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Answering Reader Questions
August 29, 2007
I received many valuable comments on last week’s blog entry ("How the Medical System Hurts People With Diabetes"). I’m going to respond to a few of them today.
Fighting the Insurance Companies
I asked Dr. Alan Glaseroff, a wonderful doctor in Humboldt County, California who has Type 1 diabetes himself, to address this question. He wrote this reply.
“I’m in the midst of a similar thing with a patient now. It may not be true that the sensor is the ‘only answer.’ It has its quirks (I wore one for two weeks, and it is still fairly unreliable). The issue is making a case that paying for the sensor will save the insurance company money. How many EMT rescues, ER visits, and/or hospitalizations have you had in the past year that could have been prevented, vs. the cost of the sensor/pump system? For the insurers, it’s all about cost vs. benefit. Proceed in a business-case manner with them, rather than threats or overstated claims such as ‘If you don’t cover this, I will die a horrible death…’ After all is said and done, they are business entities.”
I hope this helps. You could certainly share this note with your doctor and get his or her help in dealing with the company. The American Diabetes Association ( DIABETES) also offers some advocacy services and advice.
Oral Meds vs. Insulin
Congratulations on speaking up to your doctor and getting what you wanted, Gayle. Let’s see how the additional meds work for you. The current trend is to start people with Type 2 diabetes on insulin earlier, and I support that. I especially don’t like glipizide much because these sulfonylurea (SU) drugs whip the pancreas to produce more insulin when it’s already working hard. Injecting insulin may give your pancreas a break and allow it to function better.
On Medscape.com (free log-in required), Dr. Zachary T. Bloomgarden, Associate Clinical Professor of Medicine at Mount Sinai Medical School in New York, wrote: “Insulin may indeed allow better maintenance of control than oral agents. A comparison of insulin treatment resulted in HbA1c levels that were 1.6% lower compared with SUs after 2 years in a group of patients initially treated with SUs. … A comparison of conventional treatment with multiple-dose insulin in Type 2 diabetes has shown a convincing decrease in microvascular endpoints [such as eye and kidney problems]. Such improvement may also be seen with combination therapy of insulin and oral agents.”
Insulin may not be right for you, Gayle. For one thing, you would have to start being more careful about avoiding hypoglycemia. But the doctor wasn’t way off in suggesting it. Glad you’re doing what works for you. Readers with Type 2 diabetes, what do you think about starting insulin? Are you on insulin, or thinking about it? How is it going for you?
A lot of health-care professionals are way too judgmental, which is another way the system can hurt people with diabetes. I’ll be blogging about this issue soon. What do readers think? Have you had such experiences?
Thanks also to those who wrote in about health care in other countries (see “Sicker than Sicko“). It’s great to hear so many informed opinions.
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