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!).

Wednesday, December 01, 2010

The new Minutemen and a completely different kind of Tea Party

Well, if the government wants you dead, it’s a least good to know it in advance, right?

So you can prepare. Or decide how to respond.

You can just lay down and let them kill you. Or you can put your affairs in order, and then lay down.

Or… you can fight. Maybe even get others who love you, or love your ideals, to fight with you.

A fellow T-1 has decided to fight. And he has asked me to join him. And I’m asking you to join us.

It started with a fax from Dr. Steven Edelman of TCOYD (Taking Control Of Your Diabetes) Circus fame. It started off “Dear Friend.” Now, Dr. E and I have met a few times, and have even corresponded occasionally, but I doubt he would recognize my name, much less count me among his circle of friends.

It must be a form letter.

Still having nothing better to do—as no one wants to see their diabetes educator between T-day and X-mass—I read the fax. Who would have thought that five paragraphs would raise my blood pressure so much?

So first some background. Medicare is the 800 pound gorilla in health insurance. All of the smaller gorillas, like BlueCross, Presbyterian, and the like, look to Medicare to see what they can get away with and what they can’t get away with.

Of course, we are talking test strips again.

Right now Medicare’s “guidelines” allow for one strip per day for diabetics on oral meds and three strips per day for those of us who shoot up. Insulin that is. To get your one-or-three strips covered requires some pretty strange paperwork and record keeping on the part of your doc.

But these guidelines are not carved in stone. A doc can get you more by doing even stranger paperwork and record keeping. But now a proposed Medicare rule change would take this guideline and carve it into marble. Oh. No. That’s not quite right.

First it would reduce the number of strips even further. Then it would be carved in marble.

The “Draft LCD” Medicare rule would absolutely fix diabetes testing supplies at one strip per day for folks who pop pills and two strips per day for those of us who shoot up.
No exceptions.

Think this doesn’t affect you because you aren’t on Medicare? Think again. A quote from Martin Niemöller about the Holocaust comes to mind:

They came first for the Communists,
and I didn't speak up because I wasn't a Communist.

Then they came for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.

Then they came for the Jews,
and I didn't speak up because I wasn't a Jew.

Then they came for me
and by that time no one was left to speak up.

Whatever Medicare does Medicaid does. Whatever Medicare and Medicaid do private insurance does. It’ll be a falling domino effect that’ll fall on your head faster than you can read this post.

I know that, even with a CGM, I cannot safely manage my diabetes with two strips per day.

Can you?

Dr. Edelman was calling on his fellow docs to “stand up as advocates for the rights of our patients to receive quality care and for our rights as physicians to practice appropriate medicine.” Amen.

Our docs are taking up arms to defend us. I think we should join the fight. Here’s Dr. E’s simple plan of attack. Call the Congressional Switchboard at 1-866-220-0044. If you give them your zip code they’ll connect you with your Senator’s office. Each Senator apparently has a Healthcare Liaison. Give that person an earful.

OK, I might have paraphrased that last line a little bit. Dr. Edelman isn’t quite as radical as I am.

Not yet.


Anonymous Anonymous said...

I can't even see straight after reading this... This so sets the stage for it to happen across the board, I see it already and hear the insurance company monkeys on the other end of the phone trying to convince me this is so great.

I'm so on this. These idiots must be stopped. Thanks for passing the word along, Wil. I plan to repost this over at The D-Corner Booth asap. At least, as soon as I uclench my fists and stop spitting nails at the computer screen...

10:30 AM  
Blogger Brenda Bell said...

FWIW, most of the time I've been paying for my own strips and ignoring the insurance coverage. Most of that time, it's been because I can get the quantity I need cheaper through mail-order than I can by going through insurance. I can usually get the quantity insurance will cover cheaper through mail-order than by going through insurance.

And FWIW, I'm a diet-controlled Type 2 who tests on average 5x/day.

11:04 AM  
Blogger kath said...

You are right.

I know several people who are NOT on Medicare who are limited by the same restrictions.

12:28 PM  
Anonymous Tim said...

Wow! Although us Brits moan and groan about the NHS, us type ones don't have any problems getting unlimited test strips over here.

Type twos can be restricted in how many they use in some areas, depending on the wonderousness of their local Primary Care Trust (PCT) but it's never as little as one or two a day.

Move to Britain - you're all more than welcome!

3:52 AM  
Anonymous Sysy said...

Thanks for posting about this, I linked to you on this and another post you did recently in my lastest post.

Like Michael, I need to calm down right now...

7:40 AM  
Blogger Gretchen said...

I'm a type 2 who uses Levemir. So Medicare says I can have 3 strips a day. In my situation, this is usually adequate.

However, I actually get more strips when they're limited. If I were allowed 8 strips a day, I'd wait until I was almost out and then get more.

But when I know they're limited, I get the maximal allowed amount and stockpile them when I'm not testing much for the times I want to do intensive testing.

I realize not everyone could deal with this, but I think we should try to figure out how everyone can get the strips they need without wasting them.

Type 1s clearly need a lot of strips to maintain good control. They shouldn't be limited. If they are, the total costs of diabetes treatment will increase.

If the government thinks costs are too high, they should make sure strips are cheaper.

I think type 2s need a lot of strips in the first year after Dx, so they can figure out how food and exercise affects their BGs. Then they can back off.

Where the strips are really "wasted" is when a type 2 is told to test X times a day but not educated about what to do with that information and the doctor doesn't have time to look at the BG readings.

Better testing education would result in more efficient use of strips for type 2s.

8:14 AM  
Blogger Dougs ramblings said...

This comment has been removed by the author.

10:51 PM  
Blogger Dougs ramblings said...

More of the "Hope and Change" we were promised... Bah Humbug... This is just the tip of the iceberg...

Health care will be much cheaper when all the sick people are dead...

10:52 PM  
Anonymous Bernard Farrell said...

Wil, that's just crazy. Talk about a good way to increase Medicare costs. At 2 strips/per day anyone with diabetes would probably be costing Medicare a lot more after a few years.

Thanks for bringing it to my attention. For some reason I didn't get the message from Steve Edelman, I'm surprised he didn't put it up on the DOC.

2:38 PM  
Blogger Sparrow Rose said...

Just found your post. 8 months later and I'm still getting 3 strips per day on medicaid, thank . . . whomever!

I live on $600/month so if medicaid cuts back on strips, I'm in trouble. There's no money to supplement them.

As it is, 3 strips is really not enough. I wake up, take some basal insulin, wait until I'm ready to eat breakfast to check morning sugars (on those occasions when I've had the opportunity to check both morning and pre-breakfast, I know that's not accurate, because I wake up at 90 and start going up until I eat. By breakfast, I can be up to 130 or higher.)

I use that reading to correct as well as bolus. Since I can't test afterwards to see how well I did, I live on a 0-20 carb-grams-per-day diet. Which is kind of limited and can get really boring and I CRAVE salads all the time but can only safely eat plain romaine lettuce because I have to count everything else that goes in a salad and it's real easy to make a 30g salad, just adding veggies.

I don't test before lunch, so I can't do a correction and I don't feel safe bolusing when I don't know where I'm at so I eat 0 carb for lunch or I eat a few carbs (usually nuts) and expect to run a little high and correct for them before dinner.

I test, correct, bolus for dinner. That third strip is saved in case I wake up low in the middle of the night, which doesn't happen all the time but it does happen, especially if I get overheated while I'm sleeping.

When I've saved up enough of the overnight strips (I need at least two for a low - one to see where I'm at and one to check after taking sugars to see if I'm okay to go back to sleep.) I use some of them for "luxuries" like testing at lunch (so I can have a salad! yay!) or testing after a meal to see if I'm still on track with my ratios, etc.

I REALLY want to get my A1c below 6. It's my dream in my diabetic life. But I usually end up crying when I get my A1c results because it's so clear that, even withthe low carb diet and even with walking three miles a day and even with being so vigilant, I'll never get below 8 so long as I don't have enough test strips.

6:05 PM  

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