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Permalink Reply by acidrock23 on August 26, 2011 at 6:13pm

I think that some insurance covers practicioners of Native American medicine ("medicine men") as well. I am not 100% sure about CDEs. I talked to one and personally, she was great but diabetes-wise, it was sort of pointless and I'm not sure it was worth whatever I ended up paying her? I went to the clinic after we moved too, when my mom was out after having her hip replaced, and they were like "we're here" but the doctor w/ the clinic was in another town, oriented the wrong way from work so I was like "nah" and went to a different doc.

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Permalink Reply by MyBustedPancreas on August 27, 2011 at 4:33pm

OMG, that is horrible!! I don't want to believe that, but I know it's true. I love how insurance companies have no qualms covering limb amputation, admission to ERs when you go really low, and for any of the other complications you can develop from poor control of D. BUT, when you try to obtain education about managing D to avoid these expensive things, well, that's where things fall apart.

I remember even when pumps were hard to get for T1s! It was like you had to prove you either had poor control and therefore needed the intensive management that came from a pump, OR you had to show you had good control and were therefore responsible enough to have a pump. The "criteria" were never clear.

Unfortunately, I think that insurance companies and the medical community in general have more or less failed when it comes to managing T1D at least. Sometimes I wonder if the "improvements" we're seeing in the life-expectancy of T1D folks has more to do with the availability of information online and our ability to troubleshoot issues with a whole forum of other T1D folks. My control/management DEFINITELY improved once I found online forums and started reading other D blogs. I found so many answers to things that I could just never get from my endo. Also, I found other people living with T1D who could verify what I saw in my day-to-day existence (such as the positive effects of eating a diet relatively low in carbohydrates).

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Permalink Reply by Peetie on August 27, 2011 at 4:44pm

My Busted Pancreas: What you are saying makes a lot of sense. Tudiabetes and the links everyone provides has sure helped me. Joanne

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Permalink Reply by Natalie ._c- on August 27, 2011 at 4:51pm

I guess what pissed me the most was that they cover those non-effective "treatments" generously, while denying ALL diabetics even the basics. Both Type 1's AND 2's NEED a lot of help in the beginning, especially, because our society in general knows little to nothing about the realities of either type. Because of inflation, that $150 (which was $50 when I was newly diagnosed) still only covers about an hour of education -- how to use a meter, and nothing else. And if you don't know WHY you're testing your BG and what to do about it, what good is a meter?

I do wish more people, especially older people diagnosed with Type 2 were computer literate, but that's an idle dream. I'm actually much less worried about the savvy young people with Type 1 who grew up with computers, and who are nothing if not full of energy and active -- what they mostly need to do is get hooked up with the DOC on the internet. We can take care of our own. But the older people who are pretty afraid of computers, or can't afford them, or are undereducated, and not proactive are just left in the dirt. Makes me want to cry, while the CSPractitioners and homeopaths do their well-intentioned best to kill people.

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Permalink Reply by MyBustedPancreas on August 27, 2011 at 6:46pm

I agree. But also it's not just newly diagnosed people who can sometimes benefit from a CDE. Even those of us who have had D for a long time sometimes need someone like a CDE to run things by. Endos don't have a lot of time, but CDEs do. Some of the best care/advice I got this year (outside of this listserv) was from the CDE who I met with when I went back on the pump. She was able to spend lots of time with me, troubleshoot various issues as I set my basal rates, and just be there to answer random questions via email when I had them. As another woman with T1 who happens to be just a little older than me, she was really able to relate to my hormonal battles each month, and helped me come up with a different basal patterns to deal with this issue. I generally like my endo ok, but this CDE was invaluable.

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Permalink Reply by Natalie ._c- on August 27, 2011 at 6:52pm

You're absolutely right, of course! :-) I'm lucky enough to have 2 CDEs who are willing to answer my questions for free -- I feel terrible taking advantage of them, but they both claim that they do it willingly without any thought to recompense. But I think that they, like any other person who's working for a living, should be paid. When I get to Medicare in a year and a half, I fully intend to schedule sessions with the one who's local -- not because I need anything, but just because Medicare will pay for it, and she deserves the payment for the time she's put into me!

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Permalink Reply by Jim on August 28, 2011 at 5:52am

If your using the CDE for the issues you discussed, what is the purpose of the Endo then? I have only seen an endo a couple of times and really struggle with what value they actually add. I got the feeling since my A1C wasn't out of wack that the endo really didn't know what to do with me.

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Permalink Reply by acidrock23 on August 28, 2011 at 6:04am

I think a lot of endos use CDE as kind of a communication "agent" in between them and the patients. If you are wanting to make adjustments or fix numbers that are off and only see the endo every 6 months, his suggestion to "take 2 more units of Lantus before bedtime" is basically a SWAG (or perhaps an E[ducated]WAG?) but then you are left watching it work or, more likely in my experience, not work for 6 months until you go back. I had a thing recently where I'm not sure if she was a nurse or a CDE at the doctor (I didn't give a $%#@ or bother asking, and her email "signature" doesn't include her CV...) was emailing me some suggestions about making changes and eventually sort of gave up because I was like 1) the pump seems to be doing some odd stuff. (it blew up a couple of weeks later, perhaps vindicating my powers of observation) and 2) I emailed them the link to my Garmin 405 that I use to track my running miles, which were increasing quite a bit at the time, perhaps contributing to some lows. I was like "well, the pump blew up, so we'll just see what happens in August at the next appointment..." and she disappeared. It must be a very frustrating job but it seems as if this particular one is a bit inured to the challenges thereof.

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Permalink Reply by acidrock23 on August 28, 2011 at 5:30am

Maybe insurance companies are in posession of actuarial data showing CDE visits are not worth what they charge for them or are not "medical enough" to substantiate coverage under the terms of an insurance policy?

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