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!).

Saturday, July 21, 2007

Extra, extra, read all about it!

I dropped the phone. From the floor near my feet I heard a distant voice, “Hello, are you there, sir?” It was an unexpected Guardian angel. The call was from MedT. They had been advised that Presbyterian Health had approved coverage for my CGM sensors.

Yeah. Read it again. My new health insurance is covering my sensors. Holy Shit. The war was over and I barely was aware we’d fired the first shot.

Regular readers may recall a while back that I dropped my long time Blue Cross and took the Pres HMO insurance we have at the clinic. Shortly before that happened both my PCP Doc and my Endo retired in the same month. Doctorless, I found myself a new provider, a fellow T-1. I’ve felt in good hands from the start, and a few months ago we discussed starting the battle for the CGM.

She wrote a letter and her girl Friday (who didn’t take seriously the question I asked when I called her a few minutes later: Candy or Flowers?) did some leg work and called a few times. I was out of the loop, not really expecting anything to happen yet. I figured we’d be denied, would appeal, and so on until two days before I died when I’d be approved. Ut oh. I hope this doesn’t mean I’ll be dead in 48 hours…..

Anyway, my “DM Coverage” on this policy is 50%. That means I pay for a full half of all pump stuff and now, CGM sensors. It would also mean that if I ever needed a new pump I’d have to pay for half of it. Which means the two pumps I have now (CoZmo and ParaPump) will have to last me the rest of my life. Some of you out there will be saying, ‘that sucks, how unfair.’

Not me. I’m thrilled, thrilled, thrilled. I’ve been paying full price out of pocket for sensors since the beginning of this adventure. The sensors have taken a huge bite out of our family budget, at one time being our single largest monthly expense—even more than our insurance in earlier times when sensors were more and insurance was less.

So I’m thrilled #1 because I’ll be paying less money. And I’m thrilled #2 because any insurance coverage for any diabetic for any CGM is a evolutionary step in the right direction for all of us. And I’m thrilled #3 because I’ll be paying less money.

In other news, I had not realized that a lot of folks got shook up when the FDA announced a Class II recall on MedT insulin pumps recently.

Class II recall. Sounds real scary. But it’s not.

For what it is worth, a Class I recall is the one you want to be scared of. A Class I is for something that will probably kill you. One example at the FDA website is a “defective artificial hear valve.” A Class II recall is for products that “might cause a temporary health problem, or pose only a slight threat of a serious nature.” There is also a Class III as well, reserved for spending tax-payer dollars on addressing such serious threats as “leaks in a bottled drink” or typos on labels that “violate FDA labeling” regs.

I got Class II recall a while back at the clinic on Abbott meters. One of the button covers fell off of a few meters. Boom. Class 2 recall. The upshot of it was that if you had one of the few meters in the universe that had a button fall off you called Abbott and they sent you a new one. Hell, even without a recall they would have sent you a new meter. They want to sell you test strips. Call any meter company in the world and ask for a one of their meters “on the house” and I’ll bet it will be in your post office box inside of a week.

On the Class II subject, there is even a sleaze-bag company out there that scares my senior citizens by sending them a letter saying “last year there were a gazillion Class II recalls of blood glucose monitors (true). Your meter could be one of them! (maybe, but not likely). Call us today and we’ll send you a Free meter (and start charging Medicare for shipping you strips).

So back to MedT’s recall of the pumps. I got a letter at the clinic in April that basically said, “hey, tell your pumpers that they shouldn’t wear their pumps in an MRI machine.” I put it on the bulletin board outside my office door, but didn’t pay it too much attention to it otherwise, as it is common sense not to wear any electronic device, be it an I-pod, cell phone, or insulin pump anywhere near an MRI. Hell, you shouldn’t even wear jewelry near those puppies. I probably didn’t even read the whole letter.

Here’s what happened: even though the MRI warning is buried somewhere in the user’s manual, the FDA required MedT to re-label insulin pumps. I guess a few people got too near the machines with their pumps on. The pump will alarm, but if you clear it without looking at the alarm (which we all do sometimes) you could be in trouble. So future pumps will have a little logo on the back that apparently is the universal “do not MRI icon.” I don’t know if it is a little MRI machine with the classic red-circle-and-slash through it. I doubt it, but it’s a nice mental image. I’m not sure how much that will do to solve the problem. But the FDA is looking out for your interests.

So this is a field recall. You don’t need to send your pump in. You don’t really even need to worry about it. If you get an MRI leave your pump in the changing room. Interestingly, if you have had an MRI and you are worriedover the phone call MedT. My sources there tell me it is possible to actually test the pump over the phone to ensure it is working properly. I’m not sure if that is cool or scary or both. ScaryCool? If there is any sort of problem there will be a FedEx truck in your future. I’m assured that the pumps have been rigorously tested for dental X-ray, airport security systems, amusement park rides, and even nuclear power plants (seriously, this is really true, I didn’t make that last one up). In all cases no problem. Just avoid MRI machines. Probably CAT scanners too, but no one is really talking about that.

By the way, one tidbit I picked up reviewing the recall announcement at the FDA web site was the number of pumps in the field: 334,000. You are not alone.

Another news tidbit: there is now more room in your cooler for beer. Or wine, or sugar-free popsicles, or what ever your traveling vice is. Why? Because you do not need to keep your sensors cold any more.

According to a letter from MedT, the sensors can be stored between 36 degrees and 80 degrees Fahrenheit. So don’t leave them on the dash-board of your car or in a snow bank.

That said, they still ship ‘em cold. And MedT tells me that users may keep sensors in the fridge “if they choose to.” Personally, I plan to keep my “spares” in the fridge at the lab with my insulin, partly out of habit, partly out of paranoia, and partly because our house is often warmer than 80 degrees in the summer months. Hey, it is New Mexico, after all. But now travel is just that much easier. If I could only make it through air port security with out being treated like a terrorist, that would be great. Any body remember when it was actually fun to fly?

Also, did I remember to tell you folks that the price on the sensors has come down a couple of times since this all started? The first time the price dropped was bout 15 seconds after the FDA approved the DexCom. Hmmmmmm…… I’m sure that was just pure coincidence. Then they drifted down again as some point. We’re now at $350 per box of ten—which I’m pretty sure includes the shipping—not cheap given they’ve always sent them UPS Red. Now that the sensors have more flexible temperature storage it will be interesting to see if MedT switches to two day shipping instead. By the way, they also sell a four pack of sensors for $145, more per sensor by a few bucks but easier on the cash flow for the out-of-pocket crowd (which is most users).

I also got a press release (or was it an email?) about changes to CareLink. There is a new CareLink in town, CareLink Pro. This lets Doc’s access and store downloads from their patients in one handy location. No more sitting in your Endo’s office while he asks you, “now what was your CareLink password again?”

I checked with some contacts at MedT to see if the Pro version would crunch the data for Docs and make some recommendations. Not yet, but that is on the horizon. I bet that makes the MedT lawyers lay awake at night staring at the ceiling. Pro does accept data from something like 17 different meters, not just MedT products; so that’s cool. I think there have been some minor changes to the patient version too.

And incase you are living under a rock, in March the FDA approved the MedT CGM products for diabetic patients as young as seven-years-old, one hell of a blessing for parents of diabetic children. The only wrinkle is that the “Pediatric Model” of both the ParaPump and the sexy new Guardian will not let parents set a low glucose threshold below 90 mg/dl. This is spun as being “for added safety,” but is a two edged sword. I guess you do what you gotta do to get a product through the FDA, but I can envision a plague of unnecessary alarms driving both parent and child up a tree.

That said, T-1 kiddos can drop like a rock, or a crow bar, or a plane whose wings fell of, or rocket pointed the wrong direction, or….... So maybe it’s a good thing to have some extra warning.


Blogger Megan said...

Hey Wil, I just got approved for 100% coverage for a ParaPump to go with my Cozmo, so I'll be another double pumper. So far insurance is just covering the actual pump, which is a start. I'll probably buy the Minilink out of pocket, then appeal for coverage for sensors. My insurance is usually pretty cool abotu stuff.

9:32 PM  
Anonymous RichW said...

There's hope. Sensors covered by insurance. That's great news. I really believe that your posts and so many others have made a difference. If MiniMed is reading, we can only hope that others who can make a difference are reading as well. Keep up the good work. I'm a DCCT/EDIC participant and I am thinking about blogging. I’m coming up on my 25th year as a diabetic and 20 years with DCCT and EDIC. I really believe that all of you who are providing such up to date intelligent conversation about diabetes has advanced the cause for the rest of us. DCCT did a lot show us that intensive treatment is beneficial but you’ve made so much of what we learned public by telling your stories and allowing us to see into your lives. Thank you.

10:26 AM  
Anonymous Anonymous said...

I am a type one diabetic of sixteen years and just celebrated my 49th birthday. My glucose levels have been all over the map this past year. I have a hard time at work to remember to check my sugar level as I am always on the run. Now I am having lows every day and night. Last week I went to an endo and explained what was going on and that I was interested in finding out about a pump. he told me that because of the kind of work I do he would recomend the minimed with the glucose monitor. I began looking for information on the different types of monitors. I have been looking for studies picking one monitor over another, but I have had little success. Then I found you blog. After reading several comments I feel like I've found what I have been looking for; just honest people sharing their experiances Not some study. I want to thank you all for taking the time to share. What I have read somehow hase given me comfort. I'm ready for the pump.

12:31 AM  
Anonymous Anonymous said...

Ok so now it is a month later... Did you get your second months supply of sensors?

9:28 AM  

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