On Getting my CGM…

I am expecting my Dexcom CGM(Continuous Glucose Monitor) to arrive today, nearly 5 months after I made the initial attempt to get it. Why did it take so long? Insurance. Back in March I had Horizon Blue Cross/Blue Shield of New Jersey and their criteria for covering a CGM includes the need for the patient to have been hospitalized for hypoglycemia in recent months. They want documented proof that the patient’s blood sugar is out of control. The coverage, once the hypoglycemia criterion is met, covers 50% of the initial cost(they pay roughly $500.00) and 50% of the $122 monthly fee for the sensors. Even with that horrendous reimbursement policy, I did not qualify because my overall control is pretty good and I have only been hospitalized once for hypoglycemia; 27 years ago. Don’t think the thought of a purposeful hypogycemic reaction requiring hospitalization did not cross my mind. I could get my self into the hospital in a life-threatening conditions pretty easily, if I so choose! But that seemed like a rash solution. My A1c is 6.5 regularly, which is pretty good. Of course that 6.5 does not reflect the roller coaster of highs and lows that average out to 6.5. For the 29 years I have had type 1 diabetes my sugar spikes after breakfast every day – not that the rest of the day is a walk in the park. I have recently gotten some control over the morning spikes with the help of my diabetes educator, but being able to see the trends of my days would go a long way to getting a “real” 6.5 A1c or better. By “real”, I mean a steadier blood sugar throughout the day. A steadier blood sugar on a daily basis will lessen my risk of long-term complications hence, lessening my health care costs by minimizing my need for hospital care. We hear so much about the cost of health care and this could be a real step toward real savings that insurance companies still refuse to acknowledge. In diabetes we call it “tight control” and it is a scientific fact that tight control will lessen long-term complications therefore lowering the cost of caring for the condition. It boggles the mind that the profit interests of the insurance companies have not been able to see how they can increase their obscene profits margins even more. Maybe they won’t do it because that would mean actually helping the people who suffer with health issues and pay the outrageous premiums. My $20,000 per year health insurance premium – that I pay out of my own pocket – should allow me to get covered for whatever I need whenever I need it; but I digress.

 

I changed insurance companies and now, Anthem of California, will give me the same coverage as Horizon Blue Cross without the hypoglycemia requirement. So I order the CGM and then I learn through a type 1 friend that the Dexcom CGM is only warranted for a year and that it is recommended that the patient get a new one after that time. The insurance companies make it nearly impossible to get covered for this miracle of modern medicine and then the manufacturer itself makes it nearly impossible to continue for more than a year. Not only do I have to navigate the near impossible path to obtaining this device, I then have to figure out a way to maintain an additional $62 per month and then another $500 to $1,000 in another 12 months. It’s not like I don’t have other expenses, many of which are tied directly to keeping me alive; Insulin, insulin pump supplies and blood testing supplies, for example. In addition, for the past several years, my income is stagnating. This adds stress to my life and stress is bad for my blood sugar control so again, the medical accessory business and the health insurance industry appear to be conspiring to make me sick.

After that arduous and stressful journey, I am poised to get that CGM on and working. I can’t wait to give you the update… stay tuned!

Mayor Bloomberg’s portion…

New York City Mayor Michael Bloomberg has caused a stir by proposing to outlaw offering soda in a larger than 16 oz. portion. Mayor Bloomberg is right but the law may not be the way to make this happen. As a person with Type 1 Diabetes I know how important portion control is. I literally cannot go anywhere for lunch if I want to keep my blood sugar under good control. Each and every lunch item in each and every deli, restaurant or food chain is far too large, contains too many carbohydrates, fats, salt and empty calories. The healthy food choices are a joke. Order a turkey sandwich on rye and you will get a half-pound of meat or more. More than twice as much as you should have. It is processed, filled with salt and fat and is really not a very healthy choice. I have stopped eating deli or cold cuts unless it is at home where I control the portion and I know the meat is not processed or, if it is, I eat far less of it. Order a salad and there are always hidden fats, carbs and sugars. I count carbs to determine how much insulin I should take and trust me; I always underestimate the carbs in a salad bar salad. This is a national problem. Americans want it big, fatty, sweet and salty. The food industry is complicit because the more we eat the more money they make and all our businesses care about is profit. Even when the health care costs that result in this gluttonous behavior impacts every company’s bottom line. Go to any tourist attraction in America and look at the food choices. Abominable. Then take a look at the clientele. Using my less than scientific eye, 90% of the people at these food concessions are overweight. Obesity is rampant. Diabetes is at epidemic proportions and we need someone like Mayor Bloomberg to speak out and continue to hit hard on this topic. In fact, we need more than a national media campaign to bring to light the devastating effect on our economy, health care system and mortality rates that our poor nutrition is causing. The problem that starts with portion control causes obesity, diabetes, heart disease and countless other health maladies. This is all because we cannot control our portion sizes in this culture. Add to that our lack of exercise and fitness and we have a recipe for reversing all the trends toward longer, healthier lives that science is providing. These statistics come from the Center for Disease Control web site:

During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. More than one-third of U.S. adults (35.7%) and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.

We are rapidly heading to 40% of all U.S, adults being obese. The cost of obesity is nothing short of staggering. Reuters published these statistics recently:

* $190 billion in annual medical costs due to obesity, double earlier estimates.

* $1,850 more per year in medical costs for an overweight person than for someone of healthy weight, among employees at the Mayo Clinic and their adult dependents. $3,086 more per year in medical costs for a Mayo worker with a body mass index (BMI) of 35 to 40.

* $5,530 more per year in medical costs for a Mayo worker with a BMI above 40. By comparison, smokers’ medical costs were only $1,274 a year higher than nonsmokers’, who generally die earlier.

* $5 billion annually for additional jet fuel needed to fly heavier Americans, compared to fuel needed at 1960 weights.

* $4 billion annually for additional gasoline as cars carry heavier passengers.

* $1,026: annual cost of absenteeism per very obese male worker (BMI > 40). $1,262: Annual cost of absenteeism per very obese female worker.

* $277: annual cost of absenteeism per mildly obese (BMI 25 to 29.9) male worker.

* $407: annual cost of absenteeism per mildly obese female worker.

* $1,056: cost of a “bariatric chair,” able to hold 500 pounds.

* $1,049: cost of a bariatric toilet rated at 700 pounds.

Source: Reuters reporting (Reporting by Sharon Begley)

 

And diabetes? From 1970 to 2006 diabetes in America went from 2.09% of the population to 5.9% and that’s just the diagnosed cases. If there is one pertinent fact about type 2 diabetes it is that it goes undiagnosed for a long time. In 1970 there were approximately 5 million cases of diabetes in the United States. By 2012 that number is over 23 million people and rising. If you are interested in worldwide numbers (and most Americans aren’t) the number of people with diabetes is in the neighborhood of 336 million. The cost? The American Diabetes Association puts the cost of diabetes over $174 Billion in 2007. From the American Diabetes Association web site:

The national cost of diabetes in the U.S. in 2007 exceeds $174 billion. This estimate includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity. People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of diabetes. Approximately $1 in $10 health care dollars is attributed to diabetes. Indirect costs include increased factors such as absenteeism, reduced productivity, and lost productive capacity due to early mortality.

Add to that the cost of the obesity epidemic and it should be understood that we have a serious health and economic problem on our hands. If we are serious about reducing our healthcare costs in this country, portion control and a reversal of obesity trends is an excellent place to start.

The statistics, data and media on this subject is clear and yet… I can’t get a healthy, reasonable portion size lunch from any of the many food outlets near my place of work in Midtown Manhattan. Why not? Why can’t I get a cup of cottage cheese with a half cup of blueberries if I want it? Where are the cheese plates with nuts and berries? Can I get a sandwich without a pound of meat on it? How about a Tuna Salad without a jar of mayonnaise on it? Why are the salads I order from the local salad retail outlet laden with so many unknown and unadvertised fat and carbohydrate? I want to know what I am eating and how much of it I am eating with what kinds of unseen additives! Does this require legislation or common sense? Maybe the answer is a little of both.

Sometimes it is not the law that makes the difference but a shift in public behavior. When I was a kid, when we got into a car it was against the law not to wear a seat belt and no one ever wore one. We got in the car and we went. Today we don’t even think of moving the car without everyone buckling up. The law was always on the books but something change the public behavior. Ad campaigns, safety initiatives, government officials speaking out and finally, the police started to enforce the law. This change in behavior has saved countless lives. What do we have to do in today’s over-stimulated culture to make people demand smaller portions and maybe get some encouragement to do a little exercise?

Anecdotally, if we look at the French, we hear how they drink red wine, eat cheese, chocolate and very rich foods but they don’t have an obesity epidemic. Why? It is simply due to the fact that their portions are far smaller. Try this, the next time you crave sweets, eat just one cookie or one piece of chocolate and then walk away. You will be surprised to find that very often stopping after one will give you the taste you craved and satisfy that urge for sweetness; but you have to stop eating it to realize that.

If you think that eating less, more healthy food is too expensive, think again:

This $20 Food Showdown will debunk that myth!

As one who lives with portion awareness each and every day, I applaud Mayor Bloomberg for stirring this pot that needs desperately to be stirred. The simple awareness of portion size could save thousand of lives and extend a few as well. Don’t Super-Size Me!