Tag Archives: type 1 diabetes

Hi again! Big news!

Posted on by

1

Wow, hi, it’s been a minute. Over two years, actually. I think we can all agree it’s been a very challenging past couple of years, and a lot has changed since my last post. The biggest change- I have a 7-month-old son! When I first started this blog, I thought that if/when I got pregnant, I would share the entire journey. Being pregnant with type 1 diabetes was always something that scared me, I honestly didn’t know if I could achieve and maintain the type of blood sugar control that I needed in order to have a safe pregnancy for me and the baby. Spoiler alert: I did it! But it was hard, and this pregnancy took a lot of physical, mental, and emotional energy. I just did not have enough energy left to document the journey. So instead, here I am 7 months later sharing my experience in hopes that it might help someone who may be having similar fears and doubts.

Becoming a parent is transformative on so many different levels. You learn so much about caring for a tiny, helpless human, but you also learn a lot about yourself in the process. Even before my son was born, he taught me that I can overcome challenges. I can face what scares me. What an invaluable lesson and one that I will teach and instill in him as well. And those 39 weeks were certainly challenging. The level of discipline and vigilance to keep my blood sugars between 65-140 all day, every day, was exhausting. But I’m not perfect and I had to learn not to get caught up in the “what ifs” and the worries when my blood sugar occasionally spiked above those levels. Having a high-risk pregnancy added an extra layer of anxiety that I knew I was taking on, but you don’t fully understand just what it entails until you’re in it (that very first doctor apt where they list off all the potential complications and risks was INTENSE). Not to mention the time/energy commitment going to over 40 doctor appointments over the course of my pregnancy between the ultrasounds, office visits, weekly phone calls with the diabetes educator, and twice a week non-stress tests at the end of the pregnancy. It was a lot, but worth every second!

So how did I do it? Before I tell you what worked for me, I do have to say that it’s important to follow the recommendations from your healthcare provider. My experience is not meant to be medical advice, just sharing what was helpful for me.

1. I had an amazing team of doctors and diabetes educators. Every week I had an appointment with a nutritionist/diabetes educator. She would look at my Dexcom glucose numbers from the past week and my pump settings, and make adjustments. While we didn’t really restrict anything I was eating, she had helpful suggestions for the timing and types of snacks to eat. When the insulin resistance kicked in, we were ready. These continuous and often minor tweaks made a big difference in making sure that my insulin needs were aligned with changes in my body. I really believe her constant reassurance and encouragement were integral to my success. With so many doubts and fears circling, hearing someone say “You’re doing really great” goes a long way.

2. I got better about pre-bolusing. I’ve always been bad about this, but I stepped it up when it mattered. And when I remembered to pre-bolus 15-30 min before my meal, it definitely helped my blood sugar spike less.

3. I set tighter ranges for high and low alerts so that I would be alerted early when blood sugars were rising or starting to get too high, especially at night. Yes, my alarms would wake me up at night a lot, but I was already waking constantly to go to the bathroom. This helped make sure that my blood sugars were never sitting too high for an extended amount of time overnight. And every time I would wake up in the night, I would check my blood sugar and make any needed corrections. I have an Apple watch where I can see my Dexcom blood sugars, so it was very convenient to look at my watch and see how I was doing.

4. I was extra vigilant when it came to my blood sugars and probably overly aggressive. Anytime I saw my arrows starting to trend upwards, I would set temp basals or give a correction to anticipate a spike. I set a LOT of temp basals, I found them to be very helpful. I erred on the side of giving too much insulin and risking going low rather than seeing too many high blood sugars. This may not be the best approach for everyone, but it’s what worked for me.

5. I did the best I could and learned to accept that some things are just out of my control. I learned not to freak out about a handful of high blood sugars now and then. My doctors repeatedly told me how well I was doing and that the time in range was more important than a few isolated incidents. Because as diabetics know, you can do the same exact thing as yesterday, eat the same meal, give the same insulin, and your blood sugar can behave completely differently. I think this was mentally the hardest part. Even before your baby is born, there’s this fierce need to protect them from harm and the “mom (parent) guilt” can make you doubt yourself. It’s hard to overcome these types of thoughts, but the fact that you’re even having them means you’re already a great parent.

So what’s my advice for any pregnant type 1 diabetics or anyone hoping to become pregnant? I would say make sure you have a team of doctors who you trust and are in constant communication with so that you can work together to fine-tune your insulin throughout your pregnancy. It’s okay to be scared, all emotions are important and valid, but don’t let your fear hold you back. And then do the best you can each day (knowing that no one is perfect) and take things one day at a time. You can do this!! When you hold your little one, it will make all the challenges worth it.

Insurance frustrations

Posted on by

3

bubbleDuring the time that I was on my parent’s insurance, I was pretty much removed from the entire billing and insurance process. I was lucky in that my dad took care of the paperwork and the phone calls. I lived in my nice little naive bubble where all I worried about was going to my appointments, ordering my supplies, and taking care of my health. I didn’t worry if a certain device or procedure was covered by my insurance, everything just magically worked out. Oh what wonderful times those were.

Then I got a job and my beautiful bubble popped.

I know that I’m very fortunate that my job even offers insurance and that it has pretty good coverage. However, if you ever want to simultaneously raise your blood pressure while feeling like you want to bang your head against the wall, try calling your insurance company to argue a claim.

Take a few weeks ago as an example:

It all started with an email notification that I got that a new claim was available to view online. It was about my most recent routine appointment with my endocrinologist. I followed the link to an EOB. I feel like I should be able to say that I speak “Insurance” since it often feels like I’m reading a foreign language while trying to decipher what is being said. I noticed that the entire bill was higher than the past 2 appointments. Scanning the paper, I found a tiny number leading to the appendix with the following text:

Our payment policy limits the number of times this procedure is allowed and that limit has been met.

Ummm huh??? I went back up to see what billing code this was referring to, thinking perhaps it was some unnecessary test or blood work that I may have unintentionally duplicated.

GLUC MONITOR, CONT,  PHYS I&R 95251

Like I said, a foreign language. But whatever it was, I was being charged the entire amount of $120. But if it has to do with glucose monitoring, it probably is necessary. I called my insurance company. The woman explained that the billing code that the limit was referring to was 95251 (side note: I did some googling and this particular billing code can range from $35-$350!). With some simple googling I determined this billing code was referring to the following:

95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report.

Essentially it’s downloading my CGM and interpreting the numbers. At this point I was starting to get both confused and angry. I checked the EOB. I was also charged for an Office Visit so it’s not like it was the only thing they were billing for. But the part I was getting angry about was that downloading and interpreting my numbers is really all my appointments are since checking my a1c and blood work happens at an entirely different time and facility.

I called back the insurance company, asking what the limit of visits are for that code: 2. I attempted to calmly explain that the standard of care for a type 1 diabetic is seeing their endo every 3 months, so 4 visits a year. How could they only be covering half of them?!?!

The insurance woman explained that I’m going to need my doctor to call the patient management team at the insurance company and get the additional visits pre-certified ahead of time for them to be covered and additionally to appeal the charges from the last visit.

Ugh. Really??

At this point I’m just annoyed. But I’m more annoyed at the idea of having to pay so I call the health system starting with their billing department. After explaining the issue, I was told that the doctor will have to call and that it’s something that the billing department can’t take care of. Okay fine.

I call the doctor, the receptionists says I should talk to billing. No, billing said to talk to the doctor. At this point I’m ready to hit my head against the wall. My doctor is not available so I leave a message explaining the entire issue. The receptionists assures me she will deliver the message.

A week goes by. No response.

I call back. The person on the phone looks at my file. He tells me that it looks like it was seen and sent to billing. The person on the phone offers to have someone from billing follow up with me. Yes please.

I wait.

A few days pass and I finally get a message from someone from Billing. “I see the message in your file,” she says. “It looks like they’re talking with someone at the insurance company. I can call you back when I know more.”

Ughhhh.

A few more days. “It looks like they are taking off the charge for your most recent appointment.” “That’s great,” I respond “but what about the future appointments? I have one coming up in a few weeks. Are they going to charge me again? The whole point was to get them pre-certified.” “Oh ummm, well I can tell them to look at the September appointment. You’ll have to call ahead of time for each appointment and tell them to contact the insurance company.”

Are you frickin kidding me?!?! Why is this so circular?!?! I thanked her, not sure exactly what was accomplished besides not being charged for the most recent visit. However, the fact that it took almost 2 weeks does not give me much hope if this is the process I’m going to have to go through twice a year, every year!

The funny thing is, I would consider this a successful encounter compared to some of the other arguments and conversations I’ve had with the insurance company. But it’s amazing to me the number of phone calls it takes to accomplish even the simplest task. Working in the health care field and having a masters in public health, I consider myself to be more knowledgeable than perhaps the average person in navigating the health care system. And if I found this process to be arduous, I can’t imagine that many people with much less knowledge are being successful in their efforts.

If anything, I’ve become a much more assertive person through this process, but really I just wish that the whole system was fairer and simpler for everyone.