The cheap diabetic

I wanted to some advice on some of the things I do to save money. Are some of the actions I'm taking doing more harm to me than good?

Stuff I'm less educated on
1) I take Humalog and Lantus currently. I use each bottle until it runs out. I think it takes me about 2 1/2 months to go through a bottle. I don't refrigerate the bottles because it is too inconvenient.

2) I reuse needles. Each one gets used twice. (Lantus always gets a new needle.)

3) I use a CGM. I do not change the sensor until it starts to error. (It may read me waay off or be unable to read me at all.) I get 10-14 days off of a sensor instead of the 7.

Neat tricks
4) I always ask for free samples from the Endo. (Did you know a sample of insulin is a full bottle of it?)
5) I stock pile supplies and use them by the expiration date.

This is a great question, and it’s my understanding that the things you do are pretty common. After all, why would we throw away half a vial of insulin if it’s still perfectly good? It sounds like your CGM is Dexcom? I’ve heard a lot of people restart their sensors and use them for 10-14 days. I’m good for about 10, but that’s only because the site starts itching and gets irritated after that. But I haven’t had a problem with it losing accuracy by that point.

As for how long to use insulin, if you notice it starts to lose potency and your bgs start running high, I would definitely either start refrigerating it from the beginning or throw the vial away at this point. If your bgs seem stable throughout this 2 1/2 month period, I would go with it. But keep in mind this is probably not what the professionals would recommend.

I agree with you about asking your doc to give you samples. I have never bought an insulin pen yet. I always ask my PCP for samples, and they always give them to me. As far as insulin in a vial, when I used to use it, I finished the vial every time. I always was fine until it was finished. I also use my pen needles several times ( but change the needle for Lantus after using it once.) I also don't change the lancet in my lancing device until it is dull. The manufacturer would have you change it after each prick, so they can sell you more. I would refrigerate the vials of insulin to keep them better. Like Elissa says, if your bg # start going up, then toss the vial. D supplies are so expensive we have to save somewhere. I like frugal better than cheap.

With the cost of being a PWD ever increasing, I think all of us tend to try and get the most out of what we have. For me even though my insurance company covers all DME - Dexcom, sensors, Omnipod pump 100% with no copay I still use the sensor as long as I possibly can and never pull a pod until it is empty or until it has expired after 80 hours. From my MDI days I still have some levemir pens and pen needles and I always get a sample novolog pen when I see my endo or CDE every 3 months just for emergency purposes none of them expires until 2015 so they will just sit in the fridge. When they expire, they'll probably just stay in the fridge because I can't bear to throw anything away.Last time I went to the clinic I got a new Verio IQ Sync meter and 30 strips. At the time the Abbott strips that go in the Omnipod PDM had been recalled and I wanted a non-Abbott meter. My CDE is perfectly happy to open the stockroom and refrigerator door and let me shop around. I don't do it to excess and the salesmen who leave the samples expect them to be given out. I belong to a group on Facebook that is PWD helping other PWD. If I have extra of something I post it there and usually there is someone in need.

I think most of us look for safe ways to economize. What I personally do:

Keep my insulin refrigerated at all times. That way I don't even need to think about how long it's been open, where it's kept, etc. I can just forget all those things. I use it up and a vial lasts me anywhere from 2 to 4 months.

I reuse syringes. I change my basal syringe every Sunday and my fast-acting ones every 4 days.

I keep about a year's worth of supplies on hand at all times. It took quite some time to build the stockpile up to that level but now that it is, I just keep it replenished as needed.

I would love to get free samples. Unfortunately my doc doesn't stock them.

A vial lasts 2 to 4 months, David? Wow! What is your TDD?

Not meaning to judge other people's choices but I don't ask for free samples. I don't have a lot of money but I do have good insurance (my insulin and test strips are now no cost) so I figure I'll leave the samples for those who truly need them.

They don't all last that long, some are used up sooner. I'd say 3 months is fairly typical or average. It varies according to the type of insulin. Some are used less, some more.

My TDD is between 15 and 20 on a "normal" day, i.e., a day when I don't go out for pizza or otherwise take liberties. Bear in mind that I use three types of insulin, so that TDD is divided 3 ways, and not necessarily in equal proportions. That tends to make the stuff last quite a while.

I normally eat a Bernstein-style low carb diet, which goes a long way toward holding down the TDD.

Oh, ok, the three types of insulin explains it. I just checked my TDD history and in the last 30 days I used between 15 and 30 with the more typical between 17 and 25. And mine only lasts about three weeks, so I was wondering!

I still think you are a strange type I mean that in the nicest way!

I understand your puzzlement, my phenotype certainly is nowhere near the middle of the bell curve. But to put it in perspective, I went 16 years without insulin. If I were T1, I'd be dead by now. ;-)

You would think so, but John Walsh says that studies show that 94% of those with LADA/type 1 required insulin six years after diagnosis. But he doesn't give any estimates for the other 6% (at least that I"e read. Melitta might have access to these stats). I know that you are comfortable with your diagnosis and management, but I want to make sure others are not misdiagnosed due simply to age. Also per Walsh, "one in every 7-10 people said to have Type 2 diabetes actually have antibodies indicating they are LADA/Type 1. (My guess is many of these think of themselves as "thin type 2's"). "LADA/Type 1 numbers over 2 million people in the U.S. or double the million or so with Type 1."

Well, okay, here's some more data. For all of that 16 years, sulfonylureas kept my A1c in the mid sixes without my doing anything else. So if T1 was killing my beta cells, it was happening over a span of time and at a rate best described as . . . glacial. And that "leftover" 6% you mention would have to cover a ten to twelve year span. Not saying it's impossible, but you get much higher odds on a roulette wheel.

You could certainly be right, David. As I said, I have no investment in proving your case one way or another (not that I could!)I just feel the responsibility to keep others informed as to possibilities of misdiagnosis. I was misdiagnosed for 15 months - admittedly a MUCH shorter time, and I rarely had an out of range number during that time (on oral meds). I also, as a vegetarian ate lots of pasta and rice, granola and fruit for breakfast, etc. This is one of the chief places I came in search of answers when my numbers started climbing. I don't know if John Walsh has ever been here in a talk, but it sure would be interesting for you to share your story with him!

I can't endorse your concern about misdiagnosis too strongly. To say that it's a "serious problem" is a massive understatement, like calling the ocean "moist". See my comments HERE.

1) I do this (Humalog and Levemir). It takes less than 2-1/2 months but I don't refrigerate and use till gone.
2) I do this. I use needles a lot more than twice (use until numbers start to wear off or if I notice any pain). I keep a separate needle for Humalog and Levemir.
3) No CGM.
4) Only get samples when they have something new to try.
5) How does this save money? Whether you buy them now or later you still buy them?

I don't see any problems with anything you're doing.

Chadd it's called T1D's-PIF (pay it forward) there are a little over 1000 members.

What does TDD stand for?

Total Daily Dose

1) Have you used Lantus before? Did you see that Levemir had advantages over Lantus? (I'm wondering because I cannot seem to pinpoint down a carb to insulin ratio, even if I break it down by time of day. I wonder if my Lantus is effecting.)

5) Stock piling has helped me because I have struggled with what kind of insurance I'm going to be on. It gives me piece of mind to know that I have a window persay of how long I may have to attain proper insurance if I were to lose it.

Although I am a T2, I have my own tricks for saving money.

1) I use pens and use them up before they expire, but I do order 90 day supplies of everything and I ask for the prescription to be written for my "worst case," thus enabling my insulin supply to last longer than 90 days (I won't say how much longer).

2) I actually reuse needles when injecting different insulin's at the same time, but then throw them out. Since I pay the same co-pay no matter how many needles I use, there isn't any marginal cost of another needle.

4) I will ask for a free sample only when starting a new medication. I actually was given 2 boxs of pens recently when switching insulin's. On the other side, I actually give unexpired supplies to my Dr so that she can give them to people that need them, I did this with a couple of boxes of NPH pens.

5) I wouldn't say I stockpile, I would say I "hoard." Why I need a full box of lancets from 2006 which go to a lance I don't even use anymore is my issue.

I'm a hoarder too. My box of lancets from 1997 trumps yours from 2006. But it isn't as though I will ever use them. The lancing device is long since gone but alas I just can't throw them out and they're hardly something I can put out for a yard sale are they ?
My dexcom sensors and pods are on autoship. So every 3 months whether I need them or not a 3 month supply arrives at my door. First shipment was 4 boxes of pods. I guess the extras are for pod errors and the like. Since I didn't have any pod errors I'm still 1 box ahead. Then in the second shipment they only sent 1 box because there were shortages in manufacturing. I wasn't concerned but less than a month later I got 3 more boxes of pods. So the stockpile got bigger. As a result of these 2 shipping mistakes I am 2 months ahead on pods. And because I use them for 80 hours not just the 72, I gain a new pod every 12 pods. I get 12 Dexcom sensors for 3 months on Jan 20th. The first one I opened 3 weeks ago and it is still on my arm. I always worried they'd expire before I got a chance to use them but so far it hasn't seemed to matter if they're expired or not.