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I’m FREE … NO CGM for 6 hours!

I feel naked!  No, not really … but I’ve been wearing CGMs 24/7 since 2006!  Yup, I was at the head of the line for the first Dexcom, the STS, a 3-day sensor with wild variability … and Dexcom was such a small company that I invited the VP of Government Affairs and one of the 10 sales reps to my home to sit around and chat about my experiences with the Dex 3.  It was a frustrating device but with great potential … I fondly named it PoS. 

I switched to the Abbott Navigator, as soon as it became available on the market … and loved it (except the 10 hour start-up and the painful sensor insertion). And then, BAM, it went off the market in the US.  I even contemplated traveling to Israel or the Netherlands to buy it there.

But I settled for slinking back to Dexcom, for the Seven, and then the Seven Plus. It was indeed getting better and better, as I thought it would.  And I was the first in line to get the new Platinum G4 … WAY more accurate, although clunkier (explained to me for the parents who wanted a greater range away from the transmitter … which did not at all affect me but the size did).

That all said, I’ve been CGM-ing (is there a better term … maybe BG-sensing or BG-ing?) for about 8 years.  Yup, wearing a sensor, learning about Hypofix and Skin Tac, Yahoo’s Diabetes CGM forum, figuring out where to stash the receiver when wearing formal attire, etc.  Twenty Four Hours a Day, Seven Days a Week. 

I am NOT complaining at all. I am so grateful for the technology and […]

COLTON, the Diabetes Alert Dog

Our support group GNO had the opportunity to visit with Colton, the wonder diabetes alert dog recently. And he was truly amazing! Trained by one of our members, Jessica Ching, Colton wears a special collar. He is able to sense/sniff high, low or changing blood sugars … and then alert his owner by pulling on the tags on his collar or otherwise getting her attention. He is so obedient and sweet. And I understand that when he is flying on an airplane, he frequently alerts his owner because he senses a blood sugar event from another passenger.

What a wonderful dog and thank you, Jessica, for bringing him over for a visit!

By the way, I will give a free book to anyone (not associated with GNO) who can guess what GNO stands for.

 

The Changing Face of the Endocrinology Office

When I was first diagnosed, in the dark ages, there were NO insulin pumps, NO CGM, NO blood glucose meters, NO HbA1c, NO disposable syringes, NO human recombinant DNA insulin.  Yup, certainly seem hard to believe … almost 50 years ago.

Then came advances:  human insulin, portable (and even tiny) meters, disposable syringes and Lantus, insulin pumps with and without tubing, CGM, A1c … AMAZING and WONDERFUL new techniques and technologies, helping me to live better and longer and with fewer complications.

In all that time, the “doctor’s office” changed too.  Improved?  Jury’s still out on that and much of it depends on where you live, your doctor’s office and staff, and how proactive you are about managing your own health and your medical team.

Here’s what I see … and the caveat is that I live in a large metropolitan county within an hour’s drive of both Los Angeles and San Diego.  Indeed, we are offered top notch and accessible medical services.  But is it better?

I see endocrinologists, mostly in group practices, who manage T1 PWD’s mostly by the lab results and the numbers.  They are busy … very busy.  (there is talk that there will soon be a shortage of internal medicine doctors, not to mention the trickle down to a more severe shortage of internists specializing in endocrine disorders (endocrinologists).  The endos in practice do NOT have a shortage of patients, as there is a horrific boom in the diagnosis of both Type 1 and Type 2 diabetes.  What feels lacking is compassion and a sense of truly caring. 

To handle their large caseload of patients, from my vantage point, they are less personal, give less time and have less direct follow up.  They […]

And TODAY is a better day!

Why is it better today?  Don’t know!

But … it sure feels better, like this …

Reallllllly? It’s a ROLLERCOASTER day!

This was my 24-hour CGM readings yesterday!

Why?

I DON’T KNOW.  But I sure know it didn’t feel grand!

In fact, it felt like the picture below!  Know what I mean?

No Medicare CGMS Coverage??? Are you kidding me?????

by Joanne Milo
www.TheSavvyDiabetic.com
16 July 2014

Medicare (except in Advantage HMO plans) does not cover any CGMS. There are codes for sensors, receivers and transmitters! But their ruling, in 2008 (when they just came on the market), deemed them “precautionary.”
How is “precautionary” defined? Who knows … it’s certainly not a term one can find in all the Medicare formulary data. So this becomes circular logic. No one knows what “precautionary” means but because Medicare cries, “PRECAUTIONARY,” CGM is NOT COVERED.

I just couldn’t believe that I couldn’t somehow convince Medicare that CGM was not only critical to my life and my long term well-being, it was also cost-effective over multiple daily test strips. I threw my heart and soul as well as hours of research and letters from my doctors.

First Level Appeal: DENIED because CGM is PRECAUTIONARY.
Second Level Appeal: DENIED because CGM is PRECAUTIONARY.
Third Level Appeal and phone hearing with Administrative Law Judge, whose 50 year-old son has
diabetes (probably Type 2) and does just fine testing 2-3 times/day. DENIED because CGM is PRECAUTIONARY. The ALJ even wrote that I proved medical necessity and I proved cost efficiency! But still denied!
Fourth Level Appeal: DENIED because CGM is PRECAUTIONARY.

My next step, if I had the time and money, was to sue Medicare. Don’t have the money or time. Asked for support from a CGM company … again DENIED.

CGM has been available to the diabetes market since 2008 … and been improved and revised. According to Dr. Steve Edelman, UCSD and a T1, the best strategy for avoiding sudden death in bed is to use a CGM. This is an essential medical device […]

From Dr. Gabe Mirkin: Soluble Fiber Helps to Control Diabetes

May 19, 2013

by Gabe Mirkin, MD
A study in the New England Journal of Medicine showed that taking in extra soluble fiber helps to control diabetes. Now all diabetics should follow two dietary rules. First, they should restrict severely foods that cause a high rise in blood sugar: sugar-added foods such as soft drinks, pastries, cookies and so forth, all foods made from flour such as bakery products and pastas, and fruit juices. They should eat fruits and root vegetables such as potatoes with other foods to slow the release of sugar from these foods without eliminating their valuable nutrients. Second, they should eat plenty of the foods that are high in fiber: vegetables, whole grains, beans, nuts and other seeds, and fruits.
This study shows that foods that are high in soluble fiber help to prevent sugar from rising too high after meals by keeping food in the stomach longer, so the sugar is absorbed slowly, and by preventing free fatty acids and triglycerides from rising too high after meals. Free fatty acids bind to insulin receptors and prevent insulin from doing its job of driving sugar from the bloodstream into cells. Foods that are good sources of soluble fiber include most whole grains, oat bran and oat meal; beans and other seeds; many fruits, including cantaloupe, grapefruit, orange, papaya and raisins; and vegetables such as lima beans, okra and sweet potatoes.
NEJM, May 11, 2000

DiaTribe: Diabetes Friendly?

DiaTribe: Sometimes It Pays to Go With Your Gut

May 30, 2014

By Geoffrey Martello and Nancy Liu

twitter summary: A new and innovative way to address diabetes and obesity? Learning more about what’s in your gut.

short summary: A paper in Nature Medicine takes a look at the connections between the microbes in your gut, metabolism, and medication. Learning more about the gut microbiome could lead to clues about how weight loss occurs and how complicated our metabolisms can be. This growing new field of study linking the gut to type 2 diabetes and obesity is in its infancy, and many hope future therapies could be developed from this research.

A recent article in Nature Medicine titled “Microbes, metabolism, and medications” presents an exciting new tool that may soon find a place in the diabetes and obesity treatment arsenal. Even more exciting – it lives inside you and me!

The microbes that live in our gut, also called the “gut microbiome” or “intestinal flora,” are a significant contributor to human health. These organisms serve many important roles including helping with immune function and cell tissue growth. An emerging area of research concerns the role of the intestinal flora in “host metabolism” – in other words, the organisms in our gut actually influence how we digest our food. What’s more, the intestinal flora is directly shaped by our genetics, medications, our exposure to different bacteria, diet, and more. For example, some research suggests that consuming a high-fat diet can negatively impact the gut microbiome. Other studies have found that changes in the microbiome can promote obesity.

Fascinating research on mice shows that transplanting the gut microbiome of an obese mouse can actually make a thin mouse become obese, suggesting that gut microbes influence obesity. Recent animal studies have […]

Making Diabetes Prettier