On average, people with diabetes spend about $16,750 a year on health care, more than half of which goes to the costs of managing the condition and its many side effects.

That's more than double the bill their peers who don't have diabetes can expect, according to the American Diabetes Association. The biggest impact is on people over 65, which means a major impact on the Medicare program.

And costs are rising faster than ever: 26 percent just in the last five years.

Yet many people don't understand how much (or little) they can rely on their insurance.

"The element that has twisted around things are high-deductible plans and patients who may not realize what they are signing up for and find that they're on the hook for a lot more than they thought," said Robert Gabbay, chief medical officer of the Harvard-affiliated Joslin Diabetes Center. "Lots of under-insured individuals are really getting hit."

There's no way to get around the fact that diabetes is expensive. But it only gets more expensive if you go without the care you need to manage your health before diabetes leads to even more serious consequences. We talked to experts who advised that patients try these tips:

  1. If you don't have insurance, ask your doctor's office for help getting connected with resources. Or go online to HealthCare.gov, or call 1-800-318-2596 to get started. "People without insurance may qualify for Medicaid or medical assistance," said Daniel Rosenberg, medical director of Abington Diabetes Center. "Many people are ashamed to talk about these things, but you have to be your own advocate. I can't think of any providers who wouldn't be empathetic to this. And any providers who think less of a patient for bringing it up — maybe it's time to see a new provider," Gabbay said.
  2. Tell your doctor if you have trouble paying for medicine. Health-care providers "tend to know that generics are cheaper when patients are insured," Gabbay said. But in today's complex payment world, that's just the start. "It may be very easy for a provider to make a change [to a cheaper medicine], but they wouldn't know it unless a patient brings it up," he said. "Physicians may not know that you're paying out of pocket for this or you're in the Medicare doughnut hole."
  3. Bring your insurance policy formulary (which list drugs covered by your plan) to every visit. "The formulary can change if a patient's job changes or insurance changes or insurance companies make a change," Rosenberg said. "Typically,  changes are made in January but it can happen any time of the year."
  4. Shop around. For patients who need to watch out-of-pocket costs, Walmart and Target sell in-house brands of glucose meters and test strips at a cost difference that could be one-fourth that of a brand name. Rosenberg notes that the supplies have to meet U.S. Food and Drug Administration requirements. Although not everyone recommends it, many patients pay cash for testing supplies online from a Canadian pharmacy, which may be cheaper than going through insurance. The new Pennsylvania Rx Price Finder (http://www.parxpricefinder.com) shows that 500 mg tablets of Metformin, a commonly prescribed diabetes drug, can range from $30.29 to $76.58 for 100 pills, depending on the pharmacy.
  5. Consider asking doctors for samples. "It's a plus-minus when it comes to samples," Gabbay said. "Samples tend to be for newer medications and in the end, these medications tend to be more expensive. Which is not so great when the sample runs out. But it can provide a temporary fix."
  6. Look for coupon cards. Although you can't use these if you're on Medicaid and Medicare, online coupons for brand-name medications and test strips can provide huge savings. These may be for newer and more expensive brands that manufacturers are hoping you will find worth the price, but it gives you a chance to try them out at a reduced cost.
  7. Investigate mail-order drug plans offered through your insurer, which can offer savings.
  8. Find a patient assistance program. Many pharmaceutical companies have programs for patients that meet income requirements. In Pennsylvania, you can find out about these programs by calling 1-800-955-0989. "Often, the income cut-off for these plans is higher than patients might anticipate," Gabbay said. Companies will ask for tax returns and other information. Medicare.gov has a good online portal that leads to many of these programs.
  9. Consider joining a research study. If you qualify and can meet the time commitment, "typically it's going to cover all costs of care," Gabbay said.
  10. Take charge of your health. Losing weight (if needed), exercising, not smoking, eating right, checking your feet for cuts and sores to avoid serious infections and amputation, taking medication as prescribed, tracking your sugars, and visiting an eye doctor to check for retinopathies can all help reduce complications from the disease. Even if you can't do everything on the list, each step you can accomplish will help.

"Make sure that your cholesterol and blood pressure are under control, since they can lead to complications which are the most costly part of having diabetes, as well as costing you from living your life normally," said Ron Brooks, senior network medical director at Independence Blue Cross. "Many complications can be prevented with fairly simple measures," he said. "People need to be empowered and learn that if you do four or five things for your health you can reduce the overall cost of your medical care."