having diabetes mellitus (DM), specifically type 2 DM, means your body is not effectively using the insulin it is producing to metabolize your food, and it is not producing as much as insulin as it should. Diabetes, if uncontrolled, can affect the heart, kidneys and eyes over time. Many people do not know they have diabetes and only become diagnosed when they have blurred vision and go to an eye specialist to check out their vision. Further questioning can reveal that additional symptoms such as frequent urination have been mistakenly linked to suspected problems such as an enlarged prostate, or “I am just getting older,” and the real diagnosis is then unfortunately delayed. Fatigue is another symptom of diabetes...and who is not fatigued from time to time? Even headaches and leg cramps can be signs of diabetes – so if you are experiencing these symptoms, get checked!

There are two types of diabetes, type 1 and type 2. Type 1 diabetes requires treatment with insulin because the pancreas cannot produce insulin, while type 2 diabetes can be treated in its early stages by taking pills. Very typically however, if you have type 2 diabetes, you will require insulin over time. This is due to the continued decrease of insulin production in your body, eventually requiring supplementation of insulin.

So how does one deal with diabetes on a low budget? Pills and insulin can be quite expensive! I spend a lot of time talking with the patients I see discussing the benefits of exercise, meal content choices and using spices. Exercise of just 30 minutes daily has been shown to maintain weight or even cause weight loss. And exercise can increase insulin sensitivity, meaning less insulin is needed to control your blood sugar. Exercise can be fun, and varying the exercise type can make exercise more interesting on a day-to-day basis. Start with simple stretches, jumping jacks, walks, jogging stationary in one spot, and/or lifting cans of soups as weights. Also, extra calories can be burned while doing housework chores: dance to music while you vacuum or wash dishes, or walk your dog rather than simply letting your dog out to the back yard. Lift your legs up and down–“march”–while talking on the phone. No need for fancy equipment or spandex outfits! Exercise does not have to mean going to a gym and paying monthly fees. TV exercise programs such as “Namaste Yoga” and “Kundalini Yoga” offer great yoga exercises. There are fun dance exercises available on CD that include “Bollywood Dance Workout,” “Dance & Be Fit” and “Shimm” that can be borrowed from your local library or followed on YouTube. Web-based free exercise programs can entertain while making exercises enjoyable. Try it!

Though supplements, in the forms of vitamins, herbs, minerals and spices, are not approved by the Food and Drug Administration (FDA), they are regulated under the Dietary Supplement Health and Education Act of 1994 (DSHEA) under a different set of regulations than those covering "conventional" foods and drug products. Thus, caution is necessary when taking supplements. But some herbs and even foods such as aloe, karalla, fenugreek, parsley, rosemary, eyebright and almond nuts may help to control blood sugars. Scientific data is clearly sparser than one would like to see in support of many claims of benefit. However, spices can make vegetables more interesting without adding salt, and who would eat cauliflower without some flavor enhancing? Limiting or avoiding foods such as rice and pasta, candies and sodas can lower blood sugars. And substituting artificial sweeteners for sugar can minimize post-meal blood sugar spikes.

There are cost-saving strategies even for medication required in the treatment of diabetes. Using generic rather than brand-name medications typically lowers your cost of prescription medications. Ordering a higher prescription dose of medication and cutting the medication to the prescribed dose can make the medication last twice as long. Metformin can be used with insulin to lower the insulin dose in insulinresistant diabetes. Web resources can offer less costly supplies, such as meters and strips–but make sure these are reliable sources–speak with your doctor and/or diabetes educator as to whether these are reliable websites. Unfortunately, if it’s too good to be true, it could indeed be too good to be true. Many have paid for what turn out to be long-expired meter strips. Discuss with your health team how often your insulin syringe could be reused – data have been published showing reuse could be safe. Using insulin in vials rather than using prefilled insulin pens could be a big cost-saver, particularly if you are needing a lot of daily insulin. But those using small amounts of insulin might save money by switching to prefilled insulin pens!

Managing high blood pressure

High blood pressure or hypertension hardens the arteries and causes the heart to work harder. Exercise, minimizing salt in your diet, losing weight and minimizing stress are important ways to prevent as well as treat high blood pressure. The same exercises used for treatment of diabetes can be used for hypertension. Foods such as tamarind drink, spinach, beans, sunflower seeds, bananas, spinach, squash, cantaloupe, garlic, celery, lemon, honey, ginger, cumin seeds and cayenne pepper may help to reduce blood pressure because they are rich in magnesium and potassium. Avoid salty food, put away your salt shaker, eat fewer preserved foods, frozen dinners and canned foods, as these are typically high in salt. Also, avoid overindulging in alcohol — it can increase blood pressure. For those requiring medication, splitting higher dose pills to get a smaller prescribed dose is another means for cost savings, but this should not be done with pills marked as “extended release” or “slow release.”

Helping to control cholesterol

Cholesterol is a fat produced by the liver and is also taken in by diet. Cholesterol is necessary for regulating body function. But too much cholesterol can cause health problems. It can narrow the space inside arteries for blood flow to the heart, the brain and the legs. If cholesterol is not controlled, it can lead to heart disease, strokes and leg amputation. A diet high in fatty food, smoking, excess alcohol intake and obesity are associated with an increase in bad cholesterol, LDL (low density lipoprotein). Herbs and foods which can reduce cholesterol are: dandelion root, pumpkin seed, oats, sunflower seeds, whole grain breads, broccoli, cabbage, carrots, oranges and salmon. Exercise also can reduce cholesterol.

As diabetes, high blood pressure and cholesterol are contributing factors for heart disease, stroke, and even death, it is important to check for these conditions to know if treatment is necessary. Being cost conscious does not mean having less to offer you! And thank you Bender Fellowship, for supporting me in this journey!