Oh My Blood Strips!

I have been a type 1 diabetic for a long time—42 years to be exact. Over the years, I have been very diligent about taking care of me and my diabetes. I test my blood sugar 8-10 times a day, eat nutritious meals and snacks, and run 7-12 miles every morning. This hard work has paid off. To date, I feel great and have not sustained any diabetes related complications.

Granted, I have had some high and low blood sugars tossed in the mix, but I persevere. Being able to test my blood glucose level has helped me monitor my diabetes, making the necessary changes to minimize and treat the roller coaster ride of highs and lows. Even though I can feel when my blood sugar is high or low, having an exact blood glucose number allows me to treat the high or low appropriately either with a specific bolus of insulin (for high blood sugars) or a carbohydrate snack (for low blood sugars). Testing helps take out the guesswork. It is reassuring to have an actual number when trying to manage a sometimes challenging condition.

Up until recently, I tested my blood sugar at least 8 times a day—before and after meals, at bedtime, and whenever I felt “high” or “low.” The American Diabetes Association (ADA) recommends testing before every meal and 2-3 hours after every meal—a minimum of 6 times a day. And the ADA says to check with one’s doctor to determine how many times each individual should test. My endocrinologist and I had determined that testing 8-10 times a day was essential for me because of my long distance running and activity level during the day.

So I was shocked when our new health insurance company sent me a letter telling me that they would only cover 4 test strips a day. What? Four test strips a day? And they would not cover the test strips that I currently use; the ones that communicate with my insulin pump. Seriously? They only would cover 1 particular brand. I did not even have a meter for that particular brand, and they were not going to pay for a new meter.

Wow! My initial response was anger. Anger that we were paying a lot of money for this premium healthcare plan, and I could not get the test strips I needed. Then frustration set in. Frustrated that I had worked so hard at controlling my diabetes, and an insurance company was not going to provide me with the tools to continue. And then fear hit. Fear that I was going to lose control of my diabetes -fear of diabetic complications and even death.

I took a deep breath and started making phone calls to the insurance company. They informed me that I would be able to get my insulin for free. That was a relief. Thank you. And the lancets for testing my blood glucose would be free too. Wonderful news! Now I had the ability to prick my finger and give my insulin. But without blood strips, I had no idea how much insulin to give. Yet, after rounds and rounds of phone calls, 4 blood testing strips was the maximum they would approve. Their decision was final.

Or was it? I decided to get my endocrinologist involved. In the past, prior authorization had worked in situations like this. They would perhaps honor my doctor’s expertise and request? After all, my physician knew me very well. I had been her patient for 9 years, and we had worked very closely to keep my diabetes well controlled because I felt great, and the studies show that glycemic control improves patient outcomes and significantly reduces diabetes related complications. We were motivated.

My endocrinologist and I spent many hours trying to get the right paperwork read, signed, and faxed over to the insurance company. This was rigorous and required lots of follow up and clarification. I could see why so many people get frustrated and simply give up.

But there was no giving up. I was on a mission. Until my doctor said that I was simply in too good of control to qualify for more than 4 test strips a day. She could not lie about my hemoglobin A1C or lack of complications. Four strips was all I was going to get. However, if I was a poorly controlled diabetic with the A1Cs to prove it, I would qualify for more strips. Was I being punished for taking such good care of myself? My track record of diabetes care was great and my proactive approach was working. I did not want to jeopardize my life by altering the amount of blood testing.

Did the insurance company realize how their decision might impact my quality of life? Did they understand how much time and energy I was putting into this request and why? I was not going to abuse the blood strips or sell them on the street. I simply wanted to keep my diabetes well-controlled so I could work, run, play with my kids, and simply live. Wouldn’t dialysis, amputation, cardiac arrest, or retinopathy cost the insurance company a lot more than 6 additional blood test strips a day?

I know what you are thinking. But if they say “yes” to you, then they have to say “yes” to everyone. And I believe you should say “yes” to any diabetic who wants to be well controlled. Why would you say “no”? Is the expense of tight control too much for my insurance company? Sure, in the short term insurance companies can save money by restricting blood testing strips, and many other medications and medical devices, but long term can they save money if subscribers with diabetes develop complications? They may then need serious medical treatment, miss work, require care from family members, and the list goes on. Why take the risk?

So where do we draw the line? I worked in the pharmaceutical world and understand insurance is a business. I get it. But I ask that managed care decision-makers keep in mind that each and every consumer is an individual with unique needs. There is a person behind every member ID number that may need a different plan of action than someone with the same diagnosis. For example, you can’t lump all diabetics together and offer them the same protocol.

I am not asking anyone to feel bad for me. And I am not mad at the insurance company or all the awesome people who took my calls and answered my questions. They were doing their jobs. I just want people to start thinking how what happens today with my diabetes can affect me forever. It’s not just a matter of surviving with diabetes; I want to thrive with diabetes. And I know there are millions of people with diabetes out there who feel the same way.

I am still hoping to get more than 4 test strips a day. I will continue to call, research, and write to those who may be able to help me get more test strips. It never hurts to try and to simultaneously educate people about diabetes.

In the meantime, I have reduced the amount of times I test my blood sugar daily, and have really tuned in to how I feel; listening to my body and detecting the lows and highs. My endocrinologist has provided me with the new meter I needed.

I am fortunate for what I have right now — most importantly, my life. But caring for one’s condition should not be so complex. Rather, it should be a patient, doctor, and insurance company working in unison; providing the best quality of life possible using the amazing resources out there.

Creating a resolution beneficial to all is the ultimate goal, and I believe with team work we can reach that place. We are paving the way…

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