Wednesday, May 27, 2015

I can't beleive my insurance company is paying for all of this!

This is kind of the anti-post. I have to say that I haven't had much to complain write about since I've been on the University's staff health care plan. It's really quite good coverage, which I guess highlights the huge difference in quality of life that an insurance plan can impact.

I will complain about the state of maternity leave in this country in the next post (promise). 

Here's the latest: I'm now 3 weeks post-partum. My gorgeous sleeping baby is sleeping in the baby carrier strapped to me as I type this. Throughout the pregnancy, I was part of a few groups online for fellow type 1s who are pregnant or moms. There were some crazy stories about the absurd amount of money they had to pay up front to the OB department in order to receive care.

Several women report having to pay $2,000 to $4,000 for their OB care, which doesn't necessarily include all charges, such as lab work, specialists, etc. 

One woman reports, "We pay out of pocket up to $4k I think, then 20% of the next $1k then 0% (in-network). I believe that I'll be paying whatever the standard "high risk" CS delivery is but it's pretty confusing what's included."

Another says, "I had to pay my OB before week 28. 3,200 dollars [sic]... Not including [sic] pediatrician, hospital and anesthesiologist."

So you can imagine my anticipation when I received the hospital bill for my pregnancy. Wait for it... $14. That's it. The rest was covered. And if we are being accurate, the $14 was for two guest meals for my husband while we were in the hospital. I kept asking, during my 40 appointments over the 40 weeks of pregnancy, if I was going to see a bill. I thought that each OB visit qualified as a specialist visit and cost $30 copay. This would add up to $1200, which I was prepared for. 

So you can see how this surprised me, especially after getting unexpected bills quite frequently over the years. 

Good job, PremiereCare/University of Michigan. Now, if you could please work on maternity leave. 

Wednesday, March 18, 2015

MedEQUIP partially reedems itself; Dexcom comes down a peg

I blame my insurance for not being cool and amazing and doing all it can to make life easy for someone with a chronic illness. Let me explain. My insurance doesn't allow for automatic refills (ie: they just autosend you your supplies every three months). I was getting auto refills when on the AMAZING MASSHEALTH PLAN that will live on in my heart and mind as the single best plan I have ever been on. They checked the insurance every month and shipped me supplies if all checked out. The other time I had auto refills was on Kaiser. They did NOT check my coverage for changes before shipping the supplies, and I ended up with a $780 bill (of course I disputed it and WON, because I am the dispute mistress!).

So this insurance plan, which is amazing in almost every way--trust me, I read through the Benefits document front to back, doesn't allow for automatic refills. They require that you call the company (or the company calls you, before shipping out the supplies. This would be fine if the company did it (they are, after all, making money off of this service). I'm less likely to remember to refill my supplies on a regular basis and end up running out and going without a sensor, or worse, without pump supplies, until the new supplies arrive. I'm sure this is why the insurance company does it: to save money when people like me forget to refill regularly.

I was SO FRUSTRATED with MedEQUIP for not calling me when my supplies were up for refill. It happened many times, and they always CLAIMED that they did call me. Uh, in that case, there would be a missed call on my phone, and anyways don't just call once!

Pro tip: Type 1 diabetes DOES NOT GO AWAY. I will always need insulin and supplies. Why the eff do I have to continually deal with refills? There should be an exception when it comes to chronic illnesses.

Anywho, I went through this whole thing where I switched my CGM supplies ordering to Dexcom. They assured me that they would call me every 3 months to get my refill authorization. They have a vested interest in getting more products out the door, right?

I trusted them, but ONCE AGAIN found myself out of sensors, right before heading to Boston for a long weekend. This was not going to be good. I called Dexcom to ask "What the hell?" and the ordering department told me, "Oh, no, we don't call customers to refill orders. We have a lot of customers! We do have an auto-refill program."

SO, who did I have to turn to for last-minute sensors? That's right, MedEQUIP. I called and begged them to refill my sensors right away, as I was heading to the airport and had literally 15 minutes to spare. They totally came through! I swung by the office and grabbed the sensors, and made it in time for my flight. Still, I will stick with Dexcom, just knowing that I will have to call my sensor order in every three months (MedEQUIP would make me do it every month). Dexcom also sent me two free sensors to make up for the loss in my overflow. But, I will no longer shake my fist angrily every time I drive by the MedEQUIP office.

Friday, January 23, 2015

Lumped into a category: Pregnant and diabetic

It's been 26 weeks of this new category: pregnant and diabetic. I've heard others who are a bit further along say they don't know how much more they can take... that they are getting treatment from their insurance companies and medical team that are hindering their ease of diabetes management.

I've been a bit frustrated by the medical industry's lack of interest in accuracy. I know that there have to be broad designations, but there MUST be room for accuracy! Type 1 diabetes + pregnancy = high risk. Period. No way around it.

I've been doing OK with my blood sugars. My A1c hovers around a 6% (the low end of where you start seeing complications). I haven't had too many readings over 200, and only once over 250. I've been exercising 2-4 times a week, and have been taking my vitamins and eating my veggies. My eyes are fine, my kidney function is excellent, my lipids are amazing, my blood pressure and pulse on the healthy end of the spectrum... My doctor agrees that my blood glucose readings give him no cause for concern.

And yet, I still get designated a high-risk pregnancy. Not that I particularly mind; I get far more ultrasounds than the average woman, I've had growth scans every month, an echocardiogram to examine the baby's heart, and I've been sending my numbers to the doctor every week and working with him to adjust my rates. I kind of like the attention. But I don't like the inaccuracy.

This could come to a head when it comes to deciding when and how baby comes into the world. The doctor already told me that he would like to induce labor at 38 weeks. This article explains why it's best to wait until at least 39 weeks. Of course, I would like baby to be as healthy as possible, and come into the world when he or she is ready.

If there is sound medical reasoning for inducing the baby at 38 weeks (based on actual information--like how the baby is measuring, how my blood sugars have been, etc), then I will of course consider it. But if they are saying this because on average, diabetic women (lumping type 1, type 2, and gestational in one category) deliver large for gestational age babies, then I would hope that they would seek to me more accurate when dolling out medical commandments!

Thursday, October 30, 2014

Corporations are people too: MedEQUIP tries to save face through repeatedly lying

As I complain to my husband about the much-hated, much-talked-about-in-our-household Med EQUIP--the medical supplies company that my insurance company forces me to use--he reminds re, "Remember, corporations are people, too."

Apparently they are, because this company would apparently rather save face by lying repeated (verifiable lies, mind you), and hanging up on their customers, rather than actually solving a problem or having good customer service.

Here's the latest: I get a call roughly every month from MedEQUIP asking if I need my Dexcom sensors. "Yes," I tell them every time, "Still a diabetic." Some months they are a few days late in calling, some months they are a week or two late. (Why not just automate the process? We'll get to that later.)

This month, after coming back from a trip, I went to grab a new sensor, but I didn't have any left! Odd, I thought, I didn't get a refill call yet. So I called The Dreaded MedEQUIP (they get an angry fist shake every time I drive by their office), and they told me this very verifiable factoid:

"According to our notes, we called you on October 13 to refill the order."

Here's the thing--my number is a GoogleVoice number and every call, missed call, voicemail, and text message can be looked up in my GoogleVoice inbox. So I looked. Oct. 11, missed call from my mom. Oct. 16, voicemail from my dad. October 13: NOTHING.

They simply lied to me.

I was pretty stern with the woman, letting her know that this was not acceptable and telling her that it is seriously not OK for me to be off my sensors (bordering on rude, but still within the bounds), and next thing I know, I'm HEARING THE DIAL TONE. Lady hung up on me! I called back, but the office had since closed. I called again this morning, and the woman I am used to dealing with, Vicky, was not in the office yet. Not to mention that I need my #$@!ing sensors.

This is not the first time MedEQUIP lied to me.

Last June, when my Dexcom receiver died (the USB port gave out), I ordered a new one through MedEQUIP. Several days went by; nothing. Three weeks passed and still no receiver. So finally I went and camped in the MedEQUIP office (thinking about doing that again today), and talked with Vicky, who told me that it was held up because they were waiting on insurance approval.

I later verified that this was absolutely false, and that the insurance had approved it within a few days.

If you are looking for a medical supplier for sensors that it reliable rather than ego-driven and substandard, my advice is to order through Dexcom and complain to the insurance company, your endo, anyone, so that MedEQUIP is held accountable for its distinctly mediocre service. At least Dexcom will be motivated to get sensors to you on time (they want to move more units, after all). They are also available when you need them, and will overnight sensors in a pinch.

*As a note, I found out that Blue Care Network (University of Michigan's largest insurance provider) does not allow companies to autoship sensors, nor does it allow 90-day fills of sensors. WTF?

Thursday, March 20, 2014

"Your message is in the system."

So... (this is how most of my blog entries start).
The traditional health system in this country sucks. I mean, royally blows. It's pathetically broken.

I've been having a fun time with high blood sugars. And by high, I mean 120-200, which is by no means crazy high. Ever since I started my anti-diet (I had bacon fried in oil, topped with guacamole for breakfast), I have had really good control, and very few highs over 150.

Starting two days ago, my blood sugar started getting really stubborn and would not be nudged down with insulin. I took far higher doses than normal, but still no dice. I corrected for a BG of 180 with 3 units (each unit brings it down 35 points), so it should go down to 75.

Didn't happen. Only got down to 160.

No matter what I tried (short of crazy dosing with 10 units--I didn't try this as it would likely kill me), the BG stayed high, or came down temporarily and bounced back up.

Like a good diabetic, I called my endo yesterday morning. I explained it to the nurse (remember, a nurse in the clinic once told me that I could ease up on testing now that my A1c was 6.1).

"My blood sugars are not responding to insulin," I explained. "I've taken twice as much insulin as would normally be needed, plus a max dose of symlin. I haven't eaten anything carby, and still the BG is not budging. I don't know what it could be -- my insulin, my pump, perhaps I'm getting sick, maybe it's my time of the month... I am concerned that I might be in ketoacidosis. Here's what I've done: I've increased my basal rate by 35% and am drinking lots of water."

She said someone would get back to me.

NOBODY GOT BACK TO ME.

I called back in the afternoon.
"Oh yeah," I was told. "Your message is in the system."

Oh crap. Now I know I'm doomed.

NOBODY GOT BACK TO ME.

Here I am, potentially stewing in my own toxic acidic blood, and "my message is in the system."

Taking matters into my own hands (and after polling the myglu.org community), I went and did some yoga flows and strength training to get my blood flowing. By the time I was done, my levels were below 60.

OK. I can deal with lows. I turned my pump off for an hour, and it came back up slowly. The night was OK, never went above 125. Woke up this morning, went to work out, blood sugars are looking good.

Then, after eating breakfast (bacon and guac) and sitting down to work for an hour, the stubborn BGs are BACK! My blood glucose was 180. I took a total of 8.8 units (6.8 through the pump, and an additional 2 injected just to make sure it was getting in, plus 60mcg Symlin), and it only came down to 140! WTF, as my husband put it.

I called the clinic back. She said, alright, she'll make sure the doctor gets the message and will get back to me. I told her to note that I understand that they do not approve of my diet, but they will never convince me to go off it.

A few hours later, here is the call I receive from a nurse in the clinic:

Starts out with a disclaimer: "We do not recommend the zero carb diet, but if patient wants assurances that she is not in DKA, she can come in and take a ketone test. I recommend increasing her basal rate by 0.1 units and setting an alarm for 3:30am to wake up and test to make sure she isn't low.
I recommend the patient see if she is eligible for the continuous glucose monitor."

How does one describe the biggest pile of stinking, unhelpful dogcrap ever known to pass as "patient care?"

There are so many things wrong with this. It should be obvious, but I'll still take the time to outline why there are so many problems with this chain of events.
  1. If the doctor is too busy to deal with patients, he should not have any patients.
  2. This is the very doctor who prescribed me the CGM, so his advice to get one is just pure laziness on his part. 
  3. Really, doc? You thought I was calling to ask what my basal rate should be set at? Do people still do that? Did you not get the part of the message that I had to relay through 3 different nurses that I already upped my basal by 35%
  4. Lastly, and I say this with the utmost patience, it is not a ZERO carb diet. That is next to impossible to achieve. It's a 30-50g carb diet. But thanks for your accuracy and your malpractice concern.

I said thank you to the nurse, who clearly didn't know what the hell she was talking about and at several points in the conversation, actually said, "that's what the note says."

I also expressed some of the points outlined above and said, as I'll say again, THIS IS NOT CARE.

Here's my unsolicited advice. Get a doctor you like and who works with you, even if they are out of network or not covered. Honestly. I called my new doc, he called back right away. He took a moment to tell me sorry for the frustration I was experiencing, and brainstormed a series of events to try to make sure I was dealing with the problem (switch to long-acting to make sure it's not the pump's fault), and insisted that I check back in with him later in the day.




Tuesday, March 18, 2014

I'm having a really bad day but you would never know

While most days I feel relatively normal, today I really feel like a person with a disability.

What you would see on the outside is a seemingly able-bodied person, going about her day doing seemingly normal things. She goes to the gym in the morning she drives to work she eats her lunch and she does her work. 

But here's what you don't see: you don't see her getting dry mouth from having elevated blood sugars. You don't see her trying not to step too hard on her right leg because she put her continuous glucose monitor there this morning and it twitches a nerve every time she steps. You don't see her stress levels rising because no matter what she does, they don't seem to come down, which is only making the situation worse. You don't see her vision getting blurry from having elevated blood sugars. You don't see her feeling shitty about herself because she can't seem to keep things in control. You don't see the sticky marks all over her body where she placed her various devices. You don't see her hunger when she wants to eat like a normal person but can't, knowing that if she eats too many carbs she'll really be in trouble. You don't see her trying to ignore her high blood sugars and do her work well she patiently wait for them to come down with little success, but eventually caving in and having to go straight to the gym to run until they come down. 

All you see is that lazy girl next-door leaving work early again. 

Wednesday, March 12, 2014

Breaking up with conventional thinking on nutrition

I'm not trying to be all negative here, but I'm starting to get the feeling that we have got it all wrong.

My husband and I watched Cosmos last night, hosted by Neil deGrasse Tyson. I loved how he emphasized how dedicated science is to follow where the evidence leads. Except when it comes to nutrition, I guess.

Here are some revelations I have discovered in my nutrition awakening, relevant only to what I previously believed:

1. You have to limit fat if you want to lose fat.
FALSE. Limiting dietary fat is no fun and is largely unsustainable. Instead, try limiting carbs, which will subsequently lower insulin production (the hormone responsible for triggering fat storage). Of course, you shouldn't outeat your true energy needs no matter your macronutrient ratios. Fat is amazing. It tastes great. And if you can change your metabolic pathways to better utilize fat for energy, fat can be so beneficial in curbing hunger, providing sustained energy, and burning fat.

2. Every meal should be a balanced meal.
NOT REALLY. It kind of depends on what your body needs. If you need some quick energy (as an efficient fat burner), you should go for some medium-chain triglycerides or saturated fat, such as coconut butter, butter, coconut oil, and palm oil. If you need micronutrients, you should go for chia seeds, avocados, asparagus, spinach... Carbohydrates are the only non-essential macronutrient. We would die without dietary fat. Same for protein. We would function just fine without carbohydrates. The body has other mechanisms for creating glucose, which is essential for a small portion of the brain.

3. It's best to eat small meals throughout the day.
NOT IF YOU CAN BREAK YOUR CARB ADDICTION. While this may be true for the majority of the population that depends on the quicker burning (non-essential) carbohydrate diet, this is good advice. If you are working with mostly fats, then your meals will naturally be small (fat packs in a lot of calories), but you can (and should) go for at least 5 hours in between meals. Some people even try intermittent fasting (IF) and do just fine.

4. Breakfast is the most important meal of the day. 
AGAIN, TRUE FOR CARBERS. NOT TRUE FOR EFFICIENT FAT BURNERS. The reason that carbers should never skip breakfast is because their body is at the whims of the blood glucose cycle. Your body needs to replenish the glucose stores it went through during the night. If you don't replenish these supplies, you can land yourself in big trouble (read: famished by lunch, craving carby foods and further exacerbating the cycle). However, if you train your body to use fat for fuel, you will efficiently burn stored fat throughout this morning period without getting super hungry and without losing energy. This is freeing.

5. If you skip meals, your body will go into "starvation mode."
KIND OF TRUE, BUT MISREPRESENTED. Starvation mode is the amazing mechanism of our bodies turning to stored fat for fuel. But your brain needs some glucose, so it will use some stored glucose for that ~20% brain function that relies on glucose (the rest can use a byproduct of fat breakdown called ketones). If need be, your body can bust into lean muscles and tissues for protein, and create glucose from it, called gluconeogenesis. If you are already an efficient fat burner, "starvation mode" makes little difference. See the previous point about skipping breakfast. You should eat. Your body needs fuel eventually, and you do NOT want to start metabolizing muscle and tissue.

Until recently, I was participating with a group of health coaches promoting the low-fat, high-carb, restricted calorie lifestyle. I think this approach is one that will work for many people who lack the discipline to stay away from carbs and realize that they "like" carbs because carbs stimulate pleasure in the brain--let's think of other ways to do this! But if we are going to really educate people, we should be screaming from the mountaintops: There is no one size fits all approach! And if there were, it would certainly not be a high-carb, low-fat approach. Calorie restriction and low-fat, high-carb usually does not work long-term, and it certainly isn't working as a societal recommendation.

It can work short-term, and it can work for people with the right kind of genes to handle all those carbs, but I am convinced that our dietary guidelines should be steered to a lower carb approach. Maybe 60% of calories from fat, 15% from carbs, and 25% from protein.

For your entertainment, here are a few gems of the "fuzzy math" of nutrition being promoted by self-titled health coaches:
  • Your body turns protein and fat into glucose. Huh? Since when? Your body turns carbs into glucose at very high rates, turns 30-50% of protein into glucose (which is why you shouldn't overdo protein), and, in rare circumstances, can turn as much as 10% of fat into glucose (like, if you have been running for 40 hours and have run out of glucose stores and you broken down a significant amount of muscle and tissue--not a common scenario).
  • Complex carbohydrates are called as such because they have protein in them. Yeah, that's not really how the naming convention works in science. It's based on the structure of the carbohydrate molecule, and how complex it is compared to a simple sugar. Nothing to do with protein. 
  • You should eat 1.5 g of protein per pound of body weight. OK, all you are doing here is providing an excess of protein to be turned into glucose. Good job. The recommendation on this one is pretty sound, actually (about 54 g of protein for a 150-lb adult; not at least 54, but 54). It's mostly comes from the performance oriented goals of sports nutrition science. As a caveat, if you are truly building muscle, then your protein needs will be a bit greater. Also--a good benefit of protein is that is slows digestion and hence, makes you feel full. An overage of protein can stop up the works. The best approach to calculating your protein needs is to start with your bodyweight, and from there, account for any significant muscle-building you are consistently doing.
And while we are on the subject of protein, all of these protein-pushers may be making a quick buck on the trend now, but some new research even suggests that a surplus of protein might have detrimental health effects.

Unfortunately, I don't think there's as much money to be made from promoting a high-fat, low-carb, moderate protein lifestyle. Protein is expensive and has many allies (meat and soy industry, nutrition companies that are on the protein bandwagon), carbs are a cash cow for the food industry (cheap to make and you can rely on people's cravings for them), and are especially lucrative when you throw a "low-fat" banner on the label.

Where's the money to be made in promoting whole foods that naturally promote less consumption, like olive oil, butter, green vegetables, coconut milk, etc... ? In this approach, you would need to eat a lesser amount of food, as your energy is mostly coming from fats, which pack more that 2 times the amount of energy per gram than protein or carbohydrates. Instead of a huge, $15 salad with fat free dressing and chicken, you could have what I had today: 2 eggs cooked in coconut oil plus 1/2 an avocado. Last night I fasted from 4pm to 11am this morning and felt totally sustained. Not to mention my blood sugar stayed on a straight path between 75 and 110 all day. Pretty good for someone with a dysfunctional pancreas. And for someone living in a country with dysfunctional thinking on nutrition.