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Permalink Reply by Laddie on February 11, 2013 at 11:22am

For Type 1's and probably Type2's on MDI, there is a little hope on the horizon. The ADA Standards of Care in Diabetes-2013 states that patients on MDI (this would include pumpers) need to test many times a day. A number is not stated, but times to test are described.

You can find the relevant part in Section V.C.a and it states:


"Patients on multiple-dose insulin (MDI) or insulin pump therapy should do SMBG at least prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving."

You can find the Standards of care here:

http://care.diabetesjournals.org/content/36/Supplement_1/S11.full#s...

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Permalink Reply by Betty J on February 11, 2013 at 1:08pm

I don't think Medicare follows the ADA suggestions. If you look in the Medicare book that we receive each year, the section pertaining to Diabetes. I can't remember the exact times that Type 1s are suppose to test but it's something like 4 times and if a pumper I think it's 6 times. There is no consideration for people who have other health issues that impact our disease.

When I started with Medicare I was seeing my Endo every 6 months but Medicare requires me to see him every 3 months. I considered it an insult after living a lifetime with this disease I would think some considerations would be made but they don't look at each case individually...makes me think that I'm still a child and don't know how to manage my disease. If I couldn't manage it I wouldn't have made it to 54 years.

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Permalink Reply by Mayumi on February 11, 2013 at 1:08pm

Thank you for the information you posted. I never knew there was a standard of care from Medicare with regard to Type 1 diabetes.

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Permalink Reply by Betty J on February 11, 2013 at 1:25pm

If you check your Medicare book under Diabetes you'll see what policies we are suppose to follow in order to get coverage.

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Permalink Reply by Zoe on February 11, 2013 at 1:53pm

I'm always confused when I see these Medicare discussions. I'll be 65 this November. I have CalPers now (California state retirement insurance) which will integrate with MediCare. There is a website that explains exactly how the two go together. But as far as I understand, my coverage will become better not worse. Though CalPers and MediCare are unique, I thought most people also have a "Medicare supplement." But whenever people talk about Medicare they talk as if that is their only insurance. Does that mean they don't have a supplement? Or are the supplements significantly inferior to my CalPers (which is a regular Blue Cross Insurance with 80% coverage and meds from $10 to $100 (most lower) for e month med supplies.

Does anyone have a similar state insurance plan integrated with Medicare? Are you subject to these Medicare rules and limits too?

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Permalink Reply by Betty J on February 11, 2013 at 7:30pm

Zoe I don't have a state medical plan but do have Medicare and a supplement. I guess I'm like most people and refer to it simply as Medicare. Medicare is what we put into the system for 30 years or more and the supplement (which mine is also Blue Cross) which is paid for seperately. Medicare comes out of your social security and as I said the supplement (which is 20%) is seperate. Two years before I went on Medicare I researched exactly what it was all about. Although there are still some things at times that aren't clear I have a more clearer understanding then I did years ago.

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Permalink Reply by Zoe on February 11, 2013 at 7:49pm

Thanks for the explanation, Betty. So the supplement doesn't counteract the Medicare regulations about D?

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Permalink Reply by Betty J on February 12, 2013 at 10:01am

No, it's what it implies a supplement to make up what Medicare doesn't pay.

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Permalink Reply by Zoe on February 12, 2013 at 10:36am

Oh, ok, I guess mine is kind of the opposite. My Blue Cross is my main insurance, and Medicare will fill in some gaps. (For example I now have 80% coverage for hospitalization and will then have 100%). I do need to read the site that explains the integration of the two in detail, but would still like to hear anyone else whose situation is like mine. (Having permanent insurance from a government agency that gets integrated with Medicare at age 65.)

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Permalink Reply by Betty J on February 12, 2013 at 2:02pm

Aa i said earlier Medicare is confusing and I'll admit I don't have full understanding, it's a learn as you go thing. I know enough to know how to respond to questions asked by my medical team.

Permalink Reply by Laddie on February 11, 2013 at 3:02pm

Betty J, you're right that these Standards of Care are not a Medicare document. These are the Standards of Care that should govern all medical professionals who diagnose and care for patients with diabetes. This year is the first time that the American Diabetes Association has stated in the standards of care supporting the need for people on MDI and pumping to use more test strips.

These standards of care do not govern Medicare, but I do hope that they will help provide justification to make changes in some Medicare policies on how people with Type 1 are cared for.

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Permalink Reply by Betty J on February 11, 2013 at 7:22pm

I agree Lathump. That is the biggest problem we have there is the uniformity of any type of agreement. The ADA has lagged behind for so many years that no one thinks of them as the standard of that what they say is truth. What Medicare and all insurances need is to ask the patients what the standard should be, we live with this disease but we know that won't happen.

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