Canadian taxes, medical expenses, and CGMs

I’d seen that page, too, and agree it’s pushing it to extremes. Really, 10 minutes A DAY to “adjust pump programming to accommodate for temporary basal rates, exercise, changing bolus ratios or altering basal rates”? (If you’re changing your basal rates or ratios every day, you’re in need of a rescue plan, not a tax break.) 1 minute 12 times PER DAY for “establishing correction doses”? (You are wildly out of control and need a new endo.) 10 minutes EVERY OTHER DAY “for site change and rotation” AS WELL AS 17.5 minutes TWICE A WEEK for “emergency site changes due to sites falling out or failing” – therefore, by my math, changing your sites six days a week. Well, that’s just crazy.

I agree with @Scott_Eric that many of us spend more than 14 hours a week managing our diabetes, but how much of that time is quantifiable? How can we, or a government program, measure the amount of time we spend THINKING about what’s going on, what’s coming up, what we might do to prevent a high/low, etc., etc. Do we ever NOT think about our diabetes? Well, maybe we get a few seconds off each day, but try convincing the government of that.

I guess my bigger point was that I don’t think anyone who has type 1 could be considered to be abusing the system by applying for this. I bet most people use the money to pay for CGMs and whatever else provincial or private insurance doesn’t pay for yet, and it probably still isn’t enough. It would be a much fairer system if they would just give everyone a 100% refundable tax credit for all medical expenses paid out of pocket.

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Y[quote=“beacher, post:21, topic:61107”]
Really, 10 minutes A DAY to “adjust pump programming to accommodate for temporary basal rates, exercise, changing bolus ratios or altering basal rates”? (If you’re changing your basal rates or ratios every day, you’re in need of a rescue plan, not a tax break.) 1 minute 12 times PER DAY for “establishing correction doses”? (You are wildly out of control and need a new endo.) 10 minutes EVERY OTHER DAY “for site change and rotation” AS WELL AS 17.5 minutes TWICE A WEEK for “emergency site changes due to sites falling out or failing” – therefore, by my math, changing your sites six days a week. Well, that’s just crazy.
[/quote]

It’s one thing to say that the schedule outlined isn’t the same as yours, but it’s another thing to make statements with judgemental assumptions about people who do have such a schedule. The schedule outlined in the site reflects my own very accurately. I change my basal rates daily because I have highly variable basal needs. I don’t drive, so virtually every trip I take throughout the day requires an adjustment for increased activity. I also have a highly variable job where some days are walking all day and some are sitting all day and some are a mix of activity and inactivity, which often necessitates several temporary basal rates. Ditto for adjusting for actual exercise, stress, illness, weather, other chronic conditions, and plain old unexplained bouts of running high or low. Due to the shifting effects of monthly hormones and highly variable activities, I don’t have one or two pre-set basal profiles I can quickly flip back and forth between, it’s always a moving target (same with my ratios). I often take micro boluses throughout the day to nudge a drifting blood glucose line down(or eat a few carbs to nudge a line upwards), and while it may not be 12 times every day, it easily takes up 10-15 minutes each day. I use metal infusion sets and, per manufacturer instructions and due to issues with site allergies, I change sets every day or two, and it’s not uncommon for me to have to move a set twice within the same day.

My A1c is within target, I spend a high percentage of my time within a reasonable blood glucose range, and, according to my endocrinologist, I’m one of his top patients in terms of control. I’m not in need of a rescue plan, wildly out of control, in need of a new doctor, or crazy. If you’re able to keep tight control with relatively little adjustment to insulin, that’s great. Count yourself fortunate. But don’t pass judgements about people who happen to need such intensive adjustments.

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@Jen
I’m sincerely sorry if I offended. Yes, my post would read as insensitive to people whose diabetes is not as “easy” as mine. I am fairly new here, and mistakenly assumed “YDMV” was implicit in each response. I certainly did not mean to pass judgement on individuals; I was more angered that the website mentioned above appears to encourage applicants to fudge their numbers to be sure of qualifying. The problem with that is that CRA may then say, “This is out of control,” and change the requirements or even end the credit, which would be hugely unfair to the many people like you who in fact easily meet if not exceed those requirements.
My apologies again.

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I agree with Diabetes Canada’s take on the tax credit which I posted below. BOLDing is mine.

I think the discussion above shows that the current income tax act creates unfairness diabetes community as it leads to unfair treatment. People generally agree that there should be a tax credit due to the costs of supplies and the 24/7 commitment to the disease but the “14 hours per week” thing does a disservice to people with diabetes as it creates unfairness - some people feel they can’t claim, some people claim and get denied, and some people do not feel they can claim because the 14 hours is a stretch based on the narrow definition in the income tax act regarding what counts. I have heard from my endo that he has signed the same wording for many people and about 2/3 get denied.

What we need is clarity in the income tax act so All People with Insulin Dependent Diabetes are treated equally. :slight_smile:

"Diabetes Canada advocates to the federal government for the expansion of the DTC to ALL Canadians living with type 1 diabetes. Diabetes Canada recommends the federal government either expand the interpretation of the Income Tax Act or amend Section 118.3 of the Income Tax Act to permit all Canadians living with type 1 diabetes to claim the DTC.

Since type 1 diabetes is a complex disease and its management is a 24/7 responsibility, Diabetes Canada is asking the federal government to permit the time spent on all activities related to administering insulin (e.g. counting carbs; treating and recovering from lows; meal planning related to time activity profile of insulin used) to be counted toward the 14 hours per week criteria. This could ensure that adults with type 1 diabetes rightfully qualify for the DTC and enable all young Canadians with type 1 diabetes to access and grow a Registered Disability Savings Plan (RDSP) for their future.**

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It turns out my MP is the “Minister of Sport and Persons with Disabilities” who also has a visual impairment since birth.

I am going to write a letter…

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Thanks, and no offense taken. I just read your post on my lunch hour and it touched a nerve, not only because I spend a lot of time managing my diabetes, but because I don’t think it’s a “bad thing” if someone needs to spend more time on diabetes, especially if that’s what’s needed for tight control. Whenever I’ve slacked off and spent a more “average” amount of time on my diabetes my A1c creeps up into the 7-8% range (instead of 6% range). It makes me wonder how many people in “average” control would benefit from upping the time they dedicate to diabetes. But so many doctors think that testing 10+ times a day or tweaking insulin every day is excessive… Anyway, that’s a rant for another thread. :slight_smile:

But I do agree, people shouldn’t be fudging their time to get the DTC! (I don’t get the DTC for diabetes, I get it because I was born legally blind.) I agree with @AE13 and Diabetes Canada: if people with Type 1 are eligible, then everyone with Type 1 should be eligible. But I think part of the issue is that disability is based more on “limitations” (or modifications/accommodations needed to overcome limits) than on a medical diagnosis. When I apply for the DTC for my visual impairment, the form has one or two questions asking about my diagnosis and virtually all other questions ask about how my visual impairment impacts my daily life. So the qualification under “life-sustaining therapy” probably follows a similar format.

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Or maybe if enough people applied for this they would realize it’s a waste of time to impose this silly 14-hour requirement and just grant it for all type 1s. I bet most type 1s don’t know about it or think they can’t qualify and don’t bother applying even though it would help them. This is an expensive disease, which very few people have 100% coverage for or anything even close to it from government programs or private insurance. Type 1s need every tax break, deduction, program and anything else that is out there to help pay for this thing, above all the work we have to do to manage it. I’m glad the website tells people about the credit and helps them apply for it successfully. There should be more resources and advocacy towards lessening the expense burden of this disease.

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My sense from this thread though is that it’s not uncommon for T1s to be rejected when they apply for DTC?
Assuming that those people’s application forms were not incomplete, etc do we know why there seems to be inconsistency in the CRA decisions?

My endocrinologist didn’t give me indication that I could expect to be rejected or that many applicants are rejected arbitrarily. He made sure I met the requirements and gave me solid supporting documentation to submit showing that I qualify. I was approved very quickly. I’m wondering if some doctors just aren’t familiar or experienced with the DTC enough to give their patients the documentation that the CRA considers acceptable.

I know I may ruffle some feathers,but so be it. Being diagnosed as T2, I am kind of somewhat offended by the tone of some of the statements here that appear to me, to imply that T1’s should be implicitly included, yet no mention of T2’'s who may spend even more time than a T1 to control their BG levels. This sentiment appears to hold true with the DAG as well. We ALL suffer from diabetes here, Some manage with CGM’s, some with pills, some with diet and exercise, some with combinations of diet/exercise, medications and insulin. I happen to fit the latter. I test a minimum of 10 times a day, I take Metformin twice a day, I take Toujeo once a day, and Novorapid with every carb containing meal or snack. Does this exclude me? According to most, yes, simply because of the #2 instead of the #1 after the word type. Has this ever been justified or quantified by anyone to demonstrate a real difference in the methodologies and terminologies used to evaluate and determine qualifications, or treatment practices required as put forth by both regulatory bodies and advocacy groups as a whole? Simply put, I test, you test. I take medications, you take medications, I take insulin, you take insulin.
I am ignored and told I don’t count because I am T2, while many feel entitled to something because of the terminology used, T1. ALL sufferers of diabetes should receive equal recognition, both from the diabetic community as a whole, and from governing bodies. To type and divide the community is counter-productive and to me, reminds me of a child vying for a larger treat from a parent for having cried louder than the second child. If, as a community, we wish to divide, perhaps a more appropriate way to do so would be by method of control?
T1: diet and exercise
T2: diet and exercise/medication
T3: diet and exercise/medication/daily insulin
T4: diet and exercise/medication/primary/secondary insulin

Now that there is a clearer distinction, it would be easier for regulatory bodies, government agencies and advocacy groups to more clearly and concisely detail plans, benefits and credits based on that particular group. The cause of the illness to that end should be inconsequential, and the efforts of all parties should be focusing on how better to help those dealing directly with it.

I apologize for getting kind of derailed here and moving somewhat off topic, but with my short term memory as bad as it is, I find I have to speak my peace when the moment moves me, or that thought train has left the station. If this post is inappropriately placed, please feel free to move it to a more appropriate area.

I was trying to be inclusive with my statement…

What we need is clarity in the income tax act so All People with Insulin Dependent Diabetes are treated equally. :slight_smile:

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Agreed! To my understanding, that’s exactly what this forum is about.
(well, there are the discussions about the physiology of the causes, but that’s different…)

Sorry again for the thread hijack, but the very core of the issue is perpetuated even here, on a forum operated by diabetics, for diabetics. Members are sorted by type, with identifying labels right there for the world to see. There are 2 different types of thread headers, further enforcing the visible opinion that we are somehow different and require different care and treatment. I’m sorry, I just don’t understand why? Are we not all “diabetics”? If we as a group can’t even agree that we are one unified sector of the population, how in the world are we to get others to see us as one? When was the last time you heard a conversation like “oh, I’m sorry, do you have the good cancer, or the bad cancer?”? For that matter, substitute any ailment in that sentence. Public perception influences the daily decisions of everyone, including law and policy makers world wide.
Perception:
Type 1: I’m sorry to hear that, have you had it since childhood?
Type 2: I bet you wish you didn’t eat so much sugar as a kid and kept in better shape
We, as a group need to try and reeducate not only lawmakers and policy makers, but ourselves. I firmly believe we need to start that here and now. No more divisions, no more labels. I am a diabetic. I may treat my illness differently than some, but the same as many others, but the fact still remains, I am a diabetic.

We’re all trying to help each other here. It’s terribly unfair that T2s get such poor treatment, especially those who are seeking better control. (There’s another topic here from another Canadian who can’t get enough test strips because she’s not on insulin! CRAZY) Here in the US, I know many who are denied enough strips and/or cgms because they are type2 and it’s seen as excessive. JEEZ.

I’ve had type 1 for 50 years now and I’ll admit before joining here 9 years ago I knew next to nothing about type2. I’d hear about someone w t2 taking quantities of insulin 3 and 4 times as much as I do, and think, “wow, what the heck…”. Of course I didn’t know anything about insulin resistance. Or about insulin resistance causing the weight gain. this video from Peter Attia kinda was a revelation to me.

but here at TuD we are walking together in this journey. We have an uphill battle with opening the eyes and educating people about diabetes. We need to fight shame and blame and misunderstanding and stigma.

quoting from our values:
A note about the different types of diabetes: We believe that no one with diabetes is responsible for having this condition, and we do not support debates about “which type is worse” or comments which place blame on anyone for their condition. The different types of diabetes have more similarities than differences, and within this community we focus on our commonalities and the ways in which we can all support one another as a unified group. For more on this topic please see this post7 by our founder.

The Values of TuDiabetes

I agree that type 2s are unfairly stigmatized. However, I think it’s ok for this forum to recognize that there are differences between the 2 types (though agree the lines are often blurred), with differing treatment options and unique challenges for each, without reinforcing stereotypes or stigmas.

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Many of the things that are available to people with Type 1 diabetes came about through years of advocacy work from the Type 1 community, primarily from parents of children with Type 1 diabetes. I’ve seen a number of complaints from Canadians with Type 2 diabetes on this forum recently. Have those of you who have raised concerns talked with your doctors and diabetes clinics, written to or met with MLAs and MPs, liaisoned with relevant organizations, or raised awareness of these issues in the media? As someone who has been involved with disability advocacy for my entire adult life, advocacy takes years. It is a long, slow, arduous, exhausting process. When I advocate for diabetes, I can only speak to my own experiences growing up and living daily with Type 1 diabetes. I think this is often how a lot of advocacy work unfolds: through a multitude of people speaking up about their personal experiences and why change is needed to the people who have the power to enact change. It would be great to see individuals with Type 2 diabetes band together in the way individuals with Type 1 diabetes often have to engage in some serious advocacy work around these issues.

Jen, I’m sorry if I sound argumentative, but your statements only continue to solidify my sentiment. As a person who advocates for T1, NOT for diabetics. Suggesting that T2’s band together only ensures the world will never see any diabetic individual as nothing more than that, just a diabetic individual. Why should T2’s form a separate group? Would it not be more efficient and effective for T1 advocacy groups to modify their terminologies to be all inclusive and all encompassing?
Case in point, I have never heard of the American or Canadian Prostate Cancer Society, but I would bet most people have heard of the American or Canadian Cancer Society. How many different types of cancer are there, that fall under the same umbrella, yet 2 types of diabetes somehow are seen as different entities with different stigmas attached. Until all diabetics identify as just that, it can never change. I was only diagnosed 9 months ago, but from that day, never once did I ask about what type I was…who cares?? Tell me what I need to do to treat it, and maintain an happy, healthy lifestyle. I don’t need a label to identify me, just the resources available to me that are available to everyone else.

Unfortunately, I appear to see this exact thing is the first issue T2’s need an advocacy group for…To prove to fellow diabetics, who prefer to label themselves as T1’s, that T2’s face the very same issues they do. Perhaps a more appropriate way of wording your sentence would have been; It would be great to see individuals with Type 2 diabetes be invited to JOIN us to input information on how we can advocate together for all diabetics as a community of the whole and help to educate the world that diabetes is not about how we got here, but where we go from here.

I guess, in some small way, I have taken your advice and taken my first step in T2 advocacy, to try to get those on this forum to see us as the same and that there is no need to differentiate by type. If I can help push this here, perhaps at some time it will be possible outside the diabetic community. Until we all see ourselves as not more or less than another, but the same, can we attack and conquer common goals.

I agree, this is a Kafka-esque set of hoops to make us jump through. I know what life was like before being diabetic, and the hardship I’ve endured, and continue to endure, is way more than a measly 8 grand a year rebate on my taxes. Just loss of productivity alone due to hypos at work, as well as loss of concentration and focus, has certainly cost me more than the DTC gives in return. I make close to fix figures and yes I do feel entitled to this tax credit. We do have to work harder to get the same results as normals do. I have no compunction calling myself disabled because, what healthy person has been hospitalized repeatedly and ended up in comas just for the temerity of trying to live without the function of one of our internal organs? I mean, it’s so ridiculous that we even have to justify this to anyone. Type 1s did NOT bring this upon ourselves, or if we did (say, due to anti-biotics given to us as children), then it’s still not our fault.

I’m still waiting on my DTC approval which was rejected initially despite my numbers adding up to more than 14 hours. I lose at least half of those hours every week even when things go well, but a hypo can ruin my mind for an hour, and ruin my sleep too causing me to be tired at work. I’m so angry that I even have to go through this, almost “begging” for the government to recognize that my life as a type 1 is as hard as it is for any number of other type 1s out there who’ve gotten approved for DTC. It sickens me, such an unfair burden to place on sick people.