My story


#1

I was diagnosed with T1D at 19; 34 years ago.
From what I’ve been reading, my story really isn’t different from others - started out using humulin R and when I could afford it, I’d add some N to the mix. No insurance back then but it was only 20 bucks for a vial and syringes got reused until it hurt too much! Eventually switched to Humalog 70/30.
Got a new lease on life when I got a good job with insurance and found out about Humalog and Lantus!
Job changed and I’m working for one of the biggest insurance companies in my area and they take Lantus off the formulary, saying that the only long lasting insulin they’ll “cover” would be 70/30 mix! The same stuff I had used 20+ years before!
Stopped that job as I couldn’t afford -my life or bank account - to use old technology. My A1c jumped from 5.3 to 7.9!!!
My current employer recognizes the importance of insulin in a person with diabetes life and covers it 100%!!

So hear I am, working in healthcare and reading on this “new” technology - Pumps, cgms, cgms that talk to pumps?!! Crazy… So I decide to jump from MDI to a pump. My research led me to Dexcom G6 and Tandem X:2 Slim. Here is where I goofed. I started the process for the Dexcom first. My CDE thought it would work ok this way as I wasn’t really counting carbs at the time. Nope, denied as not medically necessary as my A1c was 5.7. I started the process to get approved for the Tandem at this time thinking it still was no problem, I’d just do an appeal and get both about the same time. I appealed, denied! Again as not medically necessary. By now, I’m using the Tandem pump which I realllllly like!
I paid out of pocket for a Freestyle Libre and used it for about a month and with the data from the Libre showing lows and spikes, my own research showing that a CGM is the “gold standard”, letters from my CDE and Primary provider, i filed a 2nd level appeal. This is when your insurance outsources the decision. It only took 2 weeks for the decision to be made - APPROVED as it is medically necessary!! Go figure.
So now, I’m on my second Dexcom sensor and have become completely enamored with the Basal IQ. It is really something to not have to feed a low!! My BG average is higher than I used to run. I used to keep my average at 90, with Basal IQ, my average is 105; however, I don’t have the spikes now! my last 2 weeks clarity data shows my Standard Deviation to be 12%.
In my opinion, it don’t get much better than that!!


#2

Congratulations, that is great news.
Thanks for sharing your experience. I will likely switch to tandem for next pump, so always like to hear success stories.


#3

Wow that is great! I can’t believe you were denied for a cgm and pump, unbelievable.

So are you using both features where it shuts off for lows and corrects for highs? I was just talking with my cde about this and I was concerned about the pump correcting for me, I guess that means it is increasing basal though not bolusing a correction, lol.

My Tslim x2 just arrived, I will set it up soon, but I don’t have G6 yet so I can’t test any of this out.


#4

Other people have reported running into this idiotic Catch-22. In my case the qualification wasn’t A1C; my endo just had to certify i had (I think it was) three <70 hypos in the previous 30 days, which was easy to do.

That A1C cut-off is particularly ironic in this context because I used to get yelled at by my endo for anything below ~6.5, which in the Lantus-Novolog regimen was taken to indicate too many hypos—usually something the medicos are at least as concerned about, if not more so, than running a bit high. A1C is an average, after all, so for a T1 on insulin therapy a <6.0 can just as easily indicate you’re having bad control due to hypo-insensitivity or whatever, as good control. It’s just not a medically rational criterion on which to base a universal rule for CGM eligibility.

BTW I was dx’d about the same time as you (Dec. 1983 for me) and also started out on R & N, first the animal stuff and later recombinant. I mostly had coverage through my university, but I do remember buying insulin out-of-pocket a few times, which was manageable cost-wise if you had to do it. You can still get R/N reasonably cheap at Walmart, but I wouldn’t go back to that stuff unless the only other choice was DKA.


#5

One good term to use in your request is that you are hypoglycemia “unaware”. I have found insurance will key on that term.


#6

@DrBB @BillC2

This Dexcom graphic clearly shows how similar A1C’s can be produced from individuals with wildly different time-in-range values.

Note how the values on the right, with a mere 51% in range, result in the same A1C even though BG’s were out of range high 40% of the time

Dexcom

Here’s a link to the complete 2018 Dexcom Slide Deck presentation:

https://dexcom.gcs-web.com/static-files/b7e18dca-02dc-46a6-b89f-c28ac2940a2c


#7

Yes, exactly. It’s an average!


#8

As far as I know, the Tanden pump will not correct highs… yet! I was told by my trainer that this function was coming early in 2019.

No other pump experience to judge this against; however, this pump is fantastic and customer service is even better.
I called Tandem CS, told them I goofed about 5 sets- all operator error- they told me no problem, we’ll send another box of sets.
4 days later I received a box of 10 sets, no charge.


#9

In the appeal I wrote, I stressed that my A1c was basically an average that doesnt take into account the highs and lows!


#10

It took forever for the Dexcom G6 to be approved for me, but it’s been fantastic and I do not miss stabbing my fingers 5-10 times a day. After having the CGM for 2 months and talking with my doc I decided to put in for the Tandem pump. I figured it was going to to take a couple of months like the CGM did and to my surprise it took all of two days.

I just received the pump and first batch of supplies last week but have to wait until 1/26 to meet with the trainer!

I am glad you are having good results so far.


#11

So you’re not counting carbs? Does that mean you don’t eat any carbs at all? I find it impossible to not have spikes even when I haven’t eaten at all. My blood sugar raises much quicker than the insulin will work, even when taking 20 minutes prior to eating as recommended. I find the insulin to begin working between 1 -2 hours after injecting.


#12

Maggie,
I am counting carbs -trying to anyway! I’m down to under 30g per day now, I don’t say I’m doing Keto, I say I’m being carb conscious. By doing this I’ve lost 71 pounds since June 2018.


#13

Wow. This is impressive! It takes a lot of hard work and dedication. Congratulation!


#14

Thank you.
I started this change when I looked at the data from the Freestyle Libre. That really showed what my BGs were doing based on what I was eating. The only lifestyle change was eating. I’m as active now as before. Getting a 'wrapped 'burger from a fast food joint is just as satisfying and less messy as now I eat my burgers with a knife and fork!


#15

Wow that is good they sent you new sets, I think I asked them to send me a sample when I switched to contact detach. and they said no😹 Now I am using their sets though. Yep the high correction is coming soon. I can’t try any of it until I get G6 though.