CGM for T2

I’m inquiring on behalf of my husband who is a T2. A brief bio: 69 years old, diagnosed last July, never overweight and fairly active his whole life. He followed instructions from his endocrinologist and addressed this with diet and metformin. The diet had to be adjusted to add in more carbs because he was loosing too much weight. For a number of months he seemed to have this under control, but lately his numbers have crept up…high 100’s and some in low to mid 200’s. His Endo prescribed adding an additional 500 of Metformin putting him at 1500 per day. It’s only been a couple of days, but this morning’s readout was 232. He called the doctor, and she prescribed an additional medication (haven’t picked it up yet) for him to take if his number went over 200. Although there are a couple of possibilities as to why his numbers have increased, including a recent surgery for carpal tunnel as well as all of the stress over the Covid19 crisis, I am concerned about his somewhat erratic readings and encouraged him to get a GCM. His doctor called in a prescription for FreStyle Libre, and even though Medicaid and supplemental insurance won’t pay for it, I still think it’s worthwhile to try it for a month to get a good picture of what his day is like and am encouraged by some of what I’ve read on this post.
One if the things I struggle with is that my husband goes back and forth between being really upset with the situation and downplaying it…especially when he’s talking with the doctor. Her response has been (to me) quite casual. I guess compared to many of the patients I have seen in the waiting room, he’s not that bad. I, however, want him to take steps so it doesn’t get to that point. Thoughts?

This is a great idea, and give a better idea of what is going on. I recommend to start a detailed log while using Libre (CGM- continuous glucose monitor). Are you counting carbs for food? If not, try to do that during CGM usage, since carbs is primary food that raises BG. Log time, what he ate, before meal bg, and then 1,2,3 hour after meal bg. Log activity/exercise too.

I would also question doctor if adding insulin might be better than other drugs, especially if the Libre CGM shows high spikes after meals that don’t come down, or take long time.

1 Like

Converting him to insulin would give him much more flexibility in what he can eat and then that would qualify him under medicare Part A/B to get anywhere from 80% to 100% (depending on his plan) coverage for a Dexcom CGM, an alternative you may want to consider. The following will give you all of the guidelines to qualify:

https://provider.dexcom.com/support/medicare-coverage-and-prescribing-information

This would give him the option to learn what works best for him as he will quickly learn to Eat, Dose and Exercise based on his CGM numbers and trends. It is an awesome tool those of us that are serious about our diabetic control use.

1 Like

He maybe needs to get tested for being a type 1/LADA. 40% of us are misdiagnosed as a type 2 at first, I was. I went through the whole nine yards of metformin, then it not working as well, upping the dose, in my case getting sick then from the metformin. Trying other medications etc. Those made me sick too. A lot of it was probably I needed insulin.

I refused to go back to the endo, he just wanted to try the same drugs again. I had even asked if I could have been a type 1 because I had an uncle that had been a type 1 and was told no, but they never tested me. It wasn’t until I switched doctors who sent me to a new endo who tested me immediately that I was properly diagnosed.

It’s a frustrating experience, I had been a vegan for 20 years, ate extremely healthy, swam 75 laps 5 days a week in a gym pool and my numbers kept going up. I believe in my case because I wasn’t skinny, (but not “obese” either) that they just automatically tagged on the type 2 diagnosis.

A CGM who bring you huge benefits, because a meter is just a picture taken at an exact time. The CGM is a 24 hour video. But since he was not overweight and he had weight loss and his numbers kept going up I really suggest you ask for him to be tested just in case. 50% of type 1’s get it after the age of 30. I was 46. People are commonly in their 50’s, 60’s etc.

You want a C-peptide test, this tells how much insulin you are still making. Low or low normal is a sign of type 1, high or high normal is a sign of type 2. And then you want an antibody test. A positive would tell you if you are a type 1. Rarely but sometimes people don’t have the antibodies but don’t make insulin either.

I’m not saying he is, I’m just saying it’s something you should check into. A couple things don’t completely fit as a type 2. But type 1’s and type 2’s come in all different shapes and sizes so to speak so until he’s tested you can’t know for sure.

Yes, he’s been carb counting since July, but we had to add back some carbs because he lost a considerable amount of weight (that he did not need to lose) in a short amount of time. For months he was regular about keeping a log, and with medication everything seemed to be under control. Lately, without any changes to his diet, his numbers have increased and he has had periods of irritability, which are unusual for him and he attributes to his blood sugar spikes.
I hope that the GCM gives him/the doctor a better picture of what is going on. I’m concerned. Thanks for your input.

1 Like

As Marie says get him tested for type 1. I was diagnosed as T2 at age 67. Did not respond well to T2 treatment, lost 30 pounds. At age 69 went to a CDE and she immediately ordered the tests. I am T1. Correct diagnosis is important for Medicare benefits. And his sanity.

I would ask the doctor if she has a free sample. Locally you can get a free sample which contains the reader and 1 sensor (I believe). It is not shocking that the insurance companies won’t pay for it. The plans are pretty universal in only covering it if you are on insulin (and that is if you are lucky and they are being a stinker about covering for a type 2.) I think that the idea behind only covering when someone is on insulin, is on medications like metformin, you aren’t necessarily going to see a lot of fluctuation in the blood sugars (in theory). He may not need something long term but it would be great if he use one for at least two weeks. I think it would give a better sense of what his blood sugars do when eats or exercises. It also may show if his blood sugars are ever running higher than you realize.

I’m curious as to what one the doctor prescribed for him to take if blood sugars are over 200. My guess is a sulfonylurea (though it could possibly be an SGLT-2 inhibitor).

Hi…He had blood test in August which showed that that he possibly had an autoimmune disorder; he then saw a rheumatologist who retested him and told him that was a false positive and also that he was not LADA or T1. He seemed to have this under control until recently. I just don’t understand because his diet hasn’t changed. He is holding off on the FreStyle until he is able to discuss the situation with his new primary, who he sees tomorrow. Hopefully he’ll recommend another endocrinologist…I really didn’t feel comfortable with the old one. Today he picked up a prescription tested for Glipizide Er 2.5. If he tests high tomorrow morning, he’ll take a pill.

Thanks for the input, everyone. Like many others, the whole Coronavirus thing has me overwhelmed, and I can’t think straight.

You can request copies of his blood work, you might have to pay a nominal amount, but usually if you tell them it is for another doctor to see they won’t charge you. Some just don’t charge you anyways.

But you can also get copies of his chart by that endo. This usually gives you a wealth of information about how they did or didn’t decide to treat or test.

That’s one reason I love MyChart that so many doctors are using now. With my doctors on bloodwork it’s in my chart way before I ever see the doctor.

Some endos are real jerks and you are better off with a different one. The downside is you don’t know if the new one is nice or not. But I originally had a jerk, I refused to go back to him, but my second one was a gem. She was a type 1 and tested me immediately.

He has a legal right to have access to his records. We also use MyChart,love it. Ask what program they use. Nancy50

Thanks for the suggestions. We met with his new primary who seemed to be tuned in and knowledgeable. In his opinion my husband’s diabetes is not being managed. They did some bloodwork in the office. I’m confident that he’ll get some clarity and information will be more transparent going forward.

1 Like

Glipizide is a sulfonylurea @MOOBM guessed this one right. Sulfonylureas are an older class of drug that are not used as often as they once were., newer classes of drugs have mostly taken their place.

Sulfonylureas work by forcing the beta cells to produce more insulin and there are unproven claims that they can cause beta cell destruction. They can also in rare instances cause low blood sugar, while this is an unlikely occurrence it does happen, it happened to me. Happened only once or twice until my body became accustomed to it. Be careful and aware when starting this drug.

3 Likes

I suggest setting up the libre prescription and deciding whether or not to proceed at the pharmacy counter. The pharmacies have many coupons and they usually try to bill the insurance companies, however, if they give you a price you don’t feel comfortable paying, just tell them it does not sound right, and you’ll pick it up at a later time. You might not need the libre reader as there is an app, but I have not confirmed that the app will start the sensor… its only a 1 hour warm up so you’ll know if you need the reader 1 hour after insertion which is a very easy process…

Thanks, I will.

Type 2 diabetes is very often a progressive disease. Even if he is doing everything right, and the same as he was before, his blood sugars can rise with the same treatment. Good luck, and I hope the new medication helps.

1 Like

This more likely to happen in older population; with older generation of sulonylureas; or if you are on a sulfonylurea with insulin. (In general, this is usually not a good idea, particularly in older patients.)

The drug I was on at the time was glyburide which is a second generation sulfonylurea. I was pretty young at the time still in my 30’s.

How low I was is not really known, since I was not on insulin I was not testing frequently, I may not have been very low at all just falling rapidly. I have posted about my experience a couple of times, here is one of them.

Funny Diabetes Stories

My husband’s early morning test came in at 262, so he took his first dose of Glipizide. He had a normal day, but when he tested after dinner, it showed he was BG was 80. We were concerned about the big swing…especially since it was 14 hours at that point between when he took the Glipizide and did his evening test. He was concerned about going into a hypoglycemic state, so he did not take his Metformin, which is two pills in the evening. Yesterday morning his test showed 126. Normally that would be welcome news, but considering that he did not have his Metformin the night before, it was questionable. He called his new doctor but was only able to talk to the PA who focused on that morning’s readings even though he told her he was concerned about the swings. She said the doctor would call him, but he didn’t.

The Doc might be able to put him on a loaner. That will be the fastest thing if you have immediate concerns during this time, I would recommend it. That is a big swing. Be sure to check BG until you can get access to CGM - 4 x per day. Keep written records with the time of the BG check and what he ate.

Whats his A1c? You can have one done at walgreens if his doc neglected to do that.

Is he on an extended release glipizide or immediate release? One thing that can help if you are on a sulfonylureas is to not skip meals and don’t let too much time lapse between meals.

Stemwinder_Gary mentioned that sulfonylureas work by forcing beta cells to produce more insulin. They are not what is called “glucose dependent” or, in other words, only working when glucose levels are elevated.

The blood sugar of 262 and 80 is a wide swing and I could see where it would make you nervous. I would keep contacting the doctor and, if you haven’t already and one is available, consider consulting an endocrinologist.

A good endocrinologist may have better ideas or choices about what to do with your husband’s blood sugars.

Here’s the thing with continuous glucose sensors:

  1. Medicare plans typically only allow it if you are on multiple shots a day of
    insulin and are testing your blood sugars a minimum of four times a day.
    You may be able to get (without that) it if you have a MedAdvantage
    plan and their preferred glucose monitoring products are Freestyle.
  2. Many commercial plans are starting to limit CGMS to type 1 only (don’t
    even get me going on their reasoning…dumb, dumb, dumb). There may
    be some carve out here and there but I know Aetna and “Blue Card”
    plans for sure have a policy about it and UHC and Cigna may have joined
    them. Depending on the type of plan, it may also depend a little about
    the rules of your state about diabetic coverage.
  3. Some providers have “professional” CGMS that you wear for a week or
    two and then they can download the data. Those CGMS do not give
    you (the patient) real time info though. It is more for providers to be
    able to see if there are problem areas that are not caught with
    fingersticks and/or A1c. Typically though, insurances again, won’t cover
    this unless the person is on insulin. (Though I believe you can have a
    professional CGMS done with Medicare even if you are only on one
    insulin shot a day). Most insurances won’t pay for the professional
    though unless the person is on at least one shot of insulin a day. (Again,
    this may vary from area to area depending on plans, carve outs, and
    state laws).
  4. Providers may have samples of the “patient” version. If you could get a
    sample then you could get at least a two week reading of what is going
    on without paying out of pocket for it.