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Answering Reader Questions

David Spero

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
Dangerzone wrote: “I have had diabetes for 34 yrs and have hypoglycemic unawareness. I don’t feel anything until I am in the 30’s. I’m trying to stay alive and out of the hospital. My doctor says I need the pathway pump with the sensors and my insurance refuses to cover any part of it. The insurance claims that I have met my $10,000 lifetime limit.”

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 ([800] DIABETES) also offers some advocacy services and advice.

Oral Meds vs. Insulin
Gayle wrote: “Last year I noticed my sugars were beginning to be too high. My doctor immediately said I needed insulin. I disagreed since my only meds were glipizide 5 mg twice a day and metformin 2000 mg a day. I knew that the glipizide could be increased and that there other meds that I had not tried. My doctor must have completed a crash course in Type 2 medications because I now am using Avandia, 4 mg twice a day, 5 mg glipizide twice a day, and 2000 mg metformin per day. I haven’t gotten the results of my latest HbA1c, but I’m hoping to have a 7% or less result.”

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?

Judgmental Docs
Zoebear wrote: “Doctors and nurses unfortunately DO make assumptions and refuse to listen to reasons which they hear as excuses. Key words are overweight, pain meds, fibromyalgia, arthritis, tried and failed.”

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?

Success Stories
Congratulations to Sarah, jenstype2, and Sue on their recoveries and great self-management!

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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