A1c=6.3. Vegetarian. carbs = 120g/day. Note: I have epilepsy and due to possible correlation between lows and seizure, we decided not to try for A1c below mid-6’s, although sometimes I hit 6.1 or so.
I’m not sure we have formal appeal paths here, at least none that I’ve ever heard of. I applied for a CGM three times and was just told, “Your plan doesn’t cover it,” three times.
I’m not sure something like the cost of an emergency hospital visit is something they would care about. Most healthcare costs here are covered by taxpayers. Insurance companies only cover those things that the public healthcare doesn’t. So a trip to the hospital would be picked up by the public healthcare system, as would any long-term complications.
What I’m planning on doing is getting my endocrinologist to specifically write that my A1c is low because I’m already self-funding a CGM, and then I’ll write a note to go along with the application that says the same thing, as well as print offs of my last seven years of A1c results showing every result above 7% until the time I started the Dexcom. I’ll also submit the receipt for my first Dexcom sensor, transmitter, and receiver purchases (unfortunately I bought them separately rather than buying the “starter kit”, which would look better, but oh well).
If they deny that, I’ll write an appeal letter to them asking specifically if they want me to damage my health and put myself at risk by discontinuing use of my Dexcom just so I can get an A1c of over 7% to meet their very specific criteria.
And if they say yes to that, well, not sure what I will do, but I will do something with that type of statement!
There is always an appeal process. It should be outlined in your group plan booklet.
Your starting point is, Is it covered by your insurance company? If not, you have a long road ahead – the laborious process of appealing to the company is detailed here (ignore that it deals mostly with the Libre, but it does list the points to make in your argument) – or you could be patient, as Canadian insurers are increasingly coming on board.
If your insurance company covers CGMs as a broad policy but your employer or group has decided that that benefit is not to be included in your group plan, you’ll need to instead appeal via your HR department or whoever deals with the employee benefit specialist (titles may vary) at the insurance broker (not the insurance company), to see if your company/group will add that benefit. You’ll need to contact Dexcom and ask for an insurance estimate, which they’ll email you right away, so your company has some idea of the costs involved.
My plan does not cover CGMs, though many plans through that insurance company do cover them. So when I applied for CGM coverage, my plan didn’t cover it. And the first time I applied for Libre coverage, my plan also didn’t cover it.
My plan recently added coverage specifically for FGMs (flash glucose monitors; i.e., the Libre). But it has super specific criteria, and as mentioned, I do not meet it due to my A1c level. I have not applied yet, since I only recently saw it and have not seen my endocrinologist yet. So there’s a chance I won’t have to go the appeal route (fingers crossed!).
I’m part of a union so the benefits are negotiated at the union/provincial level with years in between negotiations. Which means if something isn’t covered, there’s almost no change of being able to negotiate with a single person to get that changed. I have, however, brought up coverage for diabetes supplies (pumps and CGMs) with my union representative in hopes that it can maybe be included in the next round of negotiations.
I eat about 120-140 carbs each day. My last A1C was 6.5. But for discussion purposes my husband works in a hospital. He had a newly DXD diabetic patient that he ordered an A1C on and came back as 9.2. Another person in the hospital also ordered an A1C on that very same patient and it came back as 8.4. Food for thought.
A difference of .8 could result in an incorrect T2 diagnosis. Seems like that machine should be checked.
That’s what I thought-somebody’s machine isn’t working. Which makes me wonder about all the different machines in all the drs offices/labs I’ve been too. I didn’t think there was a wide variation in testing. I have heard of bg meters being off-and an A1c being different from what information we get from our “devices”. A1C is important but I think it’s just part of a larger picture involving our day to day control and the kind of lives we want to live. Some people enjoy the challenge of keeping low A1C’s and some of us don’t. I don’t know if there is definitive research that says keeping your A1c under 5.5 or 6 guarantees you won’t have complications or other health challenges later in life.
I agree. I don’t think there is any research yet that proves this. The DCCT only went as far as 6%. There have been a lot of new devices and insulin that have come out since then that have improved our control and quality of life significantly. It’d be nice to see a study that looks at the 5-6% range with those tools to see if going below 6% is actually a worthwhile pursuit.
I do think that targeting 6% is a good idea though. If a lower value requires compromising your quality of life considerably, then it may not actually be worth it. We don’t have a lot of evidence that getting it lower will reduce chances of complications enough to offset the impact it may have to your quality of life.
Of course, for those who don’t think their quality of life is negatively impacted… go for it!
I don’t think that the same A1c machine should have that much variation either. I certainly haven’t had variation like that with any of my past labwork even with months in between my labs.
What Compromises do you see are necessary to maintain less than 6 A1c?
Well, I think that depends a lot on the person.
Some people can get to 6% without a lot of difficulty. Others find that they need to significantly lower their carb intake in order to hit that mark, and even with that, they may not be able to get below that mark. Everyone’s body reacts differently, and I’m not able to completely reconcile why two people could have the exact same sugar levels, but different A1cs. Sure, we can say the red blood cells of one individual live less long than the other, but we actually can’t extrapolate that to mean that their risk of long-term complications is the same. Or at least, I don’t think we can. I wish we knew a bit more about this.
As my post above showed, my A1c is 5.1%. I haven’t felt the need to lower my carb intake to hit that level, but in general, I wouldn’t call my carb intake high. I try to eat healthy carbs as much as I can, rather than limiting my intake. My average blood glucose level correlates with an A1c of 5.6%-6% though.
Personally, I believe I could probably drop my A1c further by adopting a very low carb diet like others on here. I could also drop my A1c by eating earlier in the evening so that I’m not digesting any carbs before I go to bed. I could also lower my A1c by not drinking any alcohol. I could also lower my A1c by maintaining more records (input food & insulin into an app) and eating the same foods most of the time.
Each of those things would impact my quality of life in some way, and some would be more significant than others. I try my best with what I have decided I’m willing to do to control this disease. I have been diabetic for 23 years, so the balance of health and quality of life is not new to me. I’ve chosen what I’m willing to compromise, and what I’m not. Each person with D has to make the same personalized decisions, and theirs will likely be different than mine. I check my cgm fairly often and dose as frequently as needed, and that might be more annoying for some people than adopting a very low carb diet.
If I were to develop another autoimmune disease, I might be willing to do some or all of the above in order to keep my A1c lower. I think people juggling multiple conditions may have a harder time keeping things in range because blood sugar levels are likely affected by those other conditions.
May I ask what a typical day meal plan looks like for you? Curious how you keep carbs that low. Do you eat mostly protein? I eat pretty low carb but in the 50 gm range. Thank you
Hi Jane -
I generally eat one meal a day (OMAD), however I always have a large coffee with 2 Tablespoons of heavy cream (36% fat) when I get up, once in a while I’ll have 2 coffees.
Last nights meal was 2 beef smokies with mustard, plus 12 small spears of asparagus.
- 79% Fat (74 grams)
- 14% Protein (29 grams)
- 7% Carbs (14 grams)
Wow Jim, you are disciplined. I would be hungry. I generally eat twice a day. Morning and late afternoon. Good for you. Thanks for the response.
Jane - as far as hunger, it’s non-existent. My diet is 70-80% fat, which over a short period virtually satiates your hunger and eliminates the desire to eat. Obviously, I eat very little in the way of carbs, which also makes “snacks” unnecessary.
Hi Jim. It’s me again. I am fascinated about this way of eating. I’m curious as to how you handle eating out with friends and family? Assume no glass of wine or beer. How much insulin do you need? I keep my A1c at 5.3 but with a lot of checking and figuring. Truthfully feel so much better when I am stricter with diet. Also how about weight? I am fairly thin right now so do not want to lose weight. thank you for all of your insight. Jane
I am T2 but take basal and bolus insulin. I average between 90-120 grams of carbs per day. Anything less I find difficult to stick to for extended periods of time and anything more is difficult to maintain good blood glucose control.
I got a little off track this spring and my A1C in June shot up to 8.5. With an insulin regimen change due to formulary coverage issues, combined with more regimented testing, dosing, and meal planning my A1C test last week just came in at 5.9.
Jane - I don’t eat out nearly as much as a did even a year ago. The reason being I have no control over what (oils) the kitchen uses to prepare things like salads, steaks, etc. Vegetable oils are poison to me.
That said, I can easily have a salad or a burger (and just tell them to skip the bun).
I’m not much of a drinker - have never been partial to wine - and the only beer I drink is Molson’s 67, which only has 1 gram of carbs per 12 oz.
As mentioned, I’ve been on pump for 3+ years, my TDD (total daily dose) used to be 36Units (Humalog), now it’s 14U (12 U basal + 2 U bolus). My last A1C was 5.4, however that was prior to my switching to a low carb / Keto diet.
My weight is currently 150lbs (I’m 5’7"). I’ve lost 25 lbs in past 2 months and I’m just about where I want to be.
My macros are Fats 80-85% (of total caloric intake), Proteins 10-15%, and Carbs 5-10%. If your goal isn’t to lose weight, you can up your protein to as much as 30% (1 gram per kg of body weight). Unfortunately I’ve had kidney issues for some time and can’t eat much more than 50 grams a day.
Perhaps the single largest benefit of low carbs is no more spikes or dips in blood glucose. It’s been months since I’ve had a blood sugar any higher than around 8mmol/L (144); my Average blood glucose is around 4.3 (77)
How do you manage cholesterol with that much fat intake? Do you need to take statins?
I also avoid vegetable oils. I favor olive and coconut oils to prepare my foods. I enjoyed a tasty meal at a Korean restaurant recently. It contained fermented vegetable, leafy greens, sprouts, a fried egg and a filet of salmon, all flavored with a tasty spiciness. My post-meal blood glucose and digestion told me that my body liked this fare.
If you eat a meal and are unaware it was prepared with vegetable oils, how do you feel? Is it obvious to you?
Eddie - Fats (lipoproteins) and CVD have long been misunderstood. Little wonder, we’ve been told that eating fats is bad since the 70’s.
Fortunately science has finally caught up. The link below will give you some insight into what cholesterol sub-particles are risk factor in heart disease, stroke and other cardiovascular problems (“LDL” is not what you should be concerned with, Lp(a) is the particular subtype of LDL (cholesterol) that is bound to a protein called apolipoprotein).