Nothing like pushing the deadline for the October Blog Carnival by waiting until today to write my post. I could muddle on forever talking about the differences between the types of diabetes, so I have selected one area in which Type 1’s often have an easier time than people with Type 2.
And that area is Insurance. In general Type 1’s have an easier time than Type 2’s getting test strips and devices like pumps. Medicare’s standard allowance for test strips is crappy for everyone, but non-insulin users are only allotted one test strip a day. Insulin users (and that includes some Type 2’s) get 3 times as many with 3 per day. Still inadequate, but with documentation and proof of medical necessity from a doctor, overrides are available.
Pumps are easier for people with Type 2 to get than in the past, but there are definitely a lot of hoops to jump through to get coverage. A diagnosis of Type 1 diabetes is often sufficient for automatic pump coverage under many insurance plans. My first pump was approved by insurance in less than 24 hours. When I get to Medicare in 2.5 years, I will be required to have a c-peptide test to prove that I don’t produce insulin. I have been worried about that test but when I asked my endo if I should be concerned, she just laughed.
Continuous glucose monitors are almost impossible for Type 2’s to get insurance coverage for. Under my current insurance, the first mandate for CGM coverage is “Type 1 Diabetes.”
Often I read forum posts by adults who have been diagnosed as having Type 2 diabetes because of their age when they clearly have characteristics of Type 1 or the newer diagnosis of LADA. Occasionally someone will reply to them that it doesn’t matter what type they have as long as they are being treated properly. I disagree with my statement. I know that I have always had good insurance and I am not a Medicare or insurance expert, but if you are Type 1, you want to be diagnosed as Type 1 not Type 2. Although many doctors are starting to use the LADA diagnosis, there are currently no Medicare or insurance codes for that. So for insurance reasons, if you are LADA, you are Type 1. Get the diagnosis so you can get the care and devices that you need.
Do people with Type 1 diabetes have better insurance coverage because our type of diabetes is worse? Well, maybe yes. All types of diabetes are the “bad” kind, but Type 1 is flashier bad. We wear the costume of “cute little kid” even though we can be anything from an infant to an 80- year-old crotchety old guy. We pass out at inopportune times and occasionally scare the crap out of everyone with seizures. Our BG numbers can range from 30-450 in a single day and we don’t consider a jump from 100 to 110 in fasting BG to be significant. Without insulin we could die in a couple of days or weeks. In general Type 1 is more dangerous in the short run and yes, we need pumps and CGM’s more than most people with Type 2.
But Type 2 is a subversive and sneaky kind of diabetes. You may not get access to the fancy devices, but if you ignore your diabetes, you can get the nasty complications. Insurance will pay to treat your complications even if it won’t help you prevent them. So don’t ignore your diabetes. You have the bad kind too!
This post is my October entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at: http://diabetescaf.org/2014/10/october-dsma-blog-carnival-4/
Test Guess and Go 
I agree that having the right diagnosis helps get things thru insurance a lot easier. If you are really worried about getting the c-peptide done, I have a friend that did hers as a self pay so it didn’t show up on her record – she was also worried what would happen to her pump when she started on Medicare. She passed with flying colors and that was one less thing she worried about. When the time came, she had to do an official one for the record, but she didn’t worry about whether or not she would lose her pump.
Thanks for your comment, Kelly. I don’t really think I’m worried about the c-peptide except that I have never had one. I just keep remembering the Joslin medalist study that shows that most people with long term T1 still produce small amounts of insulin. But thanks for the idea of having a practice test.
I feel like I’ve had every kind of diabetes except MODY. I had gestational diabetes with my 3rd child and barely passed the test so I didn’t have it with my fourth. Then I went through TrialNet and have positive autoantibodies but my local endo said I had Type 2 and treated me like that for 4 months. Type 2 is hard as far as diet, trying not to eat any sweets makes me cranky. I saw a different endo and he diagnosed me type 1 but I really feel like I could be a LADA. I had to fight for that type 1 diagnosis, my regular doctor wanted to treat me for diabetes without a specific label.
I think type 1’s get better health information (I think we started counting carbs and following that type of plan a lot sooner than most type 2s). Type 1’s are supposed to take their blood sugar before they drive (or other “dangerous” activities) but type 2’s would never think about that (maybe because of a lack of test strips?).
I had my c-peptide tested and it was 1.5, a TrialNet researcher told me even 0.2 would be significant (helping your body with blood sugars). I doubt that after having T1 so long yours is high enough to worry about. I think the pump requirement is 0.5 or less.
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