Hi all I've had diabetes for 10+ years now but am new to the pump. I went to a presentation by minimed that my doc suggested and became interested in getting a pump now that they have an all in one CGM - pump type deal. My insurance covered the pump but requires additional information to approve the CGM supplies for it. They require at minimum a 30 day glucose log of 4 tests per day. Of those tests it must show a susceptibility to hypo and hyperglycemia despite normal testing and insulin adjustments.

Now that the background is said, my question is: has anyone else experienced a similar process? I'm tempted at this point to just throw the results for the next 30 days so that they will agree to cover the CGM. I've had problems recently with low blood sugar overnight which really scares me. I used to wake up when it was low but now it doesnt phase me much.

Just looking for other's perspective and opinions on getting insurance approvals.

Thanks in advance,

Every insurance company is different. Mine did not require any BG logs. The person I spoke to at Minimed basically just asked me a bunch of questions. I have hypo unawareness so I never knew I was low until I tested. That's a big plus when going for a CGMS but not so good to actually have! Insurance does seem to be more concerned abut low BGs rather than high. Even if they had asked me for logs I would have qualified because my numbers were all over the place including way down in the 20s. I also had a bunch of ambulance visits and was transported to the ER twice for severe lows. I have to say that all of those happened before I got the pump. I was pumping for 3 years when I added the CGMS. I still had bad lows (and highs) but was able to treat them all without assistance.

I honestly don't see what the logs will do. You can easily write down whatever you want. Unless they require you to actually mail them your meter or insist on reports that have been downloaded from the meter so they can see for themselves, there's no way of knowing if what you've logged is accurate.

I cannot disagree with your gut feeling. The insurance companies are getting more and more stingy. They seem to not want to cover the CGMS if you are in relatively good control (<7 A1C) or don't have a lot of lows.

Frankly - if you get the CGMS - you will likely be testing at least 4X a day - so get used to it. I would do the 30 day log and do what you need to to make it happen. The CGMS is worth it - even if it takes an extra month. Once you get the CGMS - u can use the Carelink software to print out your log as well. I enlisted my doctor to battle with the insurance company after they rejected my refill after paying for a year straight - and I finally got it.

Good luck - fight the good fight - its worth it!

By "just throw the results", do you mean deliberately let it go too low. I have had two different medical people, RNs, tell me that some people deliberately get some lows so that they can get the CGM. I am interested to get one, have had lows below 50, but not close enough to be in one month.

Suzan

Brent,

It sounds to me as if your overnight basal rate is set too high, and you could benefit from an adjustment. I have been pumping since mid-April after 58 years as a Type I. My insurance will not cover the CGM or the expensive consumable supplies. After reading all of the problems posted by other members about the MM CGM, I have to agree with my insurance company's refusal.

I have adjusted my overnight basal rate to the point where, on an average day, if my BG at bedtime is less close to 130, I awake the next morning between 85 and 100. If the bedtime BG is less than 130, 8 ounces of milk is enough carbs and protein to keep me from hypo episodes overnight.

But, each forum member is different- what works well for one may not work at all for another. For me though, the other advantage that lets me sleep without needless worry is the fact that my wife sleeping next to me is a retired hospital RN who can easily handle any hypo episode that I might experience overnight. The point is, I am old enough, with average BG's low enough, to have lost a LOT of my hypoglycemia sensitivity. In the last two months of pumping, I have had zero hypo episodes overnight, and fewer during the day than I had been used to with MDI. I really don't see the need, in my case, for the CGM other than the help that it might provide to keep me from wrecking any more cars. I always leave my alarm set to go off at two hours after a bolus, and I always check my BG before driving. I am old enough to have bought one of the very first BG meters to come on the market in the early '80s, and have never felt "put upon" to have to test. It isn't fun, but it is the best tool that I have for my own safety and general health.

I have not obtained A1C test results since I started on the pump, but did get test results a week prior to starting the pump. Will get A1C results at about the three month period after starting on the pump. My BG meter logs have shown much better average BG levels than I was able to achieve with MDI, so I expect very good results from the A1C test next month.

Brent,

Most of us who have experience with the CGMS disagree emphatically with Manxman's statement above. There is a learning curve with it, and so reading posts asking for assistance can be very misleading.

The CGMS has improved my control dramatically. I have been using it for 4 years and would not be a day without it. My A1C has improved from 7.2 to 6.5. But A1C is just an average. The biggest thing it did for me was to eliminate my higher highs and lower lows. The alarms on it warn you when you are trending high or low so you can catch them before they get worse.

I highly recommend that you get it, considering that you are worried about your overnight lows.

Linda B.

Brent
I went through seemlier circumstances and was afraid to sleep at night. I spent the better part of two years
without much sleep. My pump and CGM has eliminated 99.9% of my low BG at night and also I no longer
suffer form the anxiety thats caused by night time lows.

My Endo suppled a letter of medical necessity to UHC and they approved my CGM. The first of this year
my insurance changed to Anthem BCBS and they also required a letter of necessity and approved my CGM
and sensors without question.

Do what ever it takes to get your CGM. I ask my doctor to let me read my letter of medical necessity
and he smiled and said no, he said it was so sad it would bring tears to your eyes. ;-)


JohnG

I totally agree with Linda (and disagree with Manxman). I've been on the CGMS for 4 years. I paid out-of-pocket until 2008 when my insurance began covering it; we changed insurance companies in 2009 but the new insurance company covers CGMS as well. I suggest that you do whatever it takes to get the system.