RE: coverage of CGM's

My fondest wish is that everyone would know that we're all in this together, even if we have different types, and we can all benefit from the knowledge and experiences of others

I think I love you, Natalie

Thanks for that link, Melitta! It was very interesting. If the people who did my recent colonoscopy had been more knowledgeable, I might have avoided a high (because they gave me sugary Gatorade to drink with the laxative), which I treated, which turned into a low, where I had to run leaking through the house to get something to treat it, and the another high, even though I didn't treat all that much, but because my gut was under stress, I apparently absorbed the glucose tablets very fast, and my sugar zoomed. Next time (which will be 3 years, because they discovered 5 adenomatous polyps), I'm going to make sure I can do a prep without the misery and clean-up duty.

My biggest problem is that docs don't ask what type I am -- they just assume T2, because of my age and the way I look. I think the possibility of T1 enters their minds when it's a teenager or 20-something, but not for a 66-year-old. And I hope it doesn't just get worse as I get older. I don't think most of them have much experience with older T1s, because there didn't used to BE many older T1s, and the times are changing, but they haven't caught up.

YOU, a little old lady? Ms. Natalie, I think not. LOL
God bless

I agree that the costs of prevention will go up dramatically, Dave. but what about the long-term costs of what may have been avoided with complications? Dialysis, amputations. etc.. Do we pay now or later? I do not know either. Artwoman and jms have strong, valid points as well.

I just couldn't resist the mental image of a frail old lady with a cane tottering across the street KICKING someone's BUTT, like jims implied. I'm given to bizarre mental images anyway -- humorous juxtapositions of situations that DON'T belong together, LOL!!

But isn't the public already paying for the costs associated with dialysis, blindness, disability? I have to believe that keeping as strong and healthy as I can means I cam working, paying taxes, and contributing to the overall economy -I am as good as shopping as I am at managing my D.

I don't know.

Those point are certainly valid, no argument with that. And they're compelling to me, but then I'm a PWD.

My pessimism is, rather, that such points are not compelling to the rest of our fellow travelers. My proof is... the current state of affairs. For the relatively unconcerned non-PWD, asking them to fork over more $$ for an already outrageously expensive HC system (and getting dramatically more expensive as we speak) so that fewer of us will have expensive complications in the distant future, well, its a hard sell.

Especially when you can't make the simple, factual case of actual numbers demonstrating savings.

And even then, we're talking about at least a decade of "double" cost -- treating the diabetics that are already too far down the road to benefit from significantly improved management and will suffer bad complications anyway (or already are), and paying the huge increase in costs to make technology like CGMs available at low OOP cost to younger diabetics, and hope it makes a difference (this depends, of course, on "compliance", a dirty word around here).

Opponents will point to the poor behavior by the majority of existing diabetics, and ask, will all this expense up front be a worth-while investment?

And that's the rub: Those of us willing to use these tools and be disciplined about excellent control are, and always will be, a minority of PWDs (and a small one in my opinion). As much as we'd like these technologies to be more affordable, getting there looks very problematic in my view.

What will change everything is some new tech that is effortless and non-intrusive for the user, with clear, measurable benefit. Something like "smart insulin" is a great example. Imagine SI administered orally... Nearly a cure!

The barrier to use is so low that virtually all diabetics would be on the stuff in short order. Something like that would make managing D easier, not more work. It would be widely adopted.

Natalie - I'm new to Medicare and I've read many comments here saying that Medicare doesn't CGMs. I also read that Medicare supplemental insurance plans would deny coverage if Medicare denied coverage. You wrote:

But again, I'm lucky, because my secondary, which is my old primary, does cover my CGM 80%, so I'm NOT left in the cold.

I just found out the same thing today, too. Not all Medicare supplemental plans will deny CGM coverage if Medicare denies coverage. My supplemental insurance plan will cover my CGM at 80%. I also feel lucky.

I still feel that a CGM is a tremendous tool for us to use. I also feel that PWDs that closely monitor their BGs with BG meters and/or CGMs will avoid significant subsequent cost due to delaying or avoiding expensive daibetes complications.

I especially like the language that the ADA uses regarding access to test strips and CGMs.

-- Patients with type 1 diabetes should perform SMBG [self monitoring of blood glucose] prior to meals and snacks, at a minimum, and at other times, including postprandially to assess insulin-to-carbohydrate ratios; at bed- time; midsleep; prior to, during, and/or after exercise; when they suspect low blood glucose; after treating low blood glucose until they have restored normo- glycemia; when correcting a high blood glucose level; prior to critical tasks such as driving; and at more frequent intervals during illness or stress. (B)
-- Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing. Regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose level is safe enough for overnight sleeping. (B)
-- CGM is a useful tool to reduce A1C levels in adults without increasing hypoglycemia and can reduce glycemic excursions in children. Glycemic improvements are correlated with frequency of CGM use across all ages. (A)

I love the phrasing of "unimpeded access to glucose test strips"!

Don't know if this has been posted already but there is currently a bill presented that would allow medicare to cover CGM devices. If you feel it's an important part of diabetic care, write your congress representative and tell your story and insist on they're support of this bill.

HR 3710.

I do not agree with Dave's response and see them as inappropriate.

Type 2's can enbd up where type 1's are and have to exercise all the same skills and discipline to manage the type 2.

I am very offended by these cheap short sighted comments Dave!

The volumes of dollars on supporting and caring for type 2 says it all world wide.

I'll say it again, I do nopt agree with that stone henge attitude.

I'll take this a step further.

Type 1 is a pancreas fracas with some side issues.

Type 2 problems involve a complex system of liver, pancreas , intestines, kidneys, the thyroid, skeletal muscles and the whole complex system

What Doctor are you fronting for Dave?

I find your comments insensitive, arrogant and out of the ballpark.

I ended up getting my own cgms after using 30 strips a day and realized we needed a bigger picture 24/7.

The arguments are so posted were to denigrate me as a 30 year type 2 diabetic who nearly died and rotted out from this mess.

With the extra data my Doctor could resolve and get the mess under control.

As a serious type 2; I am offended by these comments as if I do not belong here!

Both and other types of diabetes are serious, dangerous and a problem and comments that serve to write off type 2 as a joke and not worth serious consideration a disgrace!



Sorry, if this is out of line, but I think the most important thing a person with Diabetes can have access to is sufficient test strips. This is the minimum and most basic requirement (it comes before GCGs and pumps and all the more expensive paraphernalia).

Whether type 1 or type 2, trying to control blood sugar without being able to monitor blood sugar is like trying to drive a car in the dark. With no feedback one is really blind, literally.

I understand about CGMS and pumps, etc being 'too expensive' (they really are too expensive to be accessible for most people in the world), but at least make the very basic tool which is test strips accurate, reliable and affordable and accessible and educate PWD enough that they understand the importance of monitoring, and what appropriate numbers are.

There are plenty of studies showing that tight control does reduce complications. Complications are very unpleasant for the sufferer, and very expensive to manage. Much more expensive than strips and education, I would bet.

Without pump / CGM and armed only with strips and insulin / careful diet and exercise I can do ok (even well) blood sugar wise, as I am sure many others can. But without strips in the equation I am in great deep dark trouble and anything I do is done blind.


But isn't the public already paying for the costs associated with dialysis, blindness, disability?
You bet!

To sell the public on something, though, that's not gonna be enough information. Consider yourself personally: Would that be enough to make the sale with you, or would you ask, how much will the cost increase be up-front, how much will it save down the road, and will that be a net savings?

And that's what I keep saying I don't know. If someone does, please share the numbers and the source(s). If we have some credible info a long those lines, we're getting somewhere.

Until then, sad as it is, the harsh reality is improving the health of diabetics in their latter years simply isn't important to the vast majority of our fellow citizens. They're the ones we're asking to pony up. While I don't agree, I can completely understand random taxpayer responding with, "you don't need a CGM... you just need to test more. I'll agree to paying a bit more so diabetics can have 10 test strips a day".

Can one accomplish mostly what's needed from a CGM with frequent testing? Yes. At that point, it then boils down to comfort and convenience for most diabetics.

Almost no one is willing to cover comfort and convenience for someone else.

Justlookin, you are right about complications being more expensive than strips and education (and yes, I do have it easier to get adequate strips as a person with type 1 - and I do believe that everyone with D should have access). I want to add to your thought and say that complications are also expensive for society in terms of lost productivity, disability payments etc. That's the argument I use when contacting policy makers and legislators.

The public is NOT necessarily paying for the costs here except medicaid, welfare.)

Those of us on medicare have supplements as well.

As for who is paying, I was and extremely angry over these comments as I was.

At Start, I paid $6,000 buying strips for 30 strips a day at the cheapest supplier out there. Once it became clear I needed cgms; I paid the $ 1500 for the dexcom 7plus plus all the sensors I paid for.

Once I was on CGMS the great hope was 2 strips a day and in reality keeping that unit on target plus insulin doses cross checking took 6 to 10 strips a day.
And you still have to dose on the caveman machine or risk killing yourself.

I did not expect medicare or anybody else-insurance to pay for thos initial strips and cgms. It was understood they would not pay for cgms and more than one strip a day.!

Once I was on the 2 to 10 strips a day and medicare ; I fought medicare every three months to get them to pay for strips and wait up to 6 months to 9 months to get payment. At the same time my healthy disabled wife had her medicare claims for allowed procedures having to fight 6 to 12 months to get payment.

Stone henge, arrogant, stupid fraudulent - you bet. I worked with my Congressman and fought C2C Solutions in Florida (Blue cross), Noridian for months to get approval on valid Doctor's prescriptions for strips as I continued to buy sensors at about $400 per month.

As for Liberty Medical going bankrupt - they should have been shot.

So don't talk to me about such silliness of the public paying these
costs. They are NOT and doing every chicken bandit avoidance scheme to avoid doing so!

All I want to know who was the three degree'd, pimple faced moron who came up with one strip a day for type 2.

So the choice is drop dead slowly and painfully or go out and pay dollars to solve problems.

My point in the "public paying these costs is related to the more indirect. Prior to the ACA, we paid for those who ended up in the ER either through costs being shared between govt and insured people (part of our premiums - although you couldn't "follow the money"). Hospitals have to recoup their costs, so fees go up across the board - and who can blame them. I read somewhere that being on dialysis qualifies a person for medicare, that's another "cost to the general public." And my other (I know harangue) is that end stage complications can take us out of the work and consumer pool, that's a cost to the public. My point (and I have one and it does take me a long time to get there - just be glad you aren't my husband) is that people with diabetes who are healthy contribute more than people who have incurred complications.

Re: the one strip a day. I got involved in the issue in Oregon where they were toying with the idea of one strip a week! (I mean what's the point?) You gotta have the before and after for meals, and other times of the day. I'm not all that familiar with the non-insulin meds, but I know as a person with type 1, I test whenever I am getting behind the wheel of a vehicle.

First, thank you for remaining civil and having a rational discussion. I'm always puzzled when people take offense at having their opinion challenged, and it gets foul when a party decides to engage in personal attacks. While you and I disagree (not as much as it may appear), our back and forth on this has been interesting and informative.

end stage complications can take us out of the work and consumer pool, that's a cost to the public. My point [...] is that people with diabetes who are healthy contribute more than people who have incurred complications.
Really, artwoman, our difference here boils down to one thing, really: You believe the truth of what you state in the quote above, and my position (as I've stated over and over) is, "I don't know".

I'd like to know. My desire, and a strong one at that, is that you are correct. However, absent some sort of well-done, scholarly research demonstrating this cost comparison, it's impossible to make such a case about so many highly variable, tenuously connected components, that the qualitative argument just isn't persuasive to most people. If it's not persuasive to me, a PWD, you can imagine how non-PWDs look at such arguments.

As an example, two people with comparable D burden, one sees it as a challenge, something they defy in their life and will not be "taken down". We all know fellow PWD's like this (I have a measure of that attitude).

Other person, same general condition, different personality, ambition, drive, etc. They feel they just can't cope, and go on disability.

What's to blame here for the difference, the lost productivity: Diabetes, or the person?

I suspect that certain members may take offense at me pointing out these harsh realities, and the way they are viewed by others, but that doesn't worry me. I am, and have always been a person that believes problems can not be solved by lying to oneself about the realities of the problem.

Once we ask others to pay for something, they justifiably have a say in how you're spending their money. Are you being responsible? If that guy over there can work and contribute, with the same issues and level of measurable disability as you, why should you be on disability?

(Wo)Man up! Yeah, we'll give you a CGM, pump, expensive insulins, but in our judgement you can work. Others are, and you're no worse off than them! If we're going to cover these expensive treatments, we'll decide when you're too sick to stop working.

And that's the problem. To get the cost of these technologies down, we need economies of scale. BIG economies of scale. Like increasing the market by a hundredfold.

That's only going to happen if the cost can be brought down dramatically before economies of scale can justify the cost decrease -- so the difference between what the technologies actually cost, and what the patient is paying (greatly reduced in order to expand the market) has to come from somewhere.

If a clear, quantitative case can be made this investment will pay off, the public will go for it. Unfortunately, several things work against that.