One out of every three adults in America now has pre-diabetes.  Of these 84 million people with pre-diabetes, most of them don’t even know they have it - since there are often no signs or symptoms.  Without taking action, many people with pre-diabetes will develop type 2 diabetes within 5 years. Whether or not it progresses to type 2 diabetes, pre-diabetes makes you more likely to get heart disease or have a stroke. 

Look at this as a wake-up call that you’re on the path to diabetes… but it’s not too late to turn things around by taking action right away to lower these risks.  Pre-diabetes can usually be reversed.  Losing 5-10% of your body weight and doing 150 minutes of exercise a week (30 min/day) can lower your risk of developing type 2 diabetes by 58%.

WHAT CAUSES PRE-DIABETES & TYPE 2 DIABETES?

The body breaks down carbohydrates from the food you eat into glucose (sugar).  The hormone insulin, made by the pancreas, is responsible for moving glucose from the bloodstream into the cells of your body for energy. In Pre-diabetes and type 2 diabetes, cells gradually become less sensitive to insulin and the pancreas cannot produce enough insulin to compensate (i.e. INSULIN RESISTANCE SYNDROME).  As a result, glucose builds up in the blood. Having pre-diabetes means your blood sugar levels are higher than normal—but not high enough to be diagnosed as diabetes.

It’s a combination of genetics and lifestyle that are proposed to be the culprit for this insulin resistance syndrome. If you are eating more carbs, sugar, and fructose than the body can handle – this sugar gets converted into fat that starts to clog the liver (contributing to fatty liver disease) and the pancreas (so it can no longer make as much insulin to bring blood sugars down). However, we understand there is also a genetic component to this disease that may make you more likely than someone else to develop diabetes, even if they have the same lifestyle as you.  Because of this, you will sometimes see “thin” people that still develop diabetes – although it is more likely that this person has LADA (latent autoimmune diabetes of adult onset).

AM I AT RISK FOR PRE-DIABETES?

Across the general US population, around 40% of people are expected to develop type 2 diabetes in their lifetime. Anyone can get pre-diabetes or type 2 diabetes, but some important risk factors besides genetics, age, weight, and lifestyle are:

• Being overweight – specifically abdominal fat – is the #1 RISK FACTOR
• Large waist size (Men with waists larger than 40 inches and for women with waists larger than 35 inches may be at increased risk).
• Eating processed foods, sugary foods and drinking sugar-sweetened beverages.
• Age over 45 years old
• Family history (for example - parents or siblings with type 2 diabetes)
• Race - African-Americans, Hispanics, Native Americans, Asian-Americans and Pacific Islanders
• Gestational diabetes or if you gave birth to a baby who weighed more than 9 pounds
• Polycystic ovary syndrome (PCOS)
• Sleep issues, obstructive sleep apnea, or people who work changing shifts or night shifts
• Darkened skin on certain parts of the body (neck, armpits, elbows, knees and knuckles)

Now even some at home genetic testing kits, specifically 23& Me, offer testing to identify certain genes that may increase your likelihood of developing Type 2 Diabetes.

The CDC and American Diabetes Association offer a test to identify if you are at risk for pre-diabetes and type 2 diabetes. Click here to take the test: https://www.cdc.gov/prediabetes/takethetest/

HOW DO I KNOW IF I HAVE PRE-DIABETES?

Blood Sugar Levels

If you think you have prediabetes or may be at risk, its best to talk with your doctor about having a Hemoglobin A1C drawn. This will tell what your blood sugars have been “averaging” for the past 3 months. Another option is to purchase a glucometer online or at the drug store and test blood sugars first thing in the morning before eating (fasting) and 2 hours after eating a typical meal.

A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. A fasting blood sugar level > 126 mg/dL or a 2 hour after meal sugar > 200 mg/dL indicates type 2 diabetes.

Signs & Symptoms

Since sugar levels are not significantly elevated in pre-diabetes, there are usually no symptoms until full blown “diabetes” has developed.  However, when sugar levels in the blood stream are elevated – common symptoms that may be an indicated that pre-diabetes is progressing into type 2 diabetes are:

• Fatigue, tiredness (since glucose isn’t being used for energy properly)
• Increased thirst
• Frequent urination
• Blurred vision

I HAVE PRE-DIABETES, NOW WHAT DO I DO?

The primary treatment for pre-diabetes is the same as what you do to prevent or reverse diabetes: lose weight, exercise, and eat a healthy diet.  A diet high in vegetables, nuts, whole grains and olive oil is associated with a lower risk of pre-diabetes.  Additionally, physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.  It is possible to reverse pre-diabetes by making these lifestyle changes.

A new study suggests that the type of exercise you do matters.  If you do BOTH aerobic (cardio) and resistance (strength training, light weight lifting) this would be better than doing only cardio or only resistance exercise.  Pre-diabetes patients who did resistance training combined with aerobic workouts for 24 months had a 74% reduced risk of developing type 2 diabetes. (https://onlinelibrary.wiley.com/doi/full/10.1002/dmrr.3143)

Click here to find a Diabetes Prevention Program in your area: https://nccd.cdc.gov/DDT_DPRP/Programs.aspx

Other Treatment Considerations

PRESCRIPTION MEDICATIONS

Diabetes medicines are not as effective as diet and exercise. However, your doctor might prescribe medicine if you are at high risk for diabetes and have other medical problems. These could include obesity, a high triglyceride level, a low HDL cholesterol level, or high blood pressure.

STRESS MANAGEMENT TECHNIQUES

Stress itself can cause high blood sugars – whether its physical or emotional. Try yoga, meditation, or deep breathing exercises to help in periods of stress.

HERBAL, VITAMIN & MINERAL THERAPIES

Certain natural therapies (link to Early Defense product description) have clinical research supporting their use in type 2 diabetes prevention.  For example, 100 mg/day increase in dietary magnesium intake is associated with a 15% risk reduction for developing type 2 diabetes.  Increasing blood vitamin D levels reduced the risk of developing diabetes by approximately 70-81%. 

With the astronomical and rising cost of prescription medications, the most common complaint I get from both patients and providers are “I can’t afford my medications!” This often creates a huge barrier for you to get the right medications to keep your sugars under control. Additionally, doctors are limited on what they can recommend based on formularies and affordability, instead of what is the best therapy for a patient.  Unfortunately, our healthcare system spends much more on treating the complications from uncontrolled diabetes than we actually do on the medications to treat it.  Here are my 10 BEST tips to help you with affordability of your diabetes medications.

• GENERICS

Most of us know that generic medication is less expensive than brand name medications. This means the original drug company’s’ patent has expired and the medication is able to be made by multiple manufacturers - which drives the price down for you. The problem is, the diabetes medications that are available as a generic are very few:

• Metformin
• Glipizide, Glimepiride, Glyburide
• Pioglitazone (Actos®)
• Acarbose
• Alogliptin (Nesina®) – this drug works in the same way as Januvia®, Onglyza®, & Tradjenta® which only come as Brand Name, so this may be a less expensive alternative to those therapies

This is why when you ask your pharmacist or doctor, “Isn’t there a cheaper drug?” The answer usually is no.

If you are paying more than $15/month for Metformin & Glipizide/Glimepiride/Glyburide medications... you shouldn’t be.  Metformin (depending on the formulation) & Glipizide/Glimepiride/Glyburide medications should be available on any major pharmacy $4 generic drug list without insurance.  Walmart also offers pioglitazone for only $9/month. YHere is a link to find participating stores and prices:

https://www.needymeds.org/DiscountDrugProgram.taf?_function=National_list

• METFORMIN

There are different kinds of Metformin formulations – Metformin immediate release, Metformin extended release (ER), and Metformin ER osmotic release.  The extended release versions are often used to help relieve stomach upset and diarrhea.  There are price differences in doses and formulations.  For example, Metformin ER osmotic release 1000 mg tablets can be 50 times more expensive than Metformin ER 500 mg tablets. You can always check with your pharmacist to find out if there is a less expensive version of Metformin than what you are taking.

• SPLITTING PILLS

There generally isn’t much difference between strengths of pills.  As examples, cash priving of Invokana 100 mg is about the same as Invokana 300 mg tablet per tablet and Januvia 50 mg is about the same as Januvia 100 mg per tablet. So (depending on your needs) it may make the most sense talking with your provider about prescribing the highest dose and then cutting the pills in half every day. This can get you the most bang for your buck! I find value in this option for patients who pay cash, have a high deductible, or who use Medicare Part D.

• COM

GoodRx offers coupons and discounts on hundreds of prescription drugs – but its utility truly is only in generic medications.  The discount is not significant enough to make brand name medications affordable and they usually remain hundreds of dollars per month.  Therefore, for brand name medications – you are much better off using a copay card directly from the manufacturer (see next tip below). Also, you cannot use both a GoodRx coupon and your insurance – again, making this not very useful in the diabetes realm. 

Where GoodRx can be useful is in getting cash pricing of medications between local pharmacies to try to find the most competitive price.

• DRUG MANUFACTURER COPAY CARDS

Pay attention if you have commercial insurance – especially a high deductible!! You cannot use these if you have any government insurance (like Medicare, Medicaid, or Military).

In order to use copay cards, the prescription must be run through your insurance first. Therefore it’s best to first find out what is covered on your insurance plan’s formulary, and then find the copay card that offers the largest discount. You can do this by calling your insurance company or referring to their formulary book that they usually mail you at the beginning of each calendar year. I also refer to this website tool:

https://lookup.decisionresourcesgroup.com/

This is also helpful when it comes time to pick the best insurance plan for you the following year!

I have compiled below categories of brand name diabetes medications, based on how they work. The medications within the table are generally interchangeable so it may make sense to switch to an alternative medication within the same class if it saves you money.

SGLT2 inhibitors (the pills that cause you to urinate out extra sugar)

GLP1 receptor agonists (non-insulin injections that help your body use its own insulin better and slows how food moves through your stomach)

DPP4 inhibitors (pills that can help lower sugars)

Long Acting Insulin

Meal Time Insulin

• FREE TRIAL VOUCHERS

Unlike copay cards, anyone can use these whether or not you have insurance, or even if you have Medicare or Medicaid, since it is not run through insurance at all.   These are usually 30 day offers to try the medication for free.   These are not advertised online, so the best option is to ask your doctor if they have them for the medications you take.  The exception is medications from AstraZeneca – Farxiga and Bydureon both have 30-day free trial offers here: www.azmedcoupons.com (*make sure you click the Free trial and not the Savings card!)

These medications have 30-day free trial vouchers available that may be available from your doctor:

• Invokana
• Farxiga
• Jardiance (14 day free-trial only)
• Humalog
• Trulicity
• Bydureon

This isn’t a long-term solution, but certainly buys you time to try a medication and know if it’s going to work before paying for it.

• PATIENT ASSISTANCE PROGRAMS

Whether you have commercial insurance, Medicare insurance, or no insurance – if you are struggling financially with paying for your medications you may qualify for FREE medication from the drug company.  The income requirements and out-of-pocket spend vary based on the company.  You will need to provide documentation for your income for all of them except Sanofi.  If you are a Medicare patient, some of these programs will require that you have tried to apply for Medicare Low Income Subsidy. (i.e. “Extra Help) – see below for guidance on this. Keep in mind, these must be renewed annually.

• MEDICARE LOW INCOME SUBSIDY

If you have Medicare and are considering patient assistance programs due to financial hardship, this is undoubtedly your best option to try first.  You may be able to get extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. This extends to ALL of your medications (not just diabetes) and does not have to be renewed each year like the patient assistance programs do. I would only attempt to do this online. Calling can take hours. If you aren’t computer savvy – find someone to help you (even someone at your doctor’s office)!

Go here to apply: https://secure.ssa.gov/i1020/start and click “Apply Now” at the bottom of the page.  You will need to have your income and asset information handy.  It takes only about 5 minutes to complete.

• INSULIN SAVINGS

First, check out my tips on copay cards and patient assistance programs. If those don’t work for you – there are still other options.  Lilly now has a hotline available for you to call, 1-833-808-1234, which is designed to help you figure out how to afford your insulin.  Sanofi also offers non-insurance pricing about 1/3 of the total cash price ($99/vial, $149/pen pack) for Lantus, Toujeo, and Ademlog at this website: https://www.admelog.com/insulins-valyou-savings-program.

Still too expensive? There are “cheaper” insulins, although most clinicians will argue they aren’t as good.  This is because the time they take to work can be different, which can pose challenges for efficacy and safety.  WALMART pharmacy offers Novolin Relion N (long-acting) and Novolin Relion R (meal time short-acting insulin) for $24.88 per vial (1,000 units per vial).   Ask your provider about substituting your insulins for these.

If you use insulin through an insulin pump and have Medicare – this insulin CAN be run through Medicare Part B (not Part D) so it is not subject to the Donut Hole and should be covered almost at 100%.... which is a SIGNIFICANT cost savings! The tricky part is finding a pharmacy contracted with Medicare Part B.  Usually the large chain pharmacies (WalMart, Walgreens, CVS/Target) will offer this, but small independent pharmacies do not.  Note, this also applies to diabetes testing supplies! Ask your pharmacy to run them against your “red, white, and blue” Part B card.

• SAMPLES

Some doctors’ offices are still given samples of medications from the drug company reps. All you have to do is ask if they have any available!