I ordered the book and will send the PM.
For seem reason the logjam at my VA hospital in Durham doesn't seem to exist. My Doctor ordered a pump for me on October 11 and I got it around Halloween. She went the extra mile and then prescribed test strips that go with the wireless glucose monitor that communicates wirelessly with the Minimed pump. Years ago when I used the VA hospital in CT they laughed when I asked for those same strips. To top it off, I am going to pump training on Monday to learn the ins and outs of my new pump. Add to that a request for CGMS is cooking through the VHA system and I am one very happy customer, indeed!
I did get a letter from my congressman (Tim Griffin) and he got it done. My letter is signed by the med center director for me to call and get started on my training. I got in touch with Kim Bittle (Medtronic) who will be my instructor. It has taken some time but, the benefit is that other veterans with Type 1 will benefit from my work (through God of course). The next few weeks will be filled with anxious moments. I will post more later. Thanks to all of you for taking interest and posting.
Congratulations Marty - well done.
The VA gave me my first pump in 2005 and my first CGMS in 2009.
I've been type 1 for at least 30 years and so far I'm still able to do the battle every day with it.
I haven't felt my feet in at least 15 years, yet they still carry me along.
Numerous studies show significant periodontal disease for diabetics(2-3x as compared to non diabetic), yet my VA will not even allow an office visit UNLESS the A1C is over 9.
I am slowly finding my teeth getting looser and looser, but the VA won't allow me a visit.
Frustrating for sure, especially since 1 of my front teeth is about ready to fall out.
It would seem that this policy suggests a patient to get their A1C over 9 just to get any dental care. My VA in Chicago has 7 at their A1C requirement for dental, but not here.
I'm not sure what to do next....
Wishing you all success...
Ron in Kansas City
It might be worth trying to file a claim for any complications that have arisen as a result of service connected diabetes. About 4 years ago I was @ 30% and decided that various complications that I was experiencing should be rated. I gathered every record from every provider I could find, got a copy of the VA Schedule for Rating Disabilities & compared it with various diagnoses and treatments. It took nearly two years from start to finish but I got bumped to 100% (permanent & total). I learned that VA treatment & care records count the most with the rater while private care (regardless of how good) means little. One of the things that motivated me to file the claim is that it would give me the opportunity to get dental care if my rating were raised high enough or a connection could be drawn between diabetes & dental issues. Fortunately it worked out that way. Another thing I learned is that when connecting a complication to diabetes, VA research & publications carry much more weight than other professional medical publications or studies.
Good for you! I know that you have been through an ordeal, but I hope that a pump will provide you the relief you need. My class is tomorrow morning and with luck I'll be driving home wired for sound.
Well, I hope you are wired for sound. How did it go? Did you get the CGMS? Anything I should be ready for? I am so dang happy for you man! I am told you feel like a new person within days?
My CGMS is still working its way through the bureaucracy. The pump is simply fantastic. I've got a private provider doing the pump training (outside the VA) who not only is extremely proficient, but she is also a Type I. She is the 2nd CDE I've worked with who is a Type 1 and they are so much better at mentoring because they know first hand what a challenge diabetes can be. Compared with my pre-pump weekly BG range of 45-450 the 63-180 BG readings I had yesterday are like a whole new world. It can be a slog getting onto pump therapy with all the bureaucratic challenges, but in the long run it is certainly worth the effort.
I used a letter like yours over a year ago and I still havent received a pump. Would you send me the email or name of the reporter (that no government agency wants to be written about by him). I am fed up. Now they are saying that I may get a pump but no cgms or strips for the meter that talks to the pump. Thank's Man!
I just got the minimed 530g with cgm “enlite sensor” I had onmipod and dexcom g4 cgm before but lost the battle for va to cover it since the military gave that to me before I got out it wasn’t hard at all to get the medtronic pump and cgm pretty simple actually the va won’t give you anything that you want you must have your doc request and request don’t give up bc they want you to that’s the game they like to play. As far as getting constant supplies (infusion sets sensors reservoirs) etc that took a few weeks since I have a resident and not a Endo at my va so he didn’t know what to get smh
"But wait, there's more."
As I talked about going from the Revel to the 530g with my Endo, she noted that the VA is no longer putting patients on the Minimed systems - it seems the contract has expired. Sets, reservoirs, sensors are no problem, but forget about going over the $3,000 threshold. Now, if you are getting a pump from the VA, be prepared to switch from the Minimed to the Animas. And you will like it.
Caveat: your VISN might (or might not) have a different arrangement. Ask the VA or Minimed, but don't count on getting an answer.
My husband is receiving the Decxom G-4 from the Sioux Falls, SD VA. Just got approved. Request was sent to VA in MN with letter from VA doctor and a letter from his Endo stating medically necessary with hypoglycemic unawareness.
Hi community,
I'm new here, but found this forum while trying to Google anything related to glucose monitoring and the VA. You are pretty much the only helpful thing I’ve found! So if you’ll permit me to revive an old thread, here’s my situation:
My husband is T1, diagnosed six years ago at age 30 with no family history. He has a disability rating through the VA, and the VA covers his diabetes treatment with basic syringe/glucometer supplies (Novolog, Lantus, AccuChek). He is very active (weight lifting, mountain biking, trail running) but works long hours as a veterans service provider and maintains an inconsistent schedule. He is deeply connected within the VA and veteran service provider community in our town/region.
When he was first diagnosed he developed extremely tight control very quickly -- A1C went from 16 to 6 in only a few months -- but I think the last few years have seen him and, by extension, me, treating it more casually. After an uptick in incidents this week I started searching online to see if what is happening is normal, and learned that indeed it's called hypoglycemia unawareness. He has serious hypoglycemia unawareness, and has what I'm coming to understand are EXTREMELY frequent, dangerously hypoglycemic incidents. He has had readings in the teens multiple times this week (though strangely enough, he can still get up and walk around at that BG level). I knew the dangers of extreme hypoglycemia, but didn’t realize that his frequency of BG drops is nowhere near normal, because it’s just become a fact of life for us. He’s only ever been unconscious & hypo once (and I called EMS), but in general I've gotten fairly good at bringing him back around when he is extremely hypo. A lot of these lows happen at night, and many times some spidey sense will wake me up to treat him. Without a glucagon kit (which I didn’t even know existed until researching online yesterday) we’ve come up with a slow-return process so he doesn’t shoot over 300mg/dL overnight.
But here's the thing, guys — and can I tell you all this even though I’m new here? — I am *terrified.* I’m terrified that he’ll drop when he’s driving (which in truth has already happened) and eventually will seriously injure himself or someone else. I’m terrified that he’ll drop in his sleep, and I won’t wake up, and he’ll die right next to me. I’m terrified that he’ll drop when I’m away from home, and I’ll come through the front door to find him dead on the floor. I’m terrified that he’ll drop in public, and nobody will know what he needs (because he won’t wear a d*mn medical ID). I'm sure these fears aren't foreign to many of you. At the same time, he is a veteran who is somewhat private about his health care, and isn’t necessarily going to be receptive to me barging into his arrangements with his doctor(s). I, and other family members, have asked him about pumps repeatedly, but his response is basically that the VA says no. Full stop. Can’t do it.
So this is my background research, I guess, or my search for the kind of information that he hasn’t gotten (or hasn’t shared) from the VA. Given his lifestyle and the current risks, what I think I'd want for him is a CGMS as soon as humanly possible (tomorrow would be nice?). We have thought about training an alert dog, but he’s disinclined to have a service dog present in his line of work — and I want some monitoring system on him NOW, not later when the dog would be ready. We are in South Carolina, and as I said, he is about as thoroughly connected in the VA community as a person can be. His primary doctor is local; the nearest endo is a few hours away at the Columbia VA. But I haven’t yet met his doctor, and find myself kind of locked out of this whole process (except of course for the part where I’m the one shoving cookies into his face at 3am). So… here are some of my more concrete questions:
- Must he use a pump in order to have a CGMS? Why?
- I’d always understood that pumps require a very consistent daily schedule. With CGMS options, is this still the case?
- Does anyone know if VA facilities in South Carolina will provide a pump or CGMS?
- I’ve heard there are certain metrics the patient must meet in order to be recommended for a pump or CGMS within the VA system; does anyone know if this is true, and if so, what these numbers or requirements are?
- Who (what department or job title) could I try to get in touch with at the VA for more information, or to understand our options?
- What are the current systems out there, and what systems would the VA actually provide or support?
- What are the drawbacks to the pump/CGMS approach, versus syringes & finger sticks? What are the benefits? I.e. what's the daily reality of living with a pump and/or CGMS?
- We may be getting into a little relationship therapy here, but — Type 1s with partners or spouses: how did you and your partner work through managing such a personal disease as a family situation? If you were resistant to changing your management strategy, how could (or did) your spouse/partner change your mind?
This note is terribly long, but this is the first opportunity I’ve found to explain to anyone who’ll understand, and certainly the first place I’ve found that might offer helpful suggestions. Thank you for reading, for providing this website, for your own service to your country (and now to this online community), and for any advice or guidance you can provide. Any — truly ANY — commentary y’all have is more than welcome.
With gratitude!
My husband receives CGM from VA. He doesn't use a pump and never has. He has his non VA Endocrinologist write a letter stating medical necessity and hypoglycemic unawareness. He doesn't feel the lows coming on. The VA doctor submitted the non Endo's letter and a VA form to the VISN for our VA system (Minneapolis, MN) The Dexcom was approved within the week and sent to us the next week (free). I know the VA in PA, and NE also provide Dexcom. The Diabetic and Prosthetic Departments seem to know the requirements and procedures in the VA for CGM approval.
The VA also provides Glucagon pens and glucose gels to work with lows, much better than trying to force cookies.
The VA provided me with a Medtronic insulin pump in 2005 and I have used it 24/7 for 10 years now and will continue to always use it.
The VA also provided me with a Medtronic CGMS in 2009 and I have used it 24/7 for 6 years now.
I have been type 1 for 34 years and also have hypo unawareness. I have lost all ability to know when I am low or going low, so the CGMS has saved me many times.
I started with the VA in Chicago where I got my first insulin pump. I am now in Kansas City and continue to get insulin pumps every 5 years and this is where I got my CGMS in 2009. I find it difficult to hear that any VA hospital does not provide pumps/CGMS to their diabetic patients.
I would write my state representatives and make them aware that many VA hospitals provide these and you want your VA to provide them as well. I see no reason why your VA does not.
I wish you all good health and success in controlling your diabetes.
Dear Spouse-of,
Me: T1D for 37 years come May. Active duty when DX’D so the VA classes it as service-connected. I get my care at the VAMC in San Francisco (first rate, btw). I’ve been using a Dexcom CGM since 2009, and the VA has footed the entire bill. I am not conversant with the inner machinations of VA red tape, but I am a clear example that VA T1 patients ARE eligible for CGMs.
Coupla quick answers for you:
CGMS and pumps are independent from one another (although, one of the major pushes in research these days is to link them together). I use a CGM and I do not use a pump. Works great!
You are in an especially difficult position. My ex-GF was as worry-prone as you are, and it added to the strain in our relationship. I am NOT saying you are wrong (quite the contrary, actually), just that you’re starting from a severe disadvantage that I GET. Your hub is also in a position that I totally get, and if you and he think it might help, I would be very happy to speak with him – tell him there’s and vet who’s been there done that . I think there’s a private message service here, so if this is a go, and me a note there and I’ll give you my phone number.
Hang in there!!! Your hub knows at some level that you love and care for him, but this disease is especially hard to share with anyone who hasn’t walked the same path, even Type 3’s (S.O.'S of T1’S – that’s you!).
Thank you guys for the replies! I broached the subject of a CGMS with him this evening and he was wondering what it feels like to wear one; what’s actually in your skin?
Incidentally I’m writing this at 3am after not one but two hypo incidents tonight. @JamesDG, THANK YOU so much for your offer; I will pass it along to him and see what he says. He works so hard to take care of other vets – it’s a blessing to have another vet reach out to take care of him!
Appreciate you guys --SOT1
The needle that puts the sensor wire in hurts about the same as a regular insulin shot. After the skin is pierced the pain disappears in a minute or two.
Occasionally I have an itchy feeling from time to time, however normally if you concentrate and “try” to feel it there is no sensation at all. I’m currently using the older ‘Soft-Sensor’ which has a larger and longer wire under the skin. The consensus on the current ‘Enlite’ sensor is that insertion is generally easier, less painful and it is likewise mostly unnoticeable in use.
I also have the same challenges as your husband and in my opinion using the CGM adds safety and tighter control. He’ll be amazed to see how his BG rises and falls when he can see it changing over time, not to mention seeing lows before they happen. My bride is also in your boat (dealing with a hard headed Type 1) and is much more at peace knowing this device helps to avoid unnecessary calamities.
I’ve generally had great support from the VA and I wouldn’t go back to just shots and no CGM for love or money.
Let us know how it works out.
My brother and I are both Vietnam Vets and we are both insulin dependent...whats up with that?
I'm using BCBS...and have a pump and CGM...my brother is using the VA Fort Worth clinic and they will not even pass out insulin pins unless you have lost the use of one upper limb.