Who Needs An Old CGM Anyway? GRRRR!

Type 1 and LADA
1

Who Needs An Old CGM Anyway??? Grrr!!!
I Used my Dexcom CGM Feb-Oct of 2010. It gave me some crazy numbers ever now and then, but it was a big help once I learned all the tricks of the trade. It enabled me to see oncoming lows and highs, so I could take care of them before they became much of a problem. My range was narrowed and I was seeing fewer highs and lows than I had ever seen before. My A1c stayed the same, but my standard deviation improved.

Then the bottom fell out of the bucket! New York State reduced their part of the financing of the community college where I had taught by several hundred thousand dollars. My health insurance is with the retired teachers group at the college. The college was forced to go with a cheaper insurance plan for my group. The previous plan payed for my pump, CGM and all the supplies for both. The new plan, an MVP plan with Medicare, will pay for the pump and supplies, but they do nor cover a CGM under any circumstances. I stopped using my CGM in Oct. because of this. I have saved my stash of sensors so I can use them when I most need them, like when I take a vacation, or am dong something that might cause my blood sugar to vary a lot.

That may sound all well and good, but it has backfired a few times. Yesterday I ate a big white sweet potato for lunch, with lots of butter. It was 45 carbs. That and a few hot chicken wings was my meal. Two hours later my test was 201. I have not had a high like that for more than a year. I bolused the proper amount and about two more hours I was dropping. I ate something, and later on I was 49. That would not have happened if I had my CGM. I did not see the high and the low soon enough. I ate only half a sweet potato today and exercised after lunch. That worked well.

In mid December I started working out at a local gym. I am using many machines to exercise my weak body muscles. One of the most likely side effects of long term diabetes is nerve damage, which causes weakened muscles. That and my being 71 has resulted in a lot of weakness, especially in my upper body. These machines at the gym are really helping!!! I am getting stronger after six weeks there. My cute little trainer is watching me, so I won’t overdo it. I gave her a signed copy of my book and she loves it.Lol!

The problem at the gym is that I keep increasing the number of machines, the number of repetitions, the amount of weight and the length of time I am there. My BG has dropped fast on some days and I cannot predict when that will happen. Without my Dexcom I don’t always catch the low soon enough, so I have to find a seat and eat glucose and wait, and maybe go home early. Not having my Dexcom on an everyday basis is not a good thing while I am doing this exercising, because it keeps changing every week.

Having to quit my CGM is very annoying, but I will survive. I did it before I had a CGM, and I can do it again. I was very spoiled by having one though.

2

I think that you should be able to make a case for it somehow. At any age exercise is beneficial but you’ve been told that you need to I think, if I recall the other thread on the subject. Exercising is much safer if you have a CGM and I would think that it would be worth it for the ADA or some other group with some deeper pockets to get involved in some type of legal challenge to redlining a very useful tool.

I will be happy to testify that I have not knocked any of my teeth out in bicycle accidents since I got my CGM.

3

Thanks for your reply. The MVP rep told me that no device that involves a needle being in the skin for more than 3 days will be insured. I use my Dex for an average of 14 days, so it will not be insured.

4

Wonder if the wall street boys still get their orgasmic bonuses ?

5

My HMO won’t cover CGM either.

I think it’s a crock.

The only thing I can suggest on the exercise is this: have you tried having a SMALL snack before and during?

When I was dropping weight, exercising a LOT more (and lowering medications) two years ago during a big push to lose weight, I had a hypo while out on my long walk. After that, my doctor suggested that I cut an apple (or pear) into small, thin slices and just sort of munch one every five minutes or so while I was walking – something like 1/20th of an apple every five minutes.

This worked wonders without upsetting my stomach and I never again had a hypo while walking.

You could approximate this by watering down some Gatorade four to one (four parts water to one part Gatorade) and sipping it as you work out.

6

I am eating an occasional glucose tab, thinking about switching to jelly beans. I hate the taste of the tabs. I still drop low because people stare at me when I test, so I don’t test enough. Nobody has said anything though. They may be concerned that I will get blood on the machine parts that they may touch. I am very careful to not let that happen. We clean the seats and parts of the machines we touch with a disinfectant. People there are careful not to spread germs, so I can see their concern. I will probably eat something more frequently, like you suggested. Thanks!

7

That is medically unfounded. I suspect they are trying to get you to call their bluff but if you can invest some time in working out, it might not be a bad idea. To me, this sort of thing screams “class action suit” because that is the only way the insurance industry will recognize that the challenges of managing diabetes need to be met with tools.

If they want to beat up pharmaceutical companies, I will certainly lobby for that too but a health plan has a contractual obligation to protect your health. If the exercise and/or trainer are helping you with the dizziness, ( :wink: ), the tools you need to manage that should be covered. I still think the “pursuit of happiness” should relate to pumps and CGMs as my experience with them has been almost entirely positive (OK, I’ll admit the first time I hit a “gusher”, it was quite alarming…) and has definitely improved the quality of my life. It really torques me off to hear these stories. I’m embroiled in one at this time however I have not been told “no” yet, only “get your doctor to fax a stupid letter to someone”.

8

Jelly beans are a great alternative to glucose tabs, IMHO.

Keeping track of BG during exercise and avoiding lows is a constant struggle. There are plenty of discussions and strategies on the subject in the Diabetic Athletes group. Come on over!

Terry

9

Thanks for your message. I asked the MVP rep if I should have my endo write a letter, and she said it would serve no purpose. My endo had offered to write a letter. I guess I tend to give up too easily. I have just started with this insurance plan, and I don’t want to rock the boat. I hate fighting with a company that is actually helping me in so many ways. I am not a fighter, that is just not my personality.

10

I am a type 1, 40 years of diabetes. The only way I can exercise without going low is if I exercise first thing in the morning–this way I don’t eat and don’t need to bolus for food. The minute I introduce any insulin anywhere near exercising (ie within 5 hours), I will go low no matter what. For me: Bolus within 5 hours + exercise=low. I will have some protein (that I don’t bolus for) before I exercise if I want some calories to hold me off till I get to the exercise.

As for the coverage–I hear you. My insurance covers neither pump nor CGM, although my province covers pump supplies…Go figure!! It’s like saying we give you car insurance, but no car!!! I did use MM CGM last year for a while, but then my income was slashed and there goes any hope of using sensors. SO I hear you…I hear you…

11

Hey Richard, The squeeky wheel gets the oil. Hound them and have your doc document your issue and send that in. You have my cell# give me a call. I hoped you kept it. Lunch soon???
Ray

12

Well, we should all sue our insurance companies for refusing to cover medically necessary equipment, medications and procedures. Mine won’t cover CGM, Levemir, gastric bypass, Byetta, counseling or treatment of any kind for eating disorders, diabetes classes for the newly diagnosed or any kind of training with a certified diabetes educator, e.g. how to use the insulin pens, managing insulin for a new user, etc. etc. etc.

I’m sick to death of bean counters practicing medicine without a license.

Perhaps we should take a lesson from Egypt and all amass in the courtyards and the streets in front of the headquarters of every insurance company in America until they submit to our demands?

LOL – I can dream, can’t I?

13

Jean, I like your spunk! Lol! You actually had me picturing myself doing that for a moment or two.

I guess I am actually very lucky. i am covered, for the time being, on almost everything except the CGM, but who knows what next year will bring?

14

We should sue them together though, rather than individually. A lot of what their processes do is involves regulatory agencies and they all will all throw each other under the bus and hidge behind definitions and pretty much clueless mickey mouse BS all the time.

15

Class action lawsuit! I like it.

Diabetics of America vs. The Bean Counters. ;0)

Who’s in?

16

I’m not sure a CGM would be much help. CGMs register what your BG was about 20 minutes ago - 20 minutes later than a BG meter does. So if you are starting from a normal BG and dropping fast you are much more likely to see it with a BG meter than you are with a CGM. For the limited time I did a trial with a CGM, I found it more useful at preventing highs than lows (although its nice to have with the alarm at night for slow moving lows).

You are stressing your muscles in a way you haven’t, and that is causing unpredictable results. I think that is normal - I don’t think you can expect to control your BG while exercising as closely as you are used to, especially when it sounds like you are doing a different amount of exercise every time. But once your body is better trained and the exercises have a more predictable effect you’ll get it much closer. You could ask your trainer to increase your exercise level from one session to the next at a slower pace; that could help too.

17

And you are Famous in ALL Diabetes communities…at least most of the 100’s I’ve been to. Fame Speaks!! :smiley:

18

I like the CGM, even though it doesn’t provide immediate feedback about your BG now, I find it pretty useful to get my BG where I want it to be, around 100, w/ a slight rising trend and a bit of food on board, and then to watch for it to fall? It’s not so much about checking the BG but watching the trends and that can still be useful?

19

I agree its useful. And watching the trends was definitely the best part (it made me realize that my BG is never really stable - it is always moving up or down by at least a little bit - that was a revelation for me). I just don’t think it will be so useful for this problem: where BG is normal and stable until sudden exercise causes a rapid drop in BG. I guess I’m assuming that Richard isn’t spending that much time in the gym - so a 20 minute delay is quite significant if you’re in the gym for less than an hour - but maybe he’s spending longer than I think.The rapidity of the drop is why I think a meter is a better tool to use here. In other words, take a water break and check every 15 minutes (or whatever) until he gets a better feel for how his body responds to exercise.

20

Thanks Jag, that is good advice. I spend an hour on each of three days, per week, at the gym. Some of the time involves cleaning off the machines after using, and testing and snacking. I guess I exercise 45 minutes while I am there. I am doing 12 exercises/machines and presently using 55-80 pounds of weights, depending on which muscles are involved. My trainer introduces a new machine each week. My number of reps and the weight are increasing too. I will have to start testing, and eating something more frequently. Friends are telling me this on several D websites.