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Comparing CGMs to Crayons…

August 24, 2009

The start of this adventure was back in December of 2008 after I started on my OmniPod system. I was getting much better control with this pump because, unlike my prior pump, this one had things like “Insulin on Board”, “Bolus Calculator”, and all that good stuff, not to mention, it was the perfect, closed loop system in my opinion because the PDM had the built in monitor as well. Everything could be kept in a neat, nice little pouch inside of my purse.

Well, as always with getting better, lower numbers, you also get more of the not so good, lower low numbers as well. I could deal with them at the time because there were only a few per week, or I’d only have one really bad day in the week where they just wouldn’t come up. But as with any time you make adjustments to lower the still-high-highs, you are more prone to getting the lows. Well, over time, I am losing the ability to tell when I am dropping low. It’s not quite as bad as some, but where I used to be able to feel a low coming on in the 80-70 range, it’s now down to the 50-40 range, and that, to me, is scary. I have a fear that I will drop too low and not be able to tell anyone what is happening or what to do. I’ve heard many of the horror stories of people passing out, and I have done so myself, and that is something I do not wish to revisit again. So, I decided to apply for a Freestyle Navigator CGM. I chose this one because it would take the same strips as my OmniPod PDM. We filed the paperwork, hassled with my unwilling doctor to get the papers signed, and waited for approval.

The weeks went by and finally I got a call from Abbott that said my insurance had denied my request due to lack of medical necessity. Okay, first off, I would like to know what doctor read my file and said that I, a diabetic of 20+ years, could not show evidence through my testing that I needed a CGM. It’s kind of like when you are a kid and you want to get crayons from the store. You want the best… you want Crayola. But your mom says, “no, these are just as good”, and gets you the dollar store waxy crayons that when you color with them, you get more wax than color on your paper. You are asking the insurance company for the Crayola… The insurance company basically says no and gives you the waxy crayon… They say “No, you can manage your glucose just as well with only doing 8-10 checks a day as opposed to having 288 readings per day, and you should have no problem attaining a great A1C to reflect it.” We were going to file for an appeal, but I never received the papers in the mail. I decided just to give it a rest and try to do my best on my own. Since then, the aim for tighter numbers has given me more lows, still in the 50-40 range, but with less symptoms than before, and also leaving me with killer headaches. Ones that have even recently caused me to lose time work because they would physically make me too sick to work. I looked over my readings on my CoPilot system, and it showed a LOT of lows in the below 50 range happening more frequently than before, most of them unnoticed…

I submitted paperwork back on the 11th of this month to Dexcom to try for their 7Plus CGM since there are reports that they are teaming up with Insulet to somehow integrate the two systems. This morning, the representative informed me that they have already verified my benefits, and were waiting on a fax from my doctors office (a new doctor, due to problems with my old doctor, we switched. That will be covered in another blog. My new one is much better and is in favor of and promotes CGMs as well), then they were submitting everything they had to my insurance company for preauthorization. So the wait begins. I am hopeful… wishful… and am being as patient as I can possibly be right now.

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2 Comments leave one →
  1. August 24, 2009 8:27 pm

    Hang in there! Hopefully this time around it will get approved. You are so right about needing the DexCom, especially since you aren’t feeling the lows till they are too low. Having my Dex for the past few months has really shown me that my control was not as tight as I thought it was (I was spiking at 2am and coming back down to range by 7am). I wish insurance companies would realize that for a compliant diabetic patient, this piece of machinery could potentially lower the risk of complications even more. Then they save money on you in the long run! Yeesh….

  2. August 24, 2009 8:57 pm

    Good luck with your CGM battle. I had to fight for 8 months for approval, but am now wearing a Dexcom. 🙂

    And great blog you have here! I’m looking forward to reading your posts.

    – Kerri.

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