Considering CBG monitor to control blood sugar at night, need advice

Diabetes Technology Glucose Monitoring
1

I am a pump user for over 10 years, but I suffer from extremely low blood sugars at night, which force me to test during the night up to 4 or 5 times. This means I am sleep deprived, and being sleep deprived means I am more likely to miss a low blood sugar. Lately I have had some severely low blood sugars, where my wife was only barely able to bring me out of them. As a result, I am considering getting a continuous blood glucose monitor and would like some advice. I am testing my blood sugars on an average of 10-15 times daily, so my diabetes is very brittle.

My pump is by Minimed, but is too old for their CBG monitors, but they tell me they can refresh it and my insurance will pay. However, my insurance will not pay for the CBG monitor or supplies.

Thanks for your help,

Danny

2

I used a Guardian by Medtronic for awile until I got my transplant. They are great. I too got quite low alot at night. I set the alarm to go off if my BS went below 100. And the alarm was plenty loud enough to wake me up. I’d just get up and drink juice when it alarmed. I know they are expensive, as are the sensors, but it may have saved my life on more than one occasion. Take care. Colleen

3

I have been on the Minimed CGMS system (722) for about four months now. I highly reccomend it. I have reduced my A1C by .5 and have also prevented multiple lows. What you may want to push for your insurance provider is the fact that you have suffered from multiple lows that have almost been hospitalized for (I am assuming this if your wife was barely able to bring you out of them). If you can get your specialist to write a justification it can go a long way towards getting you covered. You just need to find a doctor that will be willing to go the distance for you.

Good luck

4

Thanks to everyone for your input. I must admit, the price of these things is what is holding me back. As for getting insurance companies to pay for it, maybe that’s a good idea, but I am not sure. After all, we keep seeing insurance costs skyrocketing, and this would certainly contribute to that problem. Maybe the real question here is whether or not there might be a cheaper fix to the problem, if not for everyone, then at least for me. I am still agonizing over this question and working on different possibilities. Good luck to everyone else in dealing with all of this.

Danny

5

Oh, yes they WILL pay for it. You just have to go through the dance: First, your MD submits a PAR (Prior Authorization Request), then they deny it with some fake garbage about “still experimental”, or “not medically necessary”. Then comes the real letter, we show them EXACTLY HOW you and your lawyer will get them hung “by the short hairs” in Civil Court, if/when you are “forced” by their arbsurd denial to file a lawsuit to make them cover this MEDICALLY NECESSARY and EFFECTIVE treatment. (And yes, you will mention punitive damages here.)

Nighttime hypos are the absolutely strongest claim of need for CGMS treatment, exactly as you have described: You crash a lot, and the permanent sleep disruption created by the necessary testing regimen is itself a serious medical problem, putting “both myself and others at serious risks of hypo-induced accidents”. It also makes a significant quality-of-life issue, dragging through every single day after badly disrupted sleep every single night. Your wife, too. And these problems can be largely AVOIDED by this treatment.

You will not need to file a lawsuit, they will cave in when they see all this stuff you threaten to use, in conjuction with the personal threat I’mn about to describe.

You will, however, probably have to go through two levels of appeals-- the first denial comes from an administrative flunkey, it’s just part of the game and doesn’t really count for anything. (A level-1 appeal, with most companies, is merely “did you reject this because I typed something wrong, or did you really mean it?”). The one which really counts is the second one. This is where they promise to provide a medically-qualified opinion, and you will win by warning them (in advance) that you will probably go to the licensing board of the MD who dares to claim that this treatment “is not medically necessary”, or is somehow “experimental”, for your particular case.

The PAR from your MD basically pleads for coverage. The phrase which pays, in the last letter, is “practicing beyond the scope of his competence”, and they will be TERRIFIED by the threat of a Board Inquiry into this issue. When an MD is investigated by a medical board, they have to talk about the whole incident every time they get a license renewal-- even if they have moved to another State, and even if it was 30 years ago. THAT’S why they’ll cave; no MD will put his signature on another denial.

SO, the only remaining question is: Are you in an extremely small group plan, or other situation which would make it unattractive to FORCE insurance coverage in this way?

6

I had a Minimed 518 and I upgraded to a Paradigm 522. If you call Minimed 1-800-Minimed and ask to speak with an insurance representative there , they can help set you up for the introductory kit and an upgrade . The 522 was $650 approx, $400 was refunded to me when Minimed ran a special recently that was dependent on the return of the original unit following Minimed instructives that you can obtain from a Company Rep. Each area of the United States has a representative who can contact you with information and can refer you to the company for assistance. Find an Endocrinologist , a diabetes specialist,who will let your insurance company know in writing that you have episodes of severe and frequent hypoglycemia. Hypoglycemia unawareness could cause the loss of a diabetic life and have other negative effects. A good endocrinologist should be an advocate for you and hopefully can try to appeal the insurance non support of supply decision. Type 1 people need to work hard on educating awareness, esp.w/insurance Companies. Any decision should be able to be appealed ; many of us are dealing with the education of the new CGM and the ins.co. The ADA has an advocacy spot that you may want to review at American diabetes association.com. I am working on the same concerns for myself ,presently and others. The CBG could save your life…I have had my CGM for 6 weeks and already LOWS are less,the AIC is improved and so has my life. I have been diabetic for 50 yrs.

7

Dear Danny: Do you have delayed digestion without the symptoms of gastroparesis? The reason I ask is I am finding that despite testing and following the pump’s recommendations for dosage and initially getting a good match up with carbs and insulin, sometimes hours later there is a drop. Its my belief that my food digests extremely slowly sometimes. Then a high BG happens later when the carbs finally kick in and the bolus is long gone. jansfronk@aol.com

8

Hi, I’ve been on the CGMS for a couple of months now. One concern I have is that it doesn’t seem to detect extreme highs and lows very well. It can give you trends, but by the time it registers a low, in reality that might have been 20-30 min. ago so it might be too late to wake you up. Perhaps you can just set the alarm to wake you up if it hits 90, then even if it’s 70 in reality, you’ll wake up in enough time to deal with it. But that might result in more “nuisance” alarms than you’d like. Talk with your endo about this and see what his advice would be.

If you determine that you do want the CGMS, I encourage you to work with your doc to have him write a letter to your insurance company explaining why you should have coverage. With severe hypoglycemia cases like yours, many insurance companies will cover it on a case-by-case basis if you appeal it with a detailed letter from the endo. Also, just a few weeks ago Minimed released more data to the insurance companies proving the value of its trend analysis capabilities, and many insurance companies have recently gotten on board, mine included (CIGNA). So if you were denied in the past, you might want to call first to see if they’ve adjusted their policy.