My dad is a Type 2 diabetic on I believe Treshiba and only does finger sticks twice per day.
I’ve been showing him my Dexcom and he likes the idea but is not sure what the criteria is to be covered as a Type 2 diabetic. He’s on a Medicare Advantage plan but not sure which one. Anyone have a link for the Medicare rules of coverage?
Here is a link to the Dexcom criteria site. Recently the requirement for BG test 4 times a day was removed but the Dexcom site doesn’t reflect that yet. The issues that your Dad will have is that one injection per day of a long-acting insulin is not sufficient because the requirement is for MDI (3 or more injections per day) and adjustments to the insulin regimen based on CGM results.
Ok so if they switch him to short acting/mealtime insulin, then he should qualify?
I’m just concerned for him because with only 1 or 2 shots of long acting he’s not very consistent. At night his MD said he needs to be <=200 before bedtime and I thought he said <=180 before breakfast but sometimes he’s in the 240-260 range.
I know a CGM would help give him trends which he so desperately needs.
I myself think it is time for mealtime insulin but his MD is not quite ready for that yet he said. I’m no MD but he worries me. He’s 80 years young and has a bunch of other health problems, so I think his T2 Diabetes gets the short end of the stick.
Brad, I am 71 and type 2 DM for 30 years. Historically I have had really good BG control, but over the years It has progressed. 10-12 years diet and exercise was enough, then I had to add Metformin, later Lantus and most recently Humalog and a Dexcom G6.
I really think Medicare and insurance companies need to make CGMs available to all diabetics. Seeing BG trends with data every 5 minutes is an amazing tool.
When I first started MDI I was able to adjust timing and dosing of metformin and Lantus to flatten the curve. I had a problem with a rise of BG 2 hours after lunch. I had been spliting the Lantus dose for years 2/3 at night and 1/3 12 hours later. What I found worked for me was 3 doses 30 to 60 minutes before eating. This smoothed out the 2 hours spike and allowed me to reduce Lantus total by 5 units.
I’m not suggesting this for anyone, just an example of how seeing the patterns can be helpful.
There was trouble getting the CGM, even though it was covered by Aetna Medicare Advantage. Basically it was a SNAFU with the distributor and Dexcom. They tried faxing my doc, but repeatedly faxed my cell phone. This happened 3 times, recognizing the fax handshake, I called. It was fixed, not, finally they got it right.
Stay on top of it. My Dad, may he rest in peace, and my wife would both had thrown up their hands in disgust, giving up.
@BradP I am working on getting a Libre CGM though MS Medicade. I called a company and had them submit info to my medicade company and they said that they would pay it 100% BUUUUUT I had to be on Insulin and be checking my BG at least 4 time a day.
I am not on insulin but the company said if my GP doctor writes a letter explaining to medicade why I need a CGM the guy told me on the phone yesterday that he’s seen people who are not on insulin but check their BG 4 or more times a day, they actually won their case with just the doctors letter and medicade actually paid for it.
I hope he was talking about MEDICADE and not MEDICARE. But if they won their case without being on Insulin… I am sure I’ll win mine too I hope!