Smarties®: Revisited

First, if you haven't visited my post from earlier this week, please visit it at here and make a $1 donation to the Fight It! Friday campaign. On to my second post this week ...

In early 2008, I posted a story about my then new-found "discovery" of buying Smarties® in bulk (42 lbs. worth, more on that later) as a far more price-effective treatment for hypoglycemia. (Catch my post here for more details)

Well, after several years, that bulk supply is nearly empty, plus I have some money remaining in my Flexible Spending Account (FSA) that I'll lose if I don't spend it by the end of the year, so its a good opportunity to "kill two birds with one stone" as the old saying goes and replenish that supply. As I told my endocrinologist, not only did that bulk order serve my needs very cost-effectively for several years, but it also worked for more than a few trick-or-treaters (to be honest, I've also left quite a few in pants pockets, so they’ve been washed or crushed, as might be expected, which is perhaps the single biggest downside of this hypo treatment). Anyway, that supply of candy is now nearly depleted, so it’s time to order more, and I'm planning to do so, perhaps with some minor changes.

Since that massive order, which Scott K. Johnson also wrote about
here, although I'm not 100% certain what happened to the photos on the old site, as that post was before he relocated his blog to Diabetes Daily, and after using Smarties as my primary hypo remedy for the past few years, I wanted to share a few lessons I've learned along the way.

Lesson 1: Smarties May Be Called Candy, But They're Basically the Same Thing As "Glucose Tablets"

I hinted at this in my original post, but I just wanted to first remind everyone that Smarties aren't the ONLY candy made from mostly dextrose, there are others. Among them: SweeTarts (sold in rolls at the register in most drug stores), I even found them in a $1 store. The company that makes SweeTarts was acquired a few years ago by Swiss food conglomerate Nestlé. Nestlé has since rolled the SweeTarts brand into it's already-existing Willy Wonka Candy Company family of brands. However, I have not found it as easy for consumers to obtain bulk supplies directly from Nestlé/Willy Wonka Candy Co. as it is from Smarties, plus Smarties remains a family-owned business based in New Jersey, and they sell their products directly to nearly anyone who wants to buy from them via their very convenient website.

But as Scott K. Johnson commented on my original post back in 2008, keeping Smarties intact in pockets filled with change and keys without crushing them can be a challenge. Indeed, I have discarded more than a few cellophane-wrapped rolls of Smarties that became pulverized over the past few years, which is essentially a waste. I can't really quantify it, but my belief is that the cost savings nevertheless justifies that waste. But perhaps the biggest hassle is that Smarties aren't always quite as convenient as the de facto-standard 4 gram tablets in terms of size. For caregivers (type 3's), for example, its often easier just to hand over a few tablets rather than struggling with opening a few rolls of Smarties. Also, hands trembling from hypos can find it frustrating to open the tightly-wrapped cellophane, occasionally dropping some of the tiny-sized Smarties tablets in the process.

Lesson 2: The Rule of Three (3)

First, Smarties sells several different sized rolls. In truly bulk-sized boxes, among the most economically-sized options is a box of Smarties 15 tablet rolls, which the website says contains approximately 2,400 rolls per case. Each of those rolls contains 6 grams of dextrose, the same ingredient in glucose tablets sold under the Dex 4 brand name, as well as under the names of your primary retailer (Walgreens, CVS, Target, Wal-Mart, Publix, Safeway, etc.) branded glucose tablets. Although the treatment recommendation is usually 15 grams of fast-acting carbohydrates for a reading of 60 mg/dL, if it's lower, you may require more. Generally speaking, I have found "The Rule of 3" works remarkably well, and is easy because the same rule also generally applies for the number of traditionally-sized glucose tablets. Depending on the individual, you may need to follow up with some "real" food, as the durability of a recovery based on pure dextrose does not generally last for most people with type 1 diabetes, although I cannot speak for everyone, and if you have type 2 diabetes, it really depends on how your doctor has you treating your diabetes. Just remember, as a short-acting carb, its here one minute, but gone the next!

Lesson 3: New Smarties Innovations

Tropical Smarties and Mega Smarties

Since I last ordered, I have discovered a few Smarties innovations you might wish to consider.

First, Tropical Smarties. For example, if you're sick and tired of the plain old flavor, last year, Smarties introduced what it's calling Tropical Smarties which taste a bit different than the original, although in my opinion, not dramatically different. (They aren't quite the coconut/piña colada flavor I know more than a few people with diabetes call their favorite glucose tablet flavors, but still slightly better, or perhaps I should really be saying "different" than the original flavor).

I would have ordered a bulk-sized 42 lb. box of the Tropical Smarties, but alas, the company only sells them in cases of bags which contains a case of 12 bags each, each consisting of 7 oz. of the Tropical Smarties, but the true bulk sized box, the only flavor is the original. Still, if you want a different flavor, you might consider visiting a retailer who sells candy nearby and seeing if they sell Tropical Smarties before making a commitment to buying an entire case!

Second, Mega Smarties. The other innovation is perhaps even more noteworthy, that is the fact that Smarties has bulked up their tablet size to what they're calling "Mega Smarties" and each tablet is exactly 2.5 grams of carbohydrates (most glucose tabs contain 3 grams of carbohydrates), generally comparable to the glucose tablets sold by most drugstores (although they don't fit perfectly into their pocket-sized tube containers, unfortunately, but on the upside, its MUCH easier to measure 15 grams). These are sold in the usual cellophane wrapped-rolls, but cost-wise, they're about $1.50 each in a store, but each roll contains 15 tablets vs. the 10 contained in a store-branded or Dex 4 roll does. Flavor-wise, again, its the same old variety, but it really is a pretty convenient and lower-cost treatment option.

Incidentally, I picked up my first "Mega Smarties" roll at my local Bed, Bath and Beyond store (right at the register), so these appear to be quite widely distributed. Plus, Smarties will sell you an entire case of "Mega Smarties" from their online store under "Cases of Boxes & Jars" heading (each case sells for $144, but keep in mind that this consists of a case consisting of 12 boxes of "Mega Smarties", each with 24 rolls per box, which is 288 rolls (each of which has 15 "Mega" sized tablets). These tablets WILL fit into an empty bottle-sized container of the 50-tablets sold in stores, but the width of each tablet is different, so the tubes probably won't work. For convenience sake, I am really considering this option instead of the smaller-sized rolls, so I'll have to let you know how that works out!

Lesson 4: If You Want to Pay for Smarties With Your FSA, Get Your Doctor to Write a "Letter of Medical Necessity"

One important lesson I learned the hard way was exactly what it takes to seek reimbursement from your Flexible Spending Account (FSA). The first time around, when I tried to get my last bulk-order of Smarties that candy wasn't automatically considered by IRS rules to be a reimbursable expense even when used to treat a medical condition (hypoglycemia). But it CAN be, with some appropriate planning. If you get a prescription and/or letter of medical necessity for Smarties (or SweeTarts, or whatever you like to use as a hypo treatment), then you CAN seek FSA reimbursement and have the expense covered, because that letter turns, in the eyes of IRS auditors, candy into a legitimate medical treatment that is expensible under IRS guidelines.

I wasn't able to pay for my original order with my FSA, although from a purely economic standpoint, I was still better off even without being able to expense it. But this time around, I have covered all the necessary bases and asked my endo to write me a letter of medical necessity for Smarties candy, which my FSA administrator has told me WILL enable me to expense the candy using my pre-tax dollars this time around. Call it a lesson well-learned, but one you can use to avoid the hassle I went through the first time around, with a request from your doctor.

As an FYI, here is what was written on my endocrinologist's letterhead:

To Whom It May Concern:

[Insert Patient Name Here] is under my care for insulin-dependent type 1 diabetes mellitus. At this time, I have recommended that he/she treat recurrent hypoglycemic episodes with "Smarties" which contain a dominant amount of glucose (dextrose) and is less expensive than the glucose tablets otherwise available.

If I may be of any further assistance to provide any further information, please feel free to contact me.

Respectfully,
[Insert Doctor Signature and Title Here]

The other slightly challenging part is getting an actual receipt from Smarties. Sometimes a credit card statement is, depending on your FSA administrator, not considered acceptable, whereas a printed receipt would be considered acceptable. You may wish to place your order for Smarties by mail (keep copies of the order form) in that case, because you'll have the a copy of the order, the shipment receipt and the canceled check plus the doctor's letter of medical necessity to use collectively for reimbursement. Frankly, this is a case of FSA administration can be a bit testy about what they deem as "acceptable" proof, but its worth investigating before rather than having a hassle to get it reimbursed after-the-fact, so ask questions!

Anyway, given this experience, you now have some options available. I think this time around, I may skip the 42 lb. box of Smarties and go for a case of Mega Smarties for some of the reason's I've already mentioned. It's more expensive, but the option might work better, plus I have enough remaining in my FSA to make it practical. But if you're looking for a truly cost-effective option, there's nothing wrong with a big box, even if you end up discarding a few broken rolls. The markup on retail "glucose tablets" is nothing short of highway robbery, but the rule in retailing is sell for what the market will bear, so this option is definitely a c

By the way, for those of you who follow me on Twitter, my alter-ego (at least for the holiday season) is Gingy from Shrek movies, at least for the holiday season. I've always had an affinity for gingerbread men, so I kind of like the image!