DSMA Blog Carnival: Get the Diagnosis!

Posted on October 31, 2014 by Laddie

Type 1, Type 2, LADA, Gestational, diabetes brought on by surgery . . . . the list of types of diabetes goes on. Each type may have differences, but ultimately they are all diabetes. When we think about it, there is a whole lot that all types have in common. However, that doesn’t mean we can’t give credit for some differences too. So lets look back to our “Breaking down the barriers between types” chat on September 10th and discuss . . . . .Anything easy about living with your type of diabetes that isn’t easy for another type?

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.

Get the Diagnosis 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/

Becoming an Advocate

Posted on February 26, 2014 by Laddie

The topic for the February DSMA Blog Carnival is: “Advocacy is a topic that is often discussed in the Diabetes Online Community. Can you be one and not even know it? What is your definition of an advocate?”

Until recently, most of my thoughts about advocacy were laced with guilt. I’ve spent a good bit of my life “talking the talk” and not “walking the walk”. I’ve been reluctant to advocate publicly for fear that the continuing responsibility of taking a stance would be more than I wanted to handle. I have been quick to criticize myself for being one who rides on the coat tails of the Real Advocates in the Diabetes Online Community (DOC).

Early November 2013 was a low point for me. November is Diabetes Awareness Month and many members of the DOC undertake huge projects to show their commitment to advocacy. As a relatively new blogger, I was totally unprepared for the onslaught of informational posts, photo projects, and tributes to diabetes heroes. I felt like a total slacker. By mid-month, my self-criticism mellowed a bit and I took a realistic assessment of what I had done and what I was doing. My 11/15/13 blogpost convinced me that although I wasn’t an established leader in the DOC, I was slowly becoming comfortable participating in advocacy projects.

I think that “advocacy” is taking something you believe in out into the world. Beliefs are easy. Sharing them with others is harder. Crusading to turn your beliefs into reality is harder still.

I find advocacy terrifying. In his “What is an advocate?” post, Stephen of Happy-Medium stated that “An advocate is not someone who is afraid of the word “advocacy“. I disagree with Stephen. I am slowing morphing into an advocate and I’m still terrified of the word. Once you move your convictions from the comfort of your brain and the safety of your soul to the outside world, there is no going back. The doors are wide open and you’re out there to stay.

On November 1, 2013 I would have said that I was not an advocate. People like Scott Johnson would have tried to convince me that I was wrong with the argument that telling my story as a blogger was enough to grant me membership in the “A Club“. My two co-bloggers, Sue from New York and Sue from Pennsylvania, would have called me an advocate because of the behind-the-scenes work that I was doing to help them with blogposts, graphics, and logistics. Many of my friends, both D and non-D, would have awarded me advocacy status because of my active lifestyle showing what is possible with and despite diabetes.

Frankly I think that I became an advocate on February 11, 2014. That is the day that I sent a letter to my family and some of my friends asking them to participate in the Spare a Rose, Save a Child campaign. My first blogpost about Spare a Rose was easy to write because I knew that most of the readers would be members of the DOC. That’s not advocacy. They already knew about it and supported it. I wrote a good post, but I was just going through the motions. It was advocacy when I pinned a scarlet “A for Advocacy” on my chest and wrote a second post to spread the message to the larger world.

I disagree with people who say that I have been an advocate for a long time despite my opinion that I wasn’t. I was a believer; I was a follower; I worked on projects. In my mind I did not become an advocate until I was able to look in the mirror and say “You are an Advocate.” I did not become an advocate until I was brave enough to say to others “This is what I believe and I am proud and strong enough to share my beliefs with you.”

This post is my February entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetescaf.org/2014/02/february-dsma-blog-carnival-3/

Always and Never

Posted on December 19, 2013 by Laddie

The December topic for the DSMA blog Carnival is Out with the Old, In with the New – Diabetes Style. With this topic, anything goes. Maybe you have a diabetes habit you want to break and replace with a new habit. Perhaps you are going to revamp your exercise plan and trade in an old workout routine for a new one. It could be time to put a new focus on yourself, such as limiting some online advocacy in favor devoting time to things you need to stay healthy and happy. You might be thinking of changing up some current tools (meters, pumps, diabetes apps) for a new version. Or maybe you have plans to make some food swaps or try a new eating plan. What ever it is, we want to hear about it!

“Always” and “Never” are two words that are x-rated in my diabetes vocabulary. They are absolutes at opposite ends of the spectrum of possible outcomes for every diabetes decision that I make. They give the illusion that I can expect the same results day after day from identical input or that there is a reward for good decisions and a predictable punishment for bad decisions. They are black and white when most of my life is lived in gray. They have voodoo magical powers that the mere utterance of the word is guaranteed to make the “never” thing happen and the “always” thing not happen. They are the Harry Potter-ish words that like Lord Voldemort “must-not-be-named”.

So instead of saying always or never, I tend to phrase my experiences, expectations, and advice with the words “usually” or “sometimes” or “once in a while”. The aim of my diabetes regimen is to do things that work most of the time. Sometimes that means that my breakfast insulin dose yields an in-range result on 7 out of 10 days. Two days I go crazy high and one day I end up chomping glucose tabs to fight persistent lows. Sometimes that means that although I am intellectually committed to a lower-carb lifestyle, I make less-than-optimal decisions and have two bowls of ice cream after dinner. Sometimes that means that I can have a day of high blood glucose readings that seemingly have nothing to do with food, insulin, exercise, pump sites, or anything under my control.

Along the lines of always and never, I avoid making New Year’s resolutions or even pledges to forever change my behavior. As the beneficiary of good insurance, I currently own what I consider the latest and greatest medical devices with a pump and Dexcom G4. I am anxiously awaiting the Animas Vibe, but that is in the hands of the FDA and totally outside of my control. One of my strengths is that I seem to be able to wake up each morning with the aim of doing my best and then not drown in guilt over my daily imperfections. My diet is a work-in-progress and my goals for 2014 will be a mirror of my daily hopes in 2013 to do a little bit better than yesterday.

Some people look at the advent of a new year as a clean slate to start anew, change habits, and re-invent yourself. I think in smaller blocks. Every day is a new day. Every hour is a new hour. Every minute is a new minute. If I look back a few years or decades, I can see that I have changed. My diabetes technology has improved along with my types of insulin, diet, and social support. But there is no single moment when these changes happened. It is all a blur and a morph from this to that.

In summary, although I hate to use the forbidden words, I ALWAYS hope that I can end each day knowing I tried my best and that my best will be sufficient to keep me healthy for many more years of Type 1 Diabetes. And I hope that I will NEVER be less than supportive and appreciative of my many online and offline friends who share my sweet and pancreas-impaired journey through life. This year and next year and the next year.