The Long and Short of It
There are so many decisions these days to be made. One being that Tyler wants a CGM because he is tired of going high during growth spurts. He hates how he feels. He has always been scared to go low at night, he reads a lot and knows the truth about D.
We began the investigation of the CGM and guess what? If he wants the CGM our ins. wants him to have the pump too. Tyler is hesitant of the pump, again, knowledge can be a double edged sword. He knows that day to day facts and life with the pump. He is 14 and needs to make these decisions on his own. So heavy for a 14 year old, yet I can not make this decision for him.
He did a pimp trial. He did not like it. It was a constant weight ( no pun intended) on him, a constant reminder that T1 was following him... Throughout the trial he kept saying I just want a cgm...
We discussed that we could try the pump which reads the cgm.. and if he does not like using the pump, we will just use it as a cgm. His insulin needs are still very low. The Pens team evaluated us to see if we could “get” a pump. OK I will not get into that whole scene other than they were seeing if we were “worthy/competent of getting the pump.”
Case closed. His rate evaluation was .025 and the nurse said we just squeaked by to be able to use the pump.
As this post has been sitting in documents (way too long), waiting to be finished, the pump company called. They said the pump was approved by ins. but the cgm was not. Why you ask???
Because Tyler does not go low often enough in their eyes to warrant it. HUH?????
A night of below 20, nights hinging in the 80’s and 90’s that required frequent checks, the nights he goes from 190 to 88 in 4 hours? They have his numbers but they do not see a reason... I stated we want it for when he goes high too, Tyler does not like to go high. Highs do not concern them, again huh????? Honestly, I would like to invite whom ever is making this decision to come over an spend a week with us, be in charge of Tyler, get up multiple times at night and then tell me “no”. If you are out there, please call, I would love to have a break and get some sleep.....
This is a big problem for everyone. They have guidelines that say they need to have so many lows in this exact amount of time...and if they don't see that, no matter what else is on the paper...they deny. :p~~ I would call the Dexcom rep and ask their assistance in helping get a cgm. Dexcom doesn't not need to speak to a pump, and the company will lobby for you. We don't use it, but I've heard great things by other bloggers! Good luck!
ReplyDeleteHow weird that they would turn you down. When I did the paperwork for Elise's CGM, the question where they asked how many times had Elise gone below 50 in the last 3 months, I could only truthfully answer 3 (but she had a ton of lows in the mid 50s and 60s). We were still approved.
ReplyDeleteWe never even had to supply log sheets like almost everyone else I've talked to did. Maybe it just depends on the ins. company. Good luck, I hope it gets figured out.
BTW, we use Dexcom and it is wonderful! They did all the ins. stuff for us.
Hi Alix
ReplyDeleteOur son is 13 and was diagnosed in Feb of 2010. His insulin needs are very low as well. He is using the Minimed Revel pump and CGM. Deciding to pump is such a personal decision. T felt like the shots, drawing insulin and using the pens made his Diabetes more obvious to everyone. On the pump he feels a little "more normal", his words, not mine. The insurance battle is SO frustrating and wrong- I was told they would probably deny T the pump as well. Our insurance will Anthem BC will not approve a CGM unless you are on a pump. Period. It just isn't right that some one in an office makes these decisions regarding our childrens' health. I think it is entirely possible to use the CGM on the Revel without pumping insulin. Perhaps that is an avenue to pursue. I understand that with the Revel you may have more of a chance of getting the CGM because they are designed to work together. I have to say- since starting the pump T has had MUCH fewer low blood sugars and his A1c has come down from 6.0 to 5.2.
The pump was T's decision, I was the hesitant one.
Thanks for letting me know I am not the only one experiencing this problem.
ReplyDeleteApril, we are pursuing the revel/cgm...
Meri~ thanks for another route
Joann~Thanks for a second vote for dexcom, if this does not go through
Tyler wants to try the pump... but for him the cgm is a safety net....
Hi Alix...found you through Candy Hearts...blogger basal. I am the mother of Joe (7 years old) diagnosed when he was 3. We use the Dexcom and LOVE IT. I did supply the log sheets and it IS ridiculous that the "requirement" is 3 lows less than 50. Good luck...
ReplyDeleteOh Alix! I'm so sorry. I think Tyler is being very smart about this, it's a shame that the people on the other side don't understand.
ReplyDeleteWhen I broke my receiver and was looking at a replacement/new sensors, I had recently switched insurance companies. In order to pay for the sensors, my new insurance still wanted to see a certain amount of lows below 50. I found that especially odd given that those lows would have been WHILE I WAS USING THE DEXCOM. In other words, they have perverted their criteria to the point that it may even be an argument to say you can't keep using the DexCom UNLESS you are still having dangerous hypos. There's no logic to it, they just need a way for someone who knows nothing about diabetes to be able to look at a chart and decide in 2 minutes whether or not you qualify (and then tell you two weeks later).
As you know, I use the CGM w/o a pump, and find it to be a great system. I like the flexibility of MDIs, and traveling with even more supplies (and a backup pump etc etc) is too much for me. Yes, it can be more work to calculate carbs etc, but I've never had a kink in a syringe or pen- every time I think I have bolused, I know for sure I have bolused.
ps- i like the new look :)
ReplyDelete