LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Friday, June 29, 2007

Of camels and straw

Me: I want to eat.

ParaPump: are you sure?

Me: yes, I’m sure.

ParaPump: are you really, sure?

Me: yes, I’m really sure.

ParaPump: are you, really, really sure?

Me: yes, I’m really, really sure.

ParaPump: are you really, really, really sure?

Me: oh-for-Christ’s-sake-just-give-me-some-fucking-insulin!!!!!!!!

And that, dear readers, was the end of my MedT pumping days. The Cozmo is back on my belt to take care of all the direct life support duties and the ParaPump remains next to it with only the life insurance duties. I never thought I’d miss my old garage-door opener Guardian as much as I do. The ParaPump makes a sad CGM-only device, but it is better than nothing at all. It basically is just the same as the original Guardian except for the fact it is not loud enough to let you know when you are in trouble. Oh, yeah. And the mini-link transmitter, being smaller and taking up less skin landscape, is waaaaaay better.

A drug rep passing through the clinic this week asked me, “why are you wearing two insulin pumps?” To which I replied: ‘because I’m twice the diabetic!’

But the truth of the matter was, even after more than two months, I could never get use to jumping through sooooooo many hoops to do the simplest of things. My life is busy. Time is short. I don’t have the patience to deal with a clunky pump interface. I decided my life would be more worth living with two boxes on my belt again, and a pump that is easy to use. I also came to realize how much I relied on the IOB screen for making treatment decisions. I always do a fingerstick at bed time. A BGL of 120 with no insulin on board is a very different situation than 120 with 4.8 units on board.

You can get that info out of the ParaPump, if you have three hours to surf menus, and you have to enter fake bolus and carb data to get there, which you must then cancel. By then, of course, you’re in insulin shock and unconscious. But assuming you do get the Active Insulin data from the B-wiz it will be wrong anyway. MedT only tracks correction insulin. ParaPump assumes any insulin applied to food is cancelled out. Well….maybe. Maybe not. What if the pumper counted the carbs wrong? What it I ate 65 carbs of spaghetti but bloused for 125? I’ve got a dangerous boat-load of insulin on board that the ParaPump is ignoring.

Now, there is a new-and-improved Cozmo pump with an on-board carb data base, hypo manager software, and the ability to set basal patterns by day of the week, and more, but I’m still using the “old” Cozmo because I’m on Smith’s Medical shit-list. Here is how that happened:

Around the first of the year I got a huge bill from Smith’s for pump supplies. They had re-stocked me just after the end of the year, so Blue Cross didn’t pay a dime. My 1K deductible had reset to zero. Had Smith’s sent the supplies a week or two earlier I would not have paid a cent.

So the first quarter is always my brokest time of year. No weddings. Little lab work. It was lean times, and we were scraping by on my clinic income (non-profit, remember?). So I paid late. But I did pay. The next month I got another bill, for the same amount. Which I threw away, assuming the checks passed in the mail. The same thing happened the next month.

Then I called to see where I was on the upgrade list, at which point I was told I would not be allowed to upgrade ‘cause I was a deadbeat. I was told I had owed Smith’s a significant chunk of money since January of 2006. Six? You gotta be fucking kidding me.

After some digging it turns out this is what happened: for unknown reasons Blue Cross sat on a Smith’s claim from the year before for over 16 months before rejecting it and it became my problem. The folks in accounting admitted that even they were unaware of it for over a year, but that it was still a year over due so I was C-U-T O-F-F.

Well, I had a hell of a time just paying the current bill, much less a year old one I was unaware of. Can I make payments?

No. We do not accept partial payments.


So I did the only thing I could do. Nothing. Each month a new bill came. And I threw it away. I had a stash of extra sets, ‘cause I had been wearing them for four days rather than three. Then I used the ParaPump for a couple of months.

Now when I decided to give up on the ParaPump and return to the Cozmo, I could no longer use the CozMonitor. Why? Because of new insurance. Here is how that happened:

Our Blue Cross went up soooooooooo much we could no longer afford it. It was around $650 per month with a $1,000 deductible and $2,000 out-of-pocket. Pretty much like being uninsured, actually. So with great fear, I took the insurance at the clinic. This met I was forever committing to working for someone else rather than for myself, which I’ve done for over two decades. I knew that once my individual insurance was cancelled I could never get it back. T-1 is “automatic denial” for insurance. After all, insurance companies don’t want to insure people who might actually use their insurance.

This was a terrifying moment. What if the clinic fired me? Or closed? Or if gas hit $5 a gallon and I couldn’t afford to drive over any more? This was a big step. I would forever be giving up my complete freedom. But I did it. Now my new health master is Presbyterian.

Pres won’t pay for FreeStyle test strips. They’ve negotiated a special rate with AccuChek (read AccuChek gives them a kickback for forcing all of us to use their products). Actually I’ve gotten fond of the Aviva meter. I just wish the damn thing had a back-light for night time ops. Memo to AccuChek: Diabetics do need to check their sugar at night.

So now, instead of having a meter attached to my pump, I have Aviva meters scattered across the landscape of my life. One at the lab. One at the clinic. One in my Go-bag. One in each car. One on my night stand. I’ve actually gotten use to it.

One thing I really liked about the ParaPump was the plastic holster. The Cozmo has various leather cases that I don’t think too much of. Now that I wasn’t using the attached monitor it occurred to me that I could use the plastic holster that Smith’s used for the Cozmo in pre-CozMonitor times, if it was still made. A quick search of the Smith’s on-line store located the holster. Clear so the color of your pump will show. Mine is black, so no real benefit for me, but still, a nice idea.

I called to order where upon I was reminded that I was on the shit-list. Can we use this card number to clear up your debt? No, it is a debit card and there is about $42 in my account. If you run it for the supplies it will be declined.

But now enough time had passed that all of the sudden they would take payments. I’m told that once I’m paid up I’m part of the family again. Hopefully by fall I can report on the new Cozmo features.

But meantime, I can’t tell you how much happier I am, and how much less stressed my life is using the Cozmo pump. It is amazing how big a difference it makes having an easy to use pump.

Now if some one asked me to recommend a pump I’d have to say….. I’d have to say…. “sit down, this is going to take a while.”


Anonymous Scott M said...

What a headache! I can relate to the "check here for pre-existing conditions" box... otherwise known as the "check here for no chance in hell of insurance coverage" box. What a head down, spirit-crushing, feet dragging feeling.

11:11 PM  
Anonymous Jana said...

Sorry to hear that you have committed yourself to the workforce for life! By the way, the first thing my father (with whom I do not have great relations, as will be clear) said to me when I was diagnosed at age 19 in the middle of my freshman year of college was, "You know this means you'll have to get a job straight out of college, so that you have health insurance, right?"

Needless to say, I graduated from college and have not yet got a "real" job. Instead, I am taking the "eternal student" road--for the meantime, I'm still on my mom's health insurance (as long as I'm a full-time student until the age of 25) and then when (if?) I get into a Ph.D. program I will have insurance from the school. And some of the programs even pay the premium as part of their support package for graduate students...

It's amazing to me that you find the clunkiness of MedT's menus so prohibitive. Of course, I haven't known anything else, so maybe that's why I'm not too bothered about it...

4:51 PM  
Anonymous Anonymous said...

Thanks for posting the comparison of the Paradigm and Cozmo. We've been really happy with the Cozmo...but of course would love to see a sensor communicate with the pump. We'll keep waiting.

8:32 AM  
Blogger Bernard said...

Sounds like a nightmare. Thank goodness it sounds like it's finally resolved.

So I'm considering a new pump and my list is: Animas 2020, Cozmo, Minimed in that order of priority. I'd love to hear more about the Cozmo and what you think of it.

3:06 AM  

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