Being Thrifty

I mentioned something on social media a few days ago about a ‘lifetime supply’ of lancets, and how I get my test strips free every month. I’ve been getting a lot of ‘How do you do that?!’ questions, so I thought I would share.

Nothing I’m doing to get supplies is incredibly mind-blowing nor is it difficult and all of it is done honestly.

LANCETS: For my lancets – I primarily use the Accu-Chek Multiclix lancing devices, but also like the Delica lancing device from OneTouch.  The vast majority of the lancets I have are for the Multiclix, however.  What I mean when I say I have a ‘lifetime supply’ is not that I have enough to prick my finger with a brand-spanking new lancet every time……..I am notoriously BAD at changing my lancet, often not changing it until I literally just can’t make myself bleed. I recently found two large lots of Multiclix lancets on Ebay and purchased them at well below retail pricing. I have enough lancets now that I can change my lancet every two weeks and still have them last about 50 years.  (Yes, go ahead and tell me that I need to change my lancet every time or I will get infections….I’ll point out that in over 22 years I’ve never had a skin infection. Tell me I’ll get calluses….I’ll point out that I test so often my fingers were callused even as a child when I DID change the lancet every single time.)

The Multiclix lancets retail for $12.99 for a box of 102 at Target.  Even if I used insurance coverage to get 204 a month, I’d pay $15 out of pocket….averaging $7.50 a box.  The ones I got on Ebay ran me $4 a box and I only paid $2.54 to ship all of them.

To me….that is being thrifty.  For others, who wish to change their lancets every single time, this may just be a case of being silly.

TEST STRIPS: As far as my test strips, yes, it’s true….I get 250 test strips absolutely free every month.

See, my insurance formulary treats all glucose strips the same – every single brand (even store brand generics) fall into the highest co-pay tier on my insurance. They ALL cost $55/month in copay. When I learned about this I was dismayed, because my last insurance policy only charged $25/month. As an adult back in school, who gave up a full time career teaching, spending an extra $30/month was NOT something I wanted to do (especially because the cost of my insulin was also going up $30/month…and I haven’t figured a way out of that one yet!).  Incidentally, around the same time I chose to change from Walgreens pharmacy (I had been using Walgreens religiously since my diagnosis in 1992) to Target pharmacy.  I had had enough of Walgreens – they never seemed to have my Verio test strips or my Novolog in stock, and several times I had to wait a WEEK for them to get them in. They were never helpful about obtaining them from another pharmacy location for me – it was always up to ME to do the footwork, etc.  (Target, for what it’s worth, has been AMAZING.  No issues.  EVER.  And they have superb customer service.) Well, when I was in my initial consult with the pharmacist at my local Target, working out how to transfer my RXs from Walgreens to Target….she let me know about their store brand ‘premium’ meter and how with a RX from my doctor for those strips I could get a full month’s supply for just $4, under their ‘$4 generic program’.  I took some time to investigate and found that their ‘premium’ meter was a rebranded Wavesense Jazz. I went about getting a free meter and strips from Agamatrix (the manufacturer) to try it out and compare it to my Verio IQ prior to making a full jump over. After all, lower copays aren’t much good if accuracy sucks.  But the accuracy was great and I chose to get my RX changed from Verio strips to the Up & Up premium blood glucose strips.  Somehow or other I don’t even have a $4 copay….the way my insurance works in tandem with a generics assistance program somehow balances out to nothing………as in, I pay NOTHING for my strips every month.  (The best part is that Target still tells my insurance I’m being charged $55/month, but then Target ‘pays’ it on my behalf.  My insurance applies $55/month to my out of pocket maximum, even though I’m not the one paying it out of my pocket.)

So if you are willing to switch to a meter with a few less bells and whistles, it’s absolutely within everyone’s reach to obtain free or very close to free test strips every month.

DME: The last way that I’m ‘thrifty’ with my diabetes supplies is my purchase of DME supplies. If you’ve read anything else I’ve written about DME you know I HATE Edgepark because they markup their prices astronomically. I now get my supplies for my t:slim directly through Tandem. They were in-network for my insurance I had for 6 months last year, but they aren’t for the insurance I use this year. HOWEVER, because the price they charge is FAR less than what Edgepark (who IS in-network) charges and actually falls so far BELOW the maximum allowable charge by my policy, my insurance has agreed to reimburse as if they are in-network. Meaning my supplies each month work out to be about $35 out of pocket, instead of the $80 per month I was paying out of pocket for supplies from Edgepark…..for the exact same supplies. Now that I’m on a Dexcom I have to use a third-party for them (my insurance doesn’t contract with Dexcom either, and apparently Dexcom doesn’t want to touch the accounts of out-of-network patients unless they’ve exhausted all other options)………but I asked my local Dexcom rep to do some price checking for me and told him I’d under no circumstances use Edgepark. He got me hooked up with Byram. While they do markup, it’s only a few dollars per box of sensors and so basically my out of pocket payments for sensors through Byram cost the same as they would if my insurance worked directly with Dexcom.

The lesson here is that you need to price check. You need to talk to your insurance company to find out your options, call those companies and find out what their contracted rates are with YOUR policy, find out what YOU would pay out of pocket – and get it in writing if you can. Do not just accept the DME provider your insurance company at first recommends. They often are NOT the lowest cost option. (Why in the world insurance companies want to contract with higher priced options, I will never understand). If you find an option that is far cheaper but is out-of-network, talk to someone at your insurance company – they may be willing to write up a specialty contract just for you so you can use that option and save yourself and your insurance company a lot of money.

Diabetes is expensive. Look for the loopholes, use your resources…and you may be able to make it a bit cheaper for yourself, without sacrificing quality.

Diagnosis Date

I have never known my exact date of diagnosis.  Things were a blur at that time, because diagnosis came in the midst of a family vacation, so all my parents could ever tell me was that it was late July. I assumed it was near or on a weekend, because we had been on vacation for a day or so when I was diagnosed.  I estimated it was July 26, 1992 and that is the date that I’ve declared as my ‘diaversary’ every year since I started even really caring about a diaversary a few years ago.

Today my GP let me know that their clinic was accumulating records for their patients and were working with all other major networks in the state to compile one electronic record that would encompass EVERYTHING, whether I’d been seen for/diagnosed with a condition there or somewhere else. I said I’d be very interested in obtaining access to those records and I was given access right away and ……. look what I found:

Capture

Yep, that’s the date I was diagnosed with IDDM (Insulin Dependent Diabetes Mellitus)…….July 23, 1992.  My estimate was only 3 days off.

And now I FINALLY know!

 

Let’s Talk about Gluten

Gluten. (from Latin gluten, “glue“) is a protein composite found in wheat and related grains, including barley and rye. (Wikipedia)

It’s a word you hear a lot lately.  While there are definitely a lot of people with legitimate celiac disease or gluten sensitivities out there, you didn’t hear a lot about gluten until a gluten free diet became the world’s new fab fad diet within the past year or so  Now it seems like EVERYONE is worried about gluten.

My husband has (mostly) avoided gluten for several years now, to ease some pretty major digestive issues that went completely undiagnosed by his (rather stupid, in my opinion) gastroenterologist.

So when I started experiencing my own digestive issues with a high frequency, my first thought was ‘gluten’.  But then I felt silly…..after all, I reasoned, how likely was it that we BOTH have issues with gluten?  Not too likely, if you believe the statistics.

And yet….I have Type 1 diabetes.  Which means my chances of having celiac disease are at least TEN TIMES higher than someone of the ‘average’ population. (Auto-immune conditions tend to come in clusters, lucky us…)  In fact, I was tested for celiac disease 22.5 years ago, about a half a year before my Type 1 diagnosis (by the way, yesterday was 22 years with Type 1 for me – happy diaversary to me!) and my results were ‘inconclusive’. My parents were told to put me on a GF diet – and they did, for 6 months.  Back in the early 90s this was no small feat for a child who didn’t like most veggies and fruits, because there weren’t a lot of GF alternatives out there for my favorite processed foods. My mom said my diet went down to about 6 staple foods that I would eat all the time – and that was it (well, and my Flintstones multivitamins).  But my problems with nausea and weight loss and fatigue didn’t dissipate.  When I was diagnosed with Type 1 the doctors said ‘oops’ and told my parents that my symptoms had been due to the burgeoning Type 1….that I didn’t have celiac disease at all.

And so I went back to eating a gluten-filled diet.

Through the years I’d noticed that I seemed to have ‘digestive upsets’ more often than my family or friends …. but I attributed that to a bad immune system, poor control of my diabetes, minor food poisoning (over and over and over – how many times can you get food poisoning?!), etc. Never once did I think that it might be due to something I was consistently eating.

As I said, I recently (in the past few months) have experienced some major digestive issues with regularity.  I’ve had to call in to work on a few occasions and I missed school once back in early May. The symptoms would build up over several days, then get really bad for a day, then dissipate over a few days……only for the cycle to start again.

Two weeks ago I’d decided I’d finally had enough and cut out gluten completely.  This wasn’t the hugest jump for me to make – I was able to ‘copy’ many things from my husband’s diet and find alternatives for things I felt I still absolutely wanted to eat. The initial thought was that I’d do this for 3-4 weeks, see how I feel, and then reintroduce gluten to see if any improvement was coincidental or not. At that point if I felt it wasn’t coincidence I’d request re-testing for celiac disease.

My digestive issues haven’t resolved 100%…….but I’m about 70% better.  And as if that’s not reason enough to keep going with this……..

I have strong reason to believe that gluten has been causing insulin resistance in me.  Prior to cutting out gluten my Dexcom data shows that I was averaging a BG of about 137 and stayed between 70 and 150 about 60% of the time. I often had excursions over 180 after meals, no matter when I bolused.

Since cutting out gluten (and note: I am eating the SAME number of carbs per day!) I’ve decreased my meal-time insulin by about 9 units per day and I need to continue to decrease my I:C ratios because I continue to have lows after my meal boluses.  I am averaging a BG of 106 now, and I’m staying between 70 and 150 for 86% of the time.  Most of the time that I’m outside that range I’m BELOW it, not ABOVE it as I used to be. I’ve changed nothing else in my life the last two weeks.  I can only attribute this sudden increase in insulin sensitivity to the elimination of gluten from my diet.

I think that, regardless of digestive issues, I’m going to keep eating gluten free. Anything that helps me attain better control of my diabetes while simultaneously reducing insulin intake is a keeper, in my book.

An Update On My Eyeballs

Today I had my 6-month checkup with my retina specialist.  I’ve been fearful the past several months that my retinopathy was returning and/or worsening.

See, I’ve been having a lot of hemorrhages.  And all in my central vision.  It’s annoying and scary, you know?

I hadn’t gone in sooner than my regularly scheduled appointment because I’ve already been told a million times that more laser treatments are NOT an option for me.

Today I got a much better explanation of exactly what is happening in my eyes.  Some of it is GREAT news, some of it isn’t so great.

Let’s start with the GREAT news: The doctor sees absolutely no signs of active retinopathy, at any stage, in either of my eyes. Essentially, I am officially retinopathy free!

The not-so-great news: I am experiencing hemorrhaging of a different sort. I don’t have diseased or proliferating blood vessels……..but I do have an insane amount of scar tissue (in my central vision) from the many, many, MANY laser treatments that were used between 2007 and 2009 to save me from blindness. This scar tissue is pulling at healthy blood vessels, and occasionally those healthy vessels rupture.  They heal quickly because they are not diseased, but when it happens it is majorly annoying and inconvenient.

My options are to either live with it or opt for another vitrectomy, to clear out some of the scar tissue.  I am opting, for now, to live with it.  When I had a vitrectomy on my other eye in 2009……it was horrible.  I went through weeks of having to wear an eyepatch, weeks of having to use numbing and antibiotic eye drops EVERY FOUR HOURS, and months of absolutely no vision in that eye whatsoever as the trauma to the eye was significant and took a long time to heal and ‘calm down’.  I’m not willing to go through that again knowing this surgery wouldn’t even be able to realistically take out all of the scar tissue, and thus the issue may persist anyway.

So…..yeah.  My eyeballs are healthy! But the treatment that saved my eyesight is now the cause of my occasional issues.

Dexcom G4 Platinum CGM – First Impressions

I began using my new Dexcom G4 system on Monday evening.  It’s been wonderful to have – and after only just over 36 hours with it, I can’t imagine not having it.

The first night it woke me up three times to alert me to lows – the first time was a false alarm, but the next two times I was in fact low.  I have my alerts set at 70, so I can get my lows fixed as soon as they happen (minus the few minutes lag that a Dexcom can have in comparison to blood glucose).

Look at that control! Total fluke!
Look at that control! Total fluke!

Last night it woke me up for a low and then, when I overcorrected for that low, it woke me several times for being high.

I have found the information it gives me to be highly valuable and overall I’m finding it to be fairly in line with my meter readings.

My only complaint so far is that sometimes, if I am skating around an alert-level number, this can set the alert off multiple times in a short period. Last night I hit 200, the alert went off – I acknowledged and dealt with it.  A few minutes later it read 198….then a few minutes later it read up at 202 again. And because I crossed that 200 mg/dl level again, the alert went off again.  I just wanted to sleep!!!!

I’ve been using the ‘Dexcom in a glass at night’ trick that I’ve seen around the DOC, in order to hear my alerts at night (I have my Dexcom set to ‘vibrate’) and it’s worked really well – I wake up right away.  Hopefully my husband doesn’t want to kill me or my Dexcom yet.

I tend to name my devices, because I often ‘talk’ to them (that sounds crazy…..it actually started as a way to refer to my insulin pump with my kindergarteners when I was teaching – hence, my Animas Ping was named ‘Frank’), so I’ve been thinking about what to call my Dexcom. I didn’t want to use ‘Dexie’ or ‘Dexter’ because I feel like every third person in the DOC uses those names. I just call my t:slim ‘Slim 2.0′ (because this one is a replacement pump for my original t:slim) and so in line with finding a name related to the product name I’ve decided to call my Dexcom ‘Dextah’.  It has a silent ‘t’ by the way (it’s said ‘Dex-sa’).  So for anyone who knows me IRL – if you hear me talking to ‘Dextah’, know that it is NOT an imaginary friend!

Dexcom G4

In less than a week I should be live with a Dexcom G4 system and I’m very excited!

I’ve experience a lot of lows lately that I have not been able to feel, and it’s starting to scare me.  I spoke to my endocrinologist about a week and a half ago and he agreed I’d be better off with a CGM. product-1_0

I found the ordering process quite simple – all of the ‘Getting Started’ forms are right on Dexcom’s website and you can easily download them and email them to customer service. My endocrinologist’s LPN filled in the medical necessity form and got in contact with a local representative of the company that she knows.

He worked with me to figure out what we could do with my insurance coverage and I made him promise we wouldn’t even consider Edgepark Medical (because I absolutely hate them and refuse to ever work with them again).  I got set up with Diabetes Specialty Center/Byram.  Dexcom forwarded all my information, including my RX, to them so all I had to do was give them the go ahead to ship the system!

It should arrive between Monday and Wednesday.

If anyone has any tips they think would be helpful for a first time Dexcom-er, I’d love to hear them!  I’m a little intimidated from seeing videos of sensor insertions, so any comforting comments are appreciated too, haha!