I just felt the need to spread the word … as I sit on my sofa … inactively killing myself.
I hope that shocking title will grab everyone’s attention, or at least the attention of diabetic Americans. I’ve only been on Caremark since January and am already extremely dissatisfied with them for two reasons:
1) They will only cover Novolog insulin. I have nothing against Novo Nordisk or against Denmark. But, please understand that I am a U.S. citizen living in the U.S. with a U.S. based health insurance company. And, that company will not allow me to buy my insulin from a U.S. company, Ely Lilly. Instead, they require me to buy from a Danish company, Novo Nordisk. They should cover all brands of insulin as different people get different results from the minor differences in the insulin analogs we use today. Especially in difficult economic times for the U.S., U.S. based companies should not be explicitly disallowing patronage of U.S. companies for the few things we still actually do manufacture in the U.S.
2) I was just denied coverage for my continuous glucose monitoring (CGM) sensors. For anyone who is not a diabetic or does not use CGM, this technology allows for testing glucose levels every 5 minutes throughout the day. While there are a lot of issues with the current level of this technology, it has quite possibly saved my life several times. Low blood sugar, in particular, can be immediately dangerous. Diabetics can go into insulin shock and die. These sensors have alerted me to very low blood sugar before I felt the affects several times in the last 4+ years since I’ve been using them. Far more often, they alert me to high blood sugar. While high blood sugar is generally not immediately dangerous, the long term affects of high blood sugar are both devastating and costly. They include at a minimum blindness, loss of limb, kidney failure, heart disease, neurological damage and severe constant pain, and impotence.
So, while the sensors may not technically be life-sustaining, they actually can prevent death and severe diabetic complications.
If you are a diabetic and have any choice in prescription drug plans, do not choose CVS Caremark.
Medco was far better. They all suck. But, Caremark is the worst I’ve encountered. If you are not a diabetic, I would still recommend against Caremark partially just to make the statement to them that if they want to remain in business, they should provide rather than deny health care. Also, since it’s probably impossible to really find out what will be covered in advance, I would suggest that it’s a good bet that if they treat diabetics so poorly, they probably aren’t singling us out. They probably treat all of their patients poorly.
I do plan to appeal this. However, I will be off of Caremark soon. So, really we’re talking about 3 orders. Still, at $420 per order, this is not an insignificant sum.
I should have moved to a civilized country years ago.
Please vote in the poll below, even if only to let me know that I’m being overly anal-retentive.
I only learned recently that the industry standard level of accuracy for blood glucose meters is to be within 20% of lab results. I learned this after a doctor’s visit where I tested my blood glucose (BG) via my home blood glucose meter within a minute of my blood being drawn for lab work. I noted my BG as 82 and thought, good, right on target.
Anyway, this time, I was careful to check very close to the time that the blood was drawn and equally careful to note that particular reading. Again, my meter said 82.
My lab result was 69! This is a difference of just under 19% (((82 – 69) / 69) * 100) = 18.84%, though perhaps I should just round to 19 since I don’t really have that level of precision in the actual readings.
My doctor has lately been telling me that Minimed/Medtronic is going to close the loop very soon now in providing an artificial pancreas based on today’s CGM and pump technology. Given my own experience, as well as the responses I’ve gotten to my post Continuous Glucose Monitoring with Medtronic/MiniMed Updated, I find this rather difficult to believe. I’m curious whether anyone reading this blog would actually trust their lives to CGM technology telling your pump how much to pump, removing yourself from the loop. However, this peer reviewed article seems to confirm his comments.
Personally, even if I have a way to override this, I would be very uncomfortable with it. For starters, I find the device to accurately track my blood glucose about 80-90% of the time at most. Then, there’s the issue of the 15-20 minute lag. Further, I sometimes have issues with slow insulin absorption, especially during long drives. Unless they combine this with their old implantable pump technology that delivers insulin into the renal vein and unless they find a way to continuously monitor blood glucose rather than interstitial glucose, I think I’m going to have to pass on this.
I’m curious if anyone else is having trouble with high blood sugars on the first day of a new infusion set. I have noticed an issue with this, despite gradually increasing my fixed prime over time. I notice that on the first day of an infusion set it appears to take some time for the site to really begin to absorb the insulin.
I decided to create a new post for this so that my initial reaction to continuous metering would remain untouched and available for review. If you would like to see my first reactions to this device, please refer to my original post on the same topic.
I am now at the point where I am satisfied with the sensor glucose readings about 75% of the time. This has taken me a number of months, despite the fact that I consider myself quite technical and quite good at caring for my diabetes. Thus far, the sensor has helped my go from an A1C of 5.8 to 5.3, an improvement of about 9%. I do not know yet whether my next A1C will be as good. My doctor has cautioned be about going low too often. Being even more careful about lows than I had been may raise this slightly.
I have had Type I Diabetes since 1988. I have been pumping Humalog since 1998. My hemaglobin A1C tends to be in the 5.5 – 5.9 range. I have had A1Cs as high as 6.3 and as low as 5.4, not counting my long honeymoon period.
The reasons to maintain tight control and to improve whatever level of control each of us has have to do with the Diabetic Control and Complications Test (DCCT) that was performed years ago. That long term test of varying levels of control proved the intuitively obvious. Better control reduces diabetic complications. It also quantified it. Those in the tight control group saw a 50% reduction in all diabetic complications except one. For retinopathy the reduction was 60%. Tha’s a 60% reduction in the chances of going blind. That’s huge. It also proved that it was not a simple tight control yes or no type question but that improvements in control at all levels reduced risks of complications. So, that’s some serious incentive for maintaining the tightest control we can, whatever that is for each of us.
UPDATE: THIS THREAD IS CLOSED AND NOT CURRENT. For an updated view of my experience with this product, please go to my more recent post, from 12/5/2007, on the same topic, just click this link.
First I should state that I have not yet been using the continuous glucose metering from Medtronic/MiniMed for long, less than one month. The learning curve appears to be quite large, even for someone with a strong technology background and competence with other electronic devices, even for someone already in tight glucose control.
I would also like to state that even at these early stages and with the lengthy laundry list of issues I’ve had, I have also gotten some very good information from the continuous monitoring, even at this early stage. I have already adjusted my basal rate for a much more even reading throughout the night. I have already learned that I was under-bolusing, especially for breakfast and lunch. I have also had times when the alerts have told me my blood sugar was either high or low that I would otherwise have remained unaware of.
These hint at great things to come as I learn more about the proper use of this device. I would hope that this page will serve to help others set realistic expectations for what they can get from this device and shorten their learning curves to avoid some of the pitfalls I have made. As I get better with this device, I expect to post more threads with pointers for improving results. I will be more likely to do so if others respond on this thread to let me know that it is being read.