Need help navigating life with diabetes? You can always Ask D'Mine! Welcome again to our weekly Q&A column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil offers some thoughts on getting "free" test strips and logging blood sugars. So, read on!
James, type 2 from Nebraska, writes: I have been paying for my test strips and just found out about the free strips from Medicare, but I don't have any info on what I need to do to get them. Can you help me out?
Wil@Ask D'Mine answers: I was once given a free cat. Trust me, there's no such thing as a free cat. And the same is true of test strips.
Test strips are covered under Medicare Part B at 80%. That means, in theory, that you should be left picking up the tab for the remaining 20%, but it's actually more confusing than that. Medicare actually pays 80% of the "Medicare-approved amount," so if your strip is more expensive, you could pay more.
But wait, there's more. Not all Medicare plans are created equal. Parts A & B are the basic package, but many seniors have a Part C plan, or a Medigap plan. If so, those extra layers of Medicare coverage may pick up that 20% co-insurance for you, so your strips are, if not exactly free—as you are paying for the extra coverage—as least not yet another expense every month. Of course, if you have either of these optional extras, you're right that you're wasting money paying for your strips yourself.
Because it depends how good a strip you need.
As of this summer, Medicare will only cover strips that are sent mail-order from a handful of winners of a competitive bidding program. Many of these meters I wouldn't wish on my worst enemy, if I had one. They're super-cheap meters from countries whose manufacturing prowess does not inspire confidence. Many are decades-old designs with pathetic accuracy ratings. They are, in a word, stone age meters. Are you a caveman, James?
Still, I get it. Money is money, and no one has enough. The place to start is at Medicare.gov. Enter your zip code and tell the computer you're interested in mail-order diabetes supplies. It'll give you a list of about 20 outfits still left in the biz of supplying Medicare seniors with meters and strips. It will take some legwork, but you can email or call most of them (some don't have email addresses!) and ask them if they carry the meter you use now, and also ask them if your flavor of Medicare will cover the strips 100% or if you'll have a copay to make.
And if they offer you a free cat, just say no.
Kevin, type 2 from Nevada, writes: I was just diagnosed and my doctor told me to log my blood sugar. How do you go about getting a log? Do they provide it or can use your own log? And where do I send it to?
Wil@Ask D'Mine answers: Welcome to the family! Sorry to hear about your diagnosis, but I'm glad you found us, and I'm happy to see that you are taking the bull by the horns and asking questions and figuring out what to do right out of the gate!
Most meters come with a blank logbook, sometimes called a diary. It's probably buried somewhere in the box the meter came in along with the 12-languauge owner's manual, warranty card, assorted offers, test solution, and other crap you don't need. Look through the pile of papers in the box. There's probably a logbook in there somewhere. It looks like a checkbook ledger, only a hair smaller. Some are awesome, and some are just a few pathetic pages of glorified graph paper stapled together. There's no standard because no two PWDs needs are the same.
It used to be that if you liked the logbook that came with your meter, and filled it up, you could get a replacement book by calling the toll-free number on the back of your meter. You should still try that, but I've discovered a disturbing trend: Many companies have abandoned the free logbook and are now charging PWDs for them. Exhibit A: OneTouch is selling their pathetic little logbooks for $1.99 each. Gosh, I guess they aren't making enough on test strips.
I was also shocked to discover today that a wide variety of online third-party vendors that no one has ever heard of are now selling what used to be a free resource. You can buy books made by Accu-Chek, Bayer, Freestyle, NovoMax, TrueTrack and more. This is crazy! Granted, it's not a lot of money—most are only a couple of bucks—but still, who knew? Not me until today, that's for sure. Even the American Diabetes Association has gotten in on the action by selling a three-month log in their store. There's at least one hardcover log sold on Amazon, and eBay has a number of logs for sale as well.
Of course, there are a number of log sheets you can download for free, including this one designed by a doctor, but 8.5-by-11 pieces of paper are hardly handy compared to a small diary that fits into the meter case.
Back in the day, a number of PWDs who found the logbooks made by meter makers lacking in the features they needed developed what they felt were superior log books and sold them online. I myself remember being frustrated by the logs when I was first dx'd and set out to create the perfect logbook. It's easier said than done, and I never finished the project. Anyway, I guess most of these basement and garage businesses have gone under, because I couldn't find any of them. And that may be because paper logs are going the way of the dinosaur.
Most meters have a memory feature that stores the last 600 or so readings and can be downloaded to a computer for analysis by your clinician. This is a mixed blessing, however, as I've found that people who just let the meter remember their numbers tend to think less about them. Not uncommonly, when I download someone's meter I'll see some outrageous outliers. "Hey, tell me about that 560 mg/dL last week," I'll ask.
Imagine a blank stare, like a deer in the headlights, followed by a shrug of one shoulder.
Yes, some people can clock the stratosphere and it doesn't even register. Automation amnesia. Or maybe it's automation lobotomy. When I clock a stratospheric number, I'm freaking the-eff out.
Where was I going with this?
Oh, yes, logging. Logging is not only good for your doc, it can be good for you, too. Writing numbers down makes you think about them. So I salute you for being a Lumber Jack and taking logging seriously. Now of course, "writing" can be metaphorical. There's a plethora of diabetes apps for mobile devices nowadays, which may also be playing a part in the impending extinction of the blood sugar diary.
One of the oldest of this new wave of electronic diaries is Diabetes Pilot (originally developed for the Palm Pilot, the granddaddy of all mobile devices). But there are a ton of other apps like Glucose Buddy, OnTrack, and Pal. I actually use RapidCalc myself, but not so much for the logging as the insulin dose calculator and IOB tracking it features. Mike especially likes MySugr Companion, whose makers have recently teamed up with Manny's gang over at the Diabetes Hands Foundation for the Big Blue Test, while Amy's taking a serious look at a new program called ManageBGL.
One caveat on electronic logs, though. If your doc wants a paper log to look over, be sure any mobile or online app you use can print out the data so he or she can view it. To that end, you could also check out Glooko, a product with a cable that lets you print out or electronically share your meter results with your doctor.
Now, you also asked who you need to send your log to. Mainly, your log is for you and for your doc. However, your insurance company (or Medicare) has a right to see it and may require your doc to send it in, or may make your pharmacy keep a copy. Why? Your numbers are none of their business, right?
Well, your numbers aren't, but strips ain't cheap, and that's led to the folks who pay for them wanting to be sure that you are actually using the strips they are paying for. A log confirms that you are using the strips they paid for, that's all. And using a dead-tree book, a download printed to a dead-tree piece of paper, or entering numbers on a snazzy mobile device are all ways to do that.
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.