Diabetes

[JackieOnLine]

having an A1C of 5.9 upon admission helped my case. In the two days I was there, they only had to give me insulin one time and even then only two units. I never saw a reading higher than 170 the entire time while off all my diabetic meds in the hospital

that's good! were they surprised? it's a real advertisement for the DS, I think.

 

[southernlady]

that's good! were they surprised? it's a real advertisement for the DS, I think.

Pleased, yes.

 

[JackieOnLine]

I hope it is OK to ask a non-WLS diabetes question, @southernlady. (I looked for the non-WLS medical area and I think it is gone.)

My cousin (and my favorite family member) is married to a type 1 diabetic and she sometimes reports trouble when his sugar is low, which is not only bad for him it's very hard on her if she can't easily get him to eat.

Over-all he is more head-in-the-sand than on top of things since at least sometimes it's preventable: he didn't plan to eat/have a snack available or something. I'm trying not to be judgmental about that, but want to help her with some info since he clearly needs one of those continuing glucose monitors. I mean, I see it as a top priority for his health.

She assumes they can't afford it and he can't be bothered to worry about it, so the first time I mentioned it she said insurance wouldn't cover it and that was the end of that.

It's come up again (another low sugar morning) so this time I gently got her to look at his insurance, United Healthcare. She texted "they only cover it for type 2" to which I said that was so surprising I was sure she misunderstood. She texted again "may cover for some diabetics with prior authorization". I have no doubt his doctor would think it was necessary, in fact think whoever it is should be trying to make it happen.

She also said of her husband "he might agree to it if it was covered" but she is worried about ongoing costs. currently "we pay 85 for supposedly 3 months of insulin but he is frequently out sooner" and "he still has to pay for test straps and syringes".

I would guess he almost certainly would need less insulin if he was on top of it with the continuous monitor, but don't underhand the rest of it. She thinks the continuous monitor "has to be changed out monthly" at a cost.

Help me advise her. (If I were a diabetic I think I'd be looking for support forum)

She is very worried about money generally, and especially lately. Honestly, when she relates some way in which he is super casual about his blood sugar I want to just say, I hope he has good life insurance.

 

[southernlady]

I hope it is OK to ask a non-WLS diabetes question, @southernlady. (I looked for the non-WLS medical area and I think it is gone.)

My cousin (and my favorite family member) is married to a type 1 diabetic and she sometimes reports trouble when his sugar is low, which is not only bad for him it's very hard on her if she can't easily get him to eat.

Over-all he is more head-in-the-sand than on top of things since at least sometimes it's preventable: he didn't plan to eat/have a snack available or something. I'm trying not to be judgmental about that, but want to help her with some info since he clearly needs one of those continuing glucose monitors. I mean, I see it as a top priority for his health.

She assumes they can't afford it and he can't be bothered to worry about it, so the first time I mentioned it she said insurance wouldn't cover it and that was the end of that.

It's come up again (another low sugar morning) so this time I gently got her to look at his insurance, United Healthcare. She texted "they only cover it for type 2" to which I said that was so surprising I was sure she misunderstood. She texted again "may cover for some diabetics with prior authorization". I have no doubt his doctor would think it was necessary, in fact think whoever it is should be trying to make it happen.

She also said of her husband "he might agree to it if it was covered" but she is worried about ongoing costs. currently "we pay 85 for supposedly 3 months of insulin but he is frequently out sooner" and "he still has to pay for test straps and syringes".

I would guess he almost certainly would need less insulin if he was on top of it with the continuous monitor, but don't underhand the rest of it. She thinks the continuous monitor "has to be changed out monthly" at a cost.

Help me advise her. (If I were a diabetic I think I'd be looking for support forum)

She is very worried about money generally, and especially lately. Honestly, when she relates some way in which he is super casual about his blood sugar I want to just say, I hope he has good life insurance.

It’s hard to get a CGM ( Continuous Glucose Monitor) as a type 2 even as a diabetic unless on insulin. I know, I fought that battle and lost. But then I was on Medicare. As a type 1, he shouldn’t be having ANY issues, if he is, his endocrinologist is failing him.

My step daughter is a type 1 and has been on a CGM for decades along with an insulin pump. As a type 1 she can be on an insulin pump. As a type 2, even on insulin, I’m think the rules still forbid me to use an insulin pump. At least it did back in 2011. Sounds like he needs a better informed endocrinologist.

Now the Freestyle Libre, at one point, allowed those who had serious hypoglycemia proven by finger sticks and possible ER visits to be prescribed their system.

Dexcom has released an OTC version but it won’t tell you a number lower than 70. If you get a “low” you need to finger stick to find out how low. But then I was cost is out of pocket.

 

[JackieOnLine]

As a type 1, he shouldn’t be having ANY issues, if he is, his endocrinologist is failing him.

that's what I thought! but I don't think the whole issue is even on his radar, while his wife (who does the worrying for both) has it filed under "can't afford it" and spends time on other issues.

I wonder if he even has an endo?

thank you for your reply, Liz and Happy Thanksgiving! I'm going to TWO dinners today, LOL

 

[Larra]

I'm no expert on insurance for this issue, but it only makes sense for type 1 to get coverage easily if anyone can be covered by their insurance, and type 2 at best with all kinds of specific criteria to meet.
If I were advising your relative, I would suggest that she drag her husband in to see his pcp if he doesn't have an endo, and either have the pcp try to get authorization for it, or at least get referral to an endo. Sadly, it isn't unusual for wives to have to drag their husbands in for very necessary care. In the long run, insurance would save thousands if his diabetes were well controlled, when you consider the kidney failure/dialysis, heart disease, blindness, leg amputations due to damaged arteries, etc etc, but insurance only looks short term, so it's up to the patient or family to think long term.
And yeah, life insurance.

 

[JackieOnLine]

I would suggest that she drag her husband in to see his pcp if he doesn't have an endo, and either have the pcp try to get authorization for it, or at least get referral to an endo.

I can try, I know she feels like she is overwhelmed as it is. I know she feels like there is no point in getting it if they can't afford to do whatever the on-going cost (monthly) turns out to be but, honestly, it might even be less.

thank you, Larra

 

[Larra]

@JackieOnLine cost is a concern, but depending on coverage and cost of other meds, which might decrease with better glycemic control, it could work out. No fee for finding out, in any event. Of course, this shouldn't all be on her, but I've seen a lot of people with various chronic diseases become lackadaisical about it, to their detriment. I don't know why, but it happens a lot.

 

[Spiky Bugger]

I can try, I know she feels like she is overwhelmed as it is. I know she feels like there is no point in getting it if they can't afford to do whatever the on-going cost (monthly) turns out to be but, honestly, it might even be less.

thank you, Larra

Old doctor-to-doctor wisdom:

When an Emergency Dept patient says, “My wife made me come in,” assume something is HORRIBLY wrong until proven otherwise. If the patient is a farmer, just go ahead and call for the crash cart and all available resources. You will need them.”

 

[southernlady]

@JackieOnLine at some point, he could go too low or too high, especially as a type one that either forces hospitalization or could kill him. I know type 1’s who have died from going too low during their sleep.

Hypoglycemia is nothing to mess with and neither is ketoacidosis. Both are deadly. Type 1’s who are not tightly controlled are prone to a whole host of issues. And they can end up costing far more than keeping his disease under control. Yes, a chronic disease is a royal PITA AND EXPENSIVE but if we have one, we have no option. We have to deal with it.