Need help navigating life with diabetes? Well, here's your chance to Ask D'Mine! This is our weekly Dear Abby-styled Q&A column, tackling whatever questions you in the diabetes community might be itching to ask. The column is hosted by veteran type 1 and diabetes author Wil Dubois, who works professionally running the diabetes education program for a rural non-profit clinic in New Mexico.
This week, Wil offers some thoughts on glucose meter options for those looking to make a meter switch, and also advice on dealing with the ever-headache-inducing insurance companies.
Got your own questions? Email us at AskDMine@diabetesmine.com.
Doug, type 1 from Texas, writes: Hi Wil, I'm still using an out of warranty Cozmo pump which is showing signs of impending doom. I'm considering ordering the t:Slim, but my issue is I don't want to give up the integrated meter on the Cozmo. It's small and it's always with me and it sends the data to the pump. The biggest issues for me are the size and convenience. Do you have any recommendations on meters to use that won't add bulk to what I have to carry?
Wil@Ask D'Mine answers: Sure thing, but I want to start with a quick note about entering blood sugar into the t:slim. It's no secret that there a lot of things I don't like about the t:slim, but entering blood sugar is not one of them.
I agree with you that having a meter that talks to your pump is pretty swell, but we only have two choices on that front: Animas Ping and Medtronic Minimed Revel. The Ping uses a meter that's bigger than the pump, and I find that just plain wrong. The same used to be true of the Revel, but, right now anyway, the Bayer meter that Medtronic is using as part of their system is pretty petite. But with any other pump—or with either one of those two if you can't get the strips or hate the meter—you have to enter your blood sugar yourself. Manually. And, on every pump but t:slim, that means scrolling. And scrolling is a pain in the ass.
As far as I know, all pumps scroll one number at a time. The higher your sugar is, the longer it takes to enter it. On some pumps the speed increases the longer you hold down the scroll button and ultimately you end up doing the pump equivalent of pruning hedges. Oops! Too high! Back, back, back... Oops! Too low! Up, up, up...
You know, really, the damn meters are so inaccurate anyway, I wish the pumps would just scroll the BGL by fives instead of ones. It would be easier on all of us, and wouldn't affect the accuracy of the bolus at all. We're dancing on quicksand here anyway, given all the technical and biological variables.
Anyway, the t:slim is a scroll-free pump and tapping in a blood sugar is a breeze. It takes five button taps. One tap to tell it you are about to enter a BGL, three more taps to enter your level (because if it took four, your blood sugar would be 1,000 or more and you'd be dead), and one final tap to enter it. For any blood sugar level worth entering into a pump, it's faster on the t:slim than on any scroll-job.
That said, tapping or scrolling will seem primitive, slow, and aggravating to you, compared to having the data magically beamed to the pump from the meter. So be warned. But if t:slim, on all other fronts, seems like the right pump for you, you'll adapt.
Now, let's talk meter size. A small meter is actually no small request. Some meters are small in diameter, but thick, like the Accu-Chek Nano. Others are larger in acreage, but thinner, like the OneTouch's VerioIQor Walmart's Confirm. Some are more pen-shaped, helping them take up less room in a meter case next to a lancing device. I'm thinking of meters like the Ultra Mini and the various knock-offs of it. A middle of the road combination of dimensions is the AgaMatrix Presto. But when it comes to traditional meters, the King of Small remains the FreeStyle Lite, the son of the famous Flash meter.
But if you really want the smallest meter in the world, you need to break with tradition. The only choice for you is the iBGStar. Nothing is smaller or lighter. Period. If you have an iPhone, iPad or iPod Touch, it plugs right into the bottom of the Apple device and it can just live there. If you don't have an iDevice, you can actually use the iBGStar as a stand-alone meter. And it's what? About the sizeof a peanut? This is my favorite meter in the whole world. I still wake up at night crying because I miss mine so much. (My insurance would not cover the strips, nor would they accept the co-pay card to reduce the cost, nor could I afford to buy strips out-of-pocket and still eat.).
The second-smallest non-traditional meter would be the disposable Nipro Sidekick. The meter is actually the top of the teststrip vial! No shit. But of course, I'm not sure how that would play out with your insurance.
I hope that's some (small) help to you!
Sandy, type 1 from Illinois, writes: About 6 years ago my endo put me on CGM because I have very little awareness of highs and lows. I have gone as high as 400+ and as low as 42 without much indication to me or anyone around me. Using CGM, my A1C has dropped from over 9 to between 5.8 and 6.3. CGMs are great if your insurance pays for them, as mine did when I worked. But now I'm retired and my Medicare and Medicare Advantage programs will not cover my CGM, so I'm without it. Insurance for seniors is really a rip-off because they will not even partially pay for items that will maintain a healthy life. I know that my story won't change the insurance industry or the medical industry or any other industry. I can't afford the CGM, but I sure do miss it and wish I could get it back again. Well, thanks for letting me vent.
Wil@Ask D'Mine answers: It's true that as of today Medicare won't pay for CGM. Nor will any of the supplements. And as far as I know, neither Medtronic nor Dexcom has a senior discount or a Patient Assistance Program for people like you. They really should. After all, you've been supporting them by purchasing their sensors through your insurance for years! There oughta' be loyalty points or something you can cash in. (Anybody in CGM-manufacturing-land listening?)
Meanwhile, back to Medicare. Yes, it is a rip-off and it totally sucks. You've been paying into Medicare all your life. Your CGM let you live long enough to get to the point where you can use your Medicare, then you are robbed of the CGM! If your life weren't at risk you would laugh at the irony. Of course, you can always try an appeal, which is a painful and time-consuming process. Why should you have to fight the powers-that-be for your right to stay healthy and, ironically, save them money? But the sad truth is that if anyone has succeeded in winning the Medicare CGM fight, I've never heard about it, nor can I find any evidence online that anyone has.
Still, someone will win eventually. Why shouldn't it be you? This is a fight that needs to be won. And eventually it will be won. It's going to take mountains of paper work, appeals, and patience. And I think you should take it on. But I think you should go further. I think you should also start a grass-roots, noise-making, rabble-rousing movement to change the policy.
Huh. It sounds a lot like a fight from a few years ago. Don't forget that it wasn't that long ago that NO insurance covered CGM for anyone. Now, most commercial plans do, and often with very little fight at all. How did that change? Due to the hard work of patients who needed CGM and took the time to advocate, educate, and agitate. It was a long, hard road. But look where we are now.
To me, it sounds like the perfect retirement project for you. You could start a revolution dedicated to re-enfranchising the dis-enfranchised senior diabetics who are losing their CGMs. I think you'll win.
Why? Politicians are afraid of people with grey hair. You folks vote.
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.