Insurance of the Year Club


We're switching insurance again.

Of all the employer-sponsored insurance plans offered for 2019, our current plan will now be three thousand dollars more expensive for the year than the least expensive one. The cheapest of the three, of course, is the one we've never had. We will sign up for what the company calls a 'gold plan,' and the system is tiered so that all insurers in the gold plan cover similar medical services, charge the same copays and have the same deductibles. The gold plan's coverage fits our high medical use and costs, and so is our best choice. But the per-paycheck cost is staggeringly different for each plan.

We did our homework, which was easier this year after lots of practice last year. The new insurer will cover all of our current doctors and drugs (though still not Novolog which stinks). It's possible we'll be able to escape Edgepark's grip since other DME providers are listed, but I'm not holding my breath since they are still one of the options. And while I generally subscribe to the adage, 'the devil you know is better than the devil you don't know,' $3000 is a lot of money.

The big risk, the one we can't get a clear answer on, is whether there will be hoops we have to jump through to get coverage for diabetes-related equipment. We delved pretty deep into the new insurer's website and made phone calls to learn about diabetes coverage and could not come away with a clear answer on whether we'd have to prove my daughter's need for an insulin pump and CGM before coverage is granted. Between reading and conversations, the possible answers range from 'you might need a letter of medical necessity from your doctor' (which is pretty standard), to needing to submit tons of documentation, to maybe they don't cover CGM unless it's some sort of dire situation.

I'm well aware that we're incredibly fortunate that we have access to insurance at all. That we've consistently had access to really good insurance, which for the most part covered what we needed with little to no hassle, is unusual. Maybe that's about to change, but after 16 years at this, I'm prepared to use every tool I now have up my sleeve to fight for what my daughter needs. Hopefully we'll repurpose that $3000 wisely. If need be we'll spend it on things that aren't covered. Or on a little getaway to help me recover from a year of insurance fights.

Slowly but Surely


Our household diabetes policy (yours may vary) has been for my daughter to take on diabetes responsibilities as she feels ready. The understanding has been that while we do not expect to live in her college dorm with her, she should not feel rushed. Every diabetes task will ultimately be hers, for the foreseeable future.  For now, we're here to help.

Slowly but surely over the past sixteen years, one or two things at a time, my daughter has taken over her own care: blood sugar checks, carb counting, then insulin pump site changes, and so many more in between.

The Dexcom was at the center of the two lingering exceptions.

Because of the awkwardness of the G4's insertion device, I continued to assist with putting in a new sensor every 7 or so days. She did it once, to prove to herself that she could in case it failed while she was traveling without me, but it was super-awkward and I was happy to keep helping. The insertion device for the G6 is a much easier to handle one-handed push-button device. My daughter inserted the first and second ones with no problem. It's easy and nearly painless, she reports, though the spring-loaded insertion contraption is alarmingly loud.

The second area of responsibility we've recently relinquished (to some extent) is overnight diabetes care. Until the G6 arrived, the Dexcom receiver remained on a parent's bedside table each night. We got up to deal with its alarms while my daughter slept, or roused herself briefly for juice. That routine, of course, followed years of setting 2 a.m. alarms for fingerstick checks.

The new plan is that my daughter keeps her phone, and the Dexcom receiver, on her bedside so that she can awaken to deal with the alarms. She started with just the phone, but the Dexcom app alarms were not loud enough to consistently wake her (though they woke both of her parents in the next room). She's added the receiver, which she keeps on the bed with her to feel its vibrations, and so that two alarms are blaring at once. She still does not consistently wake to the alarms, while I, of course, still do. But things are improving. She did wake up and treat a low this week without my hearing anything, which was good news. And the alarms are diminishing after the Thanksgiving leftovers are gone, and as we use the Dexcom data to work on keeping numbers more consistently in range...which is the ultimate goal.

It's bittersweet to watch my kid take on these responsibilities. Yes- by all rights they're hers to deal with and it's important for her to practice with the safety net of mom and dad around to help. But how I wish she didn't have to.

G6


The Dexcom G6 is up and running, and it's keeping us running.

Technologically we're totally impressed. It's accurate. The readings flow seamlessly from the transmitter to my daughter's iPhone and the Dexcom receiver, and then on to my phone and the Dexcom Clarity page online. And no fingersticks? Amazing.

We used our previous CGM, the G4, only as a general guide. Heading up or down? Always alarms between 2-3 a.m.? Should she do anything before changing for gym? It was less accurate and had crapped out months ago on sharing numbers to anybody's phone, so unless it was alarming with an urgent low, it was mostly background noise to be addressed eventually.

The G6 feels less like a lowly assistant making suggestions from the corner of the conference room and more like the boss. What it says goes. Low predicted in 15 minutes? Eat something. Now! Suddenly skyrocketing? Drop your pants and check that site! Clarity shows you've gone over 220 after lunch five of the past seven days? Fix something!

Some of that is good for us. Most of us get lazy with diabetes at one time or another, and of late, we have. Having the G6 looking over our shoulders and nudging us at every turn is causing more action than had been happening here, at least in terms of more minor excursions from a target blood sugar range.

Some of it, though, is wearing. Already. After 12 days. (But who's counting?)

The alarms are driving us nuts. Starting it up over a busy school play weekend followed by a Thanksgiving week full of family and food certainly didn't help. Diner pancakes at 10 p.m., daily servings of stuffing, and pecan pie two nights in a row are rare treats, and as the schedule goes back to normal, alarms are settling down. We learned quickly not to have both the Dexcom receiver, and all of our phones set to alarm when all of them are in the same house. The cacophony and the subsequent process of silencing them all would jar anybody's nerves.

We're also struggling with information overload. The numbers are in our faces all the time. Because the previous system's data went only to its own receiver, my daughter would look at it at mealtime, before bed, and when it alarmed. Now can see numbers whenever she opens her phone. And with share operational again, I too can see numbers anytime I want instead of looking at the receiver once a day- or less. A diabetes-life balance is, in my opinion, a very important aspect of living sanely. It will take some time to figure out how to compartmentalize the extra information so that it does not overwhelm.

Was it worth waiting for? Absolutely. The steady stream of accurate data is incredibly useful. It helps with hour to hour decision-making. Once the bulk of the data isn't skewed by Thanksgiving food, the long-term graphs will be incredibly valuable in adjusting basal rates and bolus ratios. And maybe when the data settles down into a more predictable range we won't mind seeing it so often.

Humbled


Have you signed Dr. Frederick Banting's birthday card yet?

I did, first thing this morning. On the card (you'll see it when you click the link above to sign it) there's an area to write a personal message. I wrote, "Thanks to your work, I have an amazing teenager." 

Before Dr. Banting and Dr. Best made their discovery of insulin in 1921, people with Type 1 Diabetes died. Their bodies wasted away. It's humbling to consider.

In 2002, on a crisp December morning, we rushed my daughter to the hospital, and by mid-morning she was receiving insulin. She's now a thriving high school student who is looking forward to this weekend's school play, college in a couple of years, and a career in education.

Had she been born less than 100 years earlier, she simply would have died. Probably by Christmas, only a few days after we'd called the local doctor to stop by on his rounds to examine her.

I'm thankful to Dr. Banting, and his colleague, Dr. Best, for making insulin available so that my daughter can be alive. And I'm thankful for all of the discoveries and inventions that ensued, including modern synthetic insulins, increasingly accurate technology for glucose monitoring, and insulin-delivery tools that have come a long way from regularly boiling and sharpening the one syringe in the household.

Dr. Banting's birthday, now World Diabetes Day, helps put life with diabetes in perspective. There was no life with T1D before Dr. Banting. It's still a daily challenge, and the dangers aren't completely gone, but my daughter is here, and thriving. I couldn't be more grateful.

Happy Birthday, Dr. Banting.

Trick-or-Treat


It was 8:45 on Halloween. The doorbell hadn't rung for almost an hour. And then it did. We paused Survivor, and my daughter got up to greet the trick-or-treaters. She had enjoyed her door-answering responsibility all night, and I was glad to let her get up one more time.

Peeking through the living room window, she recognized a life-long friend at the door, dressed as Kim Kardashian.

She opened the door, and I could hear another voice, in addition to my daughter's and Kim's. There was a little chatting about the nice weather and what the girls had acquired in their travels. "There was a house handing out apples. Honeycrisp ones though, which are amazing, so I guess if I wash it I can eat it?"

My daughter then offered as much of our loot as the girls wanted to take. We didn't have as many kids as usual, and so generosity was in order.

"Are you sure? Thanks so much," Kim Kardashian exclaimed.

"Ugh, my mom won't let me eat most of it anyway," replied the other voice, which I was still trying to place.

"Take the airheads" was my daughter's quick response. "They're great for low blood sugars!"

Now, of course, I was able to narrow down which friend was accompanying Kim Kardashian on her rounds.

"Ha! Yes- I will! My mom buys terrible glucose tabs at Costco. I can't stand them."

Now Kim Kardashian's friend has a nice stash of airheads for her low blood sugar needs.

Who says Halloween and diabetes can't go well together?

Another Wait


The Dexcom G6 finally arrived last week, after a wait which was entirely too long.

And yet, we've decided to put off using it.

There are still 3 Dexcom G4 sensors here, and we've decided to use them up.

The wait is, in most respects, really hard. It's like getting a new toy on Christmas morning and not getting to play with it until February. Why would we torture ourselves like this?

We have our reasons:

We are grateful for what we have, and don't want to waste the G4 sensors. We're certain that once the switch is made, there's no way my daughter will want to go back to the G4 for a few weeks to use up the old supplies.

We feel much more comfortable with supplies in reserve. By waiting a couple of weeks, we build up a few extra G6 sensors in the supply closet for a rainy day.

We want to take the time to start it and to set it up right. Because of our family's marching band commitments, time is at a premium in October.  We're waiting for a quiet evening, or weekend morning, to sit and learn the minimal but important basics of insertion and sensor start-up, download the apps and software, and learn how to use them. That might not be until November.

And the most trivial reason? The Dexcom receiver fits perfectly in the tiny pocket of the marching band uniform jacket, and my daughter's phone (which will be her new receiver) does not. Waiting until next year to solve that problem, which will likely involve some stealthy sewing, feels easier.

So we wait, the box of G6 stuff taunting us from the corner of the dining room.

Back to Insulin One


A change in insurance has led to a change in insulin.

We've used up our stash of Novolog, and the first cartridge of Humalog in several years went in the pump 3 days before back to school.

Some people say they experience no difference at all between the two insulins. Some think Novolog withstands heat better. Maybe Humalog sticks around in the system longer. Humalog could be more likely to clog infusion sets. We switched to Novolog a few years ago because it was reported to kick in just a little bit faster. Some of the differences are detailed here, on T1D Living.

The key difference to us is that insurance will pay for Humalog now, and it won't pay for Novolog anymore.

There are too many variables here for this switch to serve as a scientific experiment. The change coincided with an already established need to make some pump setting adjustments. It also coincided with back-to-school, and with the hamster wheel which is marching band season. A couple of things do seem obviously different, despite the chaos.

What we've noticed for sure is a greater need to pre-bolus breakfast. That aspect feels familiar to me from our switch from Humalog to Novolog a few years ago. Breakfast, after which my daughter's bg had spiked significantly almost every day since diagnosis, became more manageable with Novolog. The Humalog is a little more sluggish.

I'd also agree that Humalog sticks around a little longer. It's hard to see during the day, but I'm noticing that the Dexcom graph's downward slope continues longer on the last-before-bed bolus, or for any overnight corrections.

Because we're changing basal rates anyway, based both on feedback from our last endo appointment, and on the schedule changes from the start of school, it's hard to tell what other differences there are. It won't be until we finish tweaking that we can see, for example, if the total daily dose went up.

Given my druthers, I'd say Novolog is probably a snappier variety of insulin, and that it would be nice to go back. But in accounting for Humalog's more sluggish nature we're making adjustments that are working.

Humalog and NPH were the first insulins prescribed when my daughter was diagnosed. The glass-half-full part of me will note that Humalog's challenges are minor and manageable compared to the nightmare that was NPH.