Amen!
Well I’ve got an appointment next week, so hopefully we can pound out a solution then.
It’s pretty inspiring to see that other people can get through their rough spots too! 
I also think that it can also be the stage of life you’re in that can influence how “easy” it is to control your Type 1. I’m well into menopause now and there is no doubt that things are more stable now that I don’t have the monthly hormonal swings that younger women do.
My endo indicates that she has a horrible time trying to motivate many/most of her patients to test their BG at all. Although I’m not perfect with my diet, I try to be better every day and that puts me ahead of most of her patients. So I’m sure that I’m categorized as controlled. However, my internist always categorizes me as “brittle”. And I think I am, if you define brittle as any small change in insulin or carbs having huge effect.
For 35 years, I’ve tried to do better every day. But as you all know, it’s really, really hard.
As far as insurance is concerned, any patient with an A1C over 7% is uncontrolled… whether or not your daily management really reflects being out of control is irrelevant, it’s all about that magic #.
I’ve had mine get up above 7% when I’ve had long strings of recurring illness, or I’m dealing with lots of allergies… right now I feel like I’m on the verge, as my last A1C was 6.9, but I am hoping it will be lower next time.
Endos, my guess, would set a certain A1C that you have to retain for a certain amount of time to be controlled. My last endo told me that the treatment was all up to me and he would provide me the tools to create a plan. I figured what do I need him for a family practitioner can provide me with the same tools and charge a lot less.
When I go I usually bring a complete print out of all my sugar readings and the doses I used to bring them back into check. It is sometimes helpful for them to see how you are dealing with the issues. The Endo I go to now will look them over and may say like he did a few weeks ago “Your BS is 130 before bed, so don’t take any corrections and see what it is in the morning”. When they see info like that they can see if your basel is too much causing you to drift high or low over that time. I also found when I was on the pump I had to use a different basel setting for night time then I did through out the day. Also I had to change the basel for when I am with hostil clients all week. The stress was causing my sugar to jump. These are the things those printouts are good for. Try and comment on them what you were doing around that time of day as that can help strighten things out. Good luck with the endo and don’t let them stress you out. Think happy htoughts when there:)
I spent a little time googling “250.03” on the medical-coding discussion boards.
Some of the insurance coders argue about whether “uncontrolled” is the same as “poorly controlled”. If uncontrolled for a T1 is the same as “taking no insulin” then, they argue, anyone at least taking insulin would be “poorly controlled” and not “uncontrolled”.
And some of the coders say that coders don’t interpret lab results.
At the other extreme at least some of the insurance coders, say that if A1C is even slightly elevated above lab normal range, that they code it as “uncontrolled”.
That would mean that (depending on lab reference range) a number in the low 5’s could be coded as “uncontrolled” by them.
Lab reference range for A1C varies a lot. I’ve been at labs where 5.9 was “normal” and at labs where 5.0 was the top end of “normal”.
Right now according to my most recent labwork which has these handy-dandy computer generated suggestions, my A1C puts me at a “increased risk for diabetes”. I actually laughed when I saw that!
Yup, ankle was fine and I was back running in a week but, it probably could have gone either way? I hope you can get back to cheating! Part of it is that my BG seems to like having that push but the endorphins are also very useful to have.
The codes come from doctors, not insurers. The doctor submits a diagnosis code and a procedure code with their bill. I don’t deal w/ endocrinology stuff at all however it may be that a doctor might code a pump installation in which they participate (mine did w/ the pump, I was a new patient for her and she also wanted to check out the MM person. Hazards of a new doc I guess?) as a costlier “level 5 visit” but a “Drive by” “do you need any rx’s, thanks for the logs…” visit as a level 3 but the dx is part of what the doctor submits. I believe that it would be very irregular, if not impossible for an insurer to change a code that is submitted on a bill, a lot of which is done electronically.
I’m not sure if they are all that organized? I “passed” as “controlled” with my new endo. The last one might have been dicier as I was less controlled and in the mid-7s but I didn’t scout out the code and its water under the bridge now.
I seem to feel better when I am in (according to the Endo) uncontrolled…hovering around 180-200…The more I try to get it below where the doctors want it…the worse I feel…I am not sure there is a right number for every single person…they have to be more intuned with the signle patient and not lump everyone into a box…
I really wouldn’t use how a doctor codes you in your medical records as a barometer of your success. It really has to do more with an ICD-9 coding issue, and sometimes doctors fudge the codes a bit to justify certain treatment or make getting certain treatments easier. Sadly, this has become a game that docs play with the insurance industry.
I personally do not see the A1C as a good indicator of how controlled diabetes is, especially T1. With T1, we can experience wide fluctuations in blood sugar levels that can mask our A1C results. I personally look at my daily logs as a way to measure how good I’m doing.
I am having this EXACT same problem. Just started using the pump and I often feel “low” when I’m down around 100. When my BG is around 150-70, I feel fantastic. Ugh.
Controlled diabetes to me is making a conscience effort and trying different things And learning from them. Uncontrolled to me is ignoring diabetes and its complications. I.e. Giving up
What is controlled versus uncontrolled? Well, I’d tend to think it has as much to do with how the patient deals with their diabetes as much as their blood glucose levels. If you frequently go over 250 mg/dL, but know to correct it, you could be controlled. If you can detect lows, and take appropriate action, you’re controlled. If you’re fortunate enough to have an A1C of 5.5, but you only test 3x a day, and have frequent lows (possibly even hospital visits), then you’re uncontrolled.
It could be a motivational thing from your doctor as well. If they tell you that you’re “uncontrolled”, that’s the impetus to try a little harder. If you’re “controlled”, you leave the office feeling you can relax a bit.
Where it counts is when applying for Life Insurance (which I did recently). You’ll pay a lot more if uncontrolled. (You’ll pay a lot more than a non-diabetic to begin with, but that’s beyond the point!)
Doctors are responsible for assigning a diagnosis. The diagnostic codes for diabetes are an utter mess, they bear no relation to an actual diagnosis and are more a reflection of treatment effectiveness or symptoms displayed. Sure there are rough categories for T1 and T2, but they are not defined. Think about it, we argue here all the time about a “diagnosis.” We are an autoimmune T1, or we are LADA , MODY or T2, or ketosis-prone T2. But we also have other separate conditions with their own diagnosis, neuropathy, gastroparesis, etc. Instead, the stupid ICCD codes say we are all lumped into a “heterogenous” disorder of carb intolerance, only T1 or T2, sometimes with complications, sometimes with DKA and sometimes "uncontrolled."
In the end, the medical system has found this coding less and less useful and although it’s primary purpose is for insurance reimbursement, in the case of diabetes, the insurance companies depend less and less on this useless designation system. Usually, “uncontrolled” is interpreted as not meeting blood sugar control targets, which are whatever targets your doctor defines. And often, when we first see doctors, we are truly “uncontrolled.” But doctors think these codes are stupid, so they don’t bother switching back and forth every time they see you. I mean that is stupid, that would imply they can’t figure out your diagnosis.
In practice, being stuck with an “uncontrolled” diabetes diagnosis is not a good thing. It is unlikely to cause a negative coverage decision with your current insurance provider, but it reflects poorly on you. Try to get new insurance, health or life and expect that the diagnosis of “uncontrolled diabetic” will impact you negatively. Go for a job, flying an airplane, driving a truck. Will that diagnosis help? I don’t think so. When your doctor gives you a little form and it says diagnosis 250.03, and you feel you are controlled, then question your doctor. If your doctor can prove you are uncontrolled, fine. But being a stable insulin dependent T1 with an A1c of 7.5% is not “uncontrolled.”
Feeling badly when you are below 180, wj, might be because your body is used to being much higher, so it feels low when it gets down a bit. The more time you spend in normal ranges, the more used to it your body will be and you won’t feel low until you actually are low. I don’t think staying hovering between 180-200 is an answer, because you are accumulating damage at that level.
Yes, I was approved both by Prudential and New York Life. At first NY Life came back with what seemed to be a better rate (but the NY Life agent kept pushing different types: whole life versus term, $1-million or more policy versus the lower amount I was looking for, investment accounts … ridiculous… as if she was a car salesperson working for a commission), but when I brought that to Prudential, that agent was able to go back to the underwriters and beat it. (I should say that I was quoted $1M from NY life, and told that it scales proportionally, so $500k would be half that amount, etc.). I ended up with a 20-year term from Prudential.
One thing I’ll tell you about my observation of the two. With New York Life, they take your information in a big corporate office, let it go “through the nameless, faceless system” and see what comes back. With Prudential, I met with my agent in a small local office, and he was able to go back and forth with the underwriters a couple of times; finding out which parts of my medical history counted against me, so I could get additional clarification from doctors who could say, basically “It’s not as bad as you think” and hopefully erase that blemish. Give them a try.
But yes, it’s a real pain in the butt. An insurance broker kept quoting me numbers that I knew were too low to be realistic, even though I kept asking “are you SURE you put Type 1?” and he insisted they were. Eventually, he 'fessed up and said that “someone else” made the mistake. Unless you’re young and in good health (not diabetic), I’d avoid brokers entirely.
Good luck. Now back to your regularly scheduled discussion…
I had never noticed the ICD codings before and just so happened I had a lab slip from my doctor yesterday so I took a look and he has 250.02! So what is that, halfway between controlled and uncontrolled???