My Medicare Nightmare

I go on medicare next July. Despite the fact that I will have been pumping for more than 8 years, as things now stand I won't be able to pump on medicare. If you are type 2, then you must have a c-peptide no more than 110% of the minimum that the lab you use considers normal.

For me, that number is 0.88 There has to be a matching glucose measurement of 225 mg/dL or less taken the same day.

My c-peptide came back 2.7. A retest a week later came back 2.0

On 4/20/09 the result was 0.5
On 1/21/10 the result was 0.2

I am asking my doctors office to see if glucose reading were taken for the 09 and 10 test dates

Type 1 do not have to meet this requirement

The insulin I require via pump has gone up, I just increased all my basal rates by 10% I am on about 80 to 85 U TDD, and the max metformin dosage.


Lloyd hate to tell u this but us t1's have to take a c=pepside test for a pump also ask me even though I don't produce any insulin at all I've had to take them MANYtimes.

It's in the current medicare rules that an alternative is "must be beta cell autoantibody positive"

I've had gad 65 test and no autoantibodies were found. Remember, I am not talking about commercial insurance rules, this is medicare.

I just had to do a c-pep test this week...I've been T1 for 31 years. All so my insurance company would keep me under the same treatment.

But enough about me. I certainly hope you are not trying to start a heated discussion about the care/coverage between the two types. Bad idea.


This is medicare, not commercial insurance.

not talking about commercial insurance. And neither is Doris

I've been pumping for 8 years on commercial insurance, the coverage is fair.

Lloyd i'm on medicare so i know all the things ur fussing about

All I am fussing about is that despite dawn phenomenon, I won't be able to continue pumping.

For medicare, you only need 1 qualifying c-peptide with glusose 225 or lower done the same day in your medical records.

oh ur sooo wrong

I would love to be wrong on this, can you point me to a file that says otherwise? That would mean there are newer rules than the ones Josh pointed me to.

There is a clear bias in the coverage for T2 diabetes. I believe if you can dig up the glucose reading from your c-peptides in '09 and '10 then you could use those as qualifying. I think you only need one test. I have one. But even if you pass that hurdle I think they make you justify it based on meeting criteria that demonstrates out of control diabetes in some form. That seems like a sad thing to have to demonstrate.

MDI may be different than the therapy you are used to. But at the end of the day, you'll be fine with it. It will take some hard work for sure. But, it IS possible.

I have the two c-peptide reports, but not the same day matching glucose reports. I have asked my doctor to look into my files and find the glucose tests, or let me.
If you are already on a pump you can use Criterion B, but you still have to either have autoantibodies or c-peptide below 110% of the minimum that your lab considers normal.

It is very difficult to treat dawn phenomenon on MDI. I have 9 basal rates on my pump. I have insomnia and take Ambien. I'd likely have to use NPH as my third insulin.

Several people do that already. David is an expert at it. And....I hate to break this to you but.....DP isn't unique to you. Many of us have it and deal with it.

I need 4 x as much basal in the middle of the night as in the afternoon. My high basal rates last 14 hours, I treat them in steps approximating a curve.

I don't think that Lloyd is trying to start a "heated discussion about the care/coverage between two types." I think he is distressed about no longer being able to use the pump once he goes on medicare.