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Insurance

I lost the genetic lottery. Let me explain.

  • My father was a type 2 diabetic. He died 18 years ago at 63 years old.
  • My grandmother was a type 2 diabetic. She died 50 years ago at 63 years old.
  • My grandfather died at 56 years old in 1948. It could have been diabetes, but there was no real testing for that back then.
  • You can trace it back. My great-grandfather died at 47 years old, his mother died at 57 years old.
  • My sister has diabetes. My brother does not.

So genetics are working against me here. I was diagnosed with diabetes about 12 years ago, while I was in my mid 40s. I went on a diet and lost 90 pounds. That was good enough to manage my diabetes for the next 6 years.

As you may or may not know, diabetes is a progressive disease. Those with it know that it will progress eventually, and I am medically knowledgeable enough to know that it will likely be what kills me at some point. I am just committed to making that date as far in the future as I can. So I watched what I ate, stayed active, and kept up doctor visits.

At any rate, it was about six years ago that my blood sugar began climbing. My A1C was right around 8. So the doctor put me on Metformin. The doses slowly increased, another drug was added. Still, my A1C stayed pretty good, wavering between 6.5 and 7.5.

My levels slowly have been increasing. Last September, my A1C was up to 7.8. Then in April, my A1C was as high as it ever has been: 10.0. The doctor tested my blood to see if I was still making my own insulin, and I am. So we talked about a few options.

One option is to stay the course. That is the worst of the choices and, considering my family history, will lead to a death within a few years. Not a good choice.

The second option is insulin, meaning that I would have to inject myself at least once per day. There are a lot of drawbacks to that plan, and isn’t much better than option one. I’ve seen for myself that type 2 diabetics don’t do well or last very long once they go on insulin.

The third option was to try one of the new drugs: Trulicity, Ozempic, Rybelsus. The one we decided on is Trulicity. The catch? The drug costs $800 to $1,000 a month. None of the others are any cheaper. My insurance company says that they won’t cover it unless I can prove that I am a diabetic who has tried other, cheaper options, and those options don’t work. The Dr wrote the prescription.

Of course the insurance company kicked it back and demanded more documentation. We provided it. According to their own website, I fit the criteria.

The doctor just called me. The insurance company denied it anyway.

I have some calls to make to try and take care of this. I don’t think that I have any legal recourse, so I have to review my options. It is stuff like this that makes me believe that insurance companies should be liable for malpractice.

31 replies on “Insurance”

Also a family history of it and sadly big land whale is the default genetic setting.
After a stroke four years ago, lost 140 pounds on an extreme KETO, less than 80 carbs per day ZERO sugar diet.
Sugar is hidden everywhere and has many names, it must be avoided at all costs along with too many carbs and starches.
Use the discipline force to beat the dread disease if a standard grade Not Sure dumbazz like me can do it then you can.

You nailed it. Despite what the sickcare system tells us we can indeed impact this disease without thousand dollar a month meds for everyone. Congrats on grabbing it by the throat and dealing with it. Love hearing the success stories. Carry on.

That works. For awhile. You must have missed the part where I said that diabetes is a progressive disease. Yes, there is a portion of it that you can affect with diet and exercise. However, there is a genetic component that will get you eventually.

Nah, I didn’t miss it, I just no longer subscribe to that theory as it is inaccurate. I have the genetic component also, so do many of my patients. The ones that firmly go low carb/keto are able to reverse, partially reverse or arrest the process. Ingesting little to no carbs will get most people with Type 2 DM to a very healthy spot and hold them there. For a large amount of people T2DM can be put into a remission of sorts (certainly not cured but diseaase held at bay) Keeping exogenous carbs at a bare minimum stops the insulin spikes, stops hyperinsulinemia and the viscous circle that comes with it. The body can make what it needs through gluconeogenesis without us ingesting carbs. It doesn’t have to get us all eventually despite what we have been led to believe. Just wanted to share some info. I hope you find solutions that work for you and keep you healthy.

I agree with dirtroadlivin. My wife was pre-diabetic about 10 years ago. Multiple tests over 2-3 years confirmed it, and she was getting rapidly worse. Doctors told her to lose weight, drastically change her diet, and if she was lucky she wouldn’t have full-blown diabetes in 5 years. She went on that weird meat-only diet that Jordan Peterson is on. She dropped a bunch of weight and shows no signs of diabetes.

I’m not a doctor, but saw the tests. The stupid at-home tests regularly showed her around 135 in the morning after fasting all night. After she started testing around 85 for 6 months straight, she stopped testing.

I’m not saying it’s a magic cure or anything, but it’s definitely something worth looking into.

I’m glad I don’t have it. While I love meat, if my diet consisted solely of fried beef, I’d rather die.

That’s my experience, too. A dozen years ago or so, I felt crappy every morning and one day at the store, I saw a guy that reminded me of several of the people at the care center where I was an orderly back in college, and said to myself, “That guy is getting diabetic.” Then realized I had almost all the same symptoms I saw in him. Stopped in the pharmacy and bought a test kit. Took it home and thought it was broken because the readout showed a line. A couple hours later, I tested again and it came up with 480.

Serious keto diet, i.e., <10 g carbs, preferably 0. Fought the blood sugar even with that. Had to drop protein to <10 g. So pretty much the 2 sticks of butter a day diet. Dropped #80 the first year, another #30 or so over the next 6. Never took any drugs.

I also have a lousy family history. All grandparents, both sides, 3/4 had to be on insulin. Dad and 3/5 sibs on metformin. I'm not cured, not by a long shot, but I can now have a decent dinner like fajitas with rice and beans (no tortillas, no chips) a couple times a week. Sugar will spike to 130-140, but generally back to 100 by bedtime, and be low to mid 80s for fasting.

It might be genetic and progressive and there's nothing you can do about it, but that was not my experience.

Sure, try the cheap treatments to see it they work. How will you know? By dying. Sure helps their bottom line.

Diabetes effects everyone differently. Unfortunately there is not a standard treatment that can be applied to all T2 diabetics. I am able to keep my A1C at 5.6 for the last eight months using exercise, good diet, and Metformin. But I was also diagnosed last year. I’m in my early 30’s. So maybe I was lucky to catch it early and that has helped me to keep my A1C under control.

I understand that it gets progressively worse with age, but can it still not be managed with a good diet? Or exercise? Blood sugar cannot spike with a sugar free or simple carb free diet. I’m still learning about diabetes and in figuring out the right treatment for me.

I pray and hope you will be able to find an effective treatment and lower your A1C. I don’t have a steady health insurance so I am lucky that Metformin is relatively cheap out of pocket ($50 for 3 months). I’m doing my best to not accelerate my diabetes so I don’t have to worry about insulin, or more expensive treatments.

I believe Big Pharma and the health insurance providers want more diabetics. We are their cash cows for the next 50+ years of our lives. So more high-fructose corn syrup, more carbs, and less education about exercise and healthy foods. More diabetics, means more money to line their pockets.

“Blood sugar cannot spike with a sugar free or simple carb free diet.” Ture enough. The carb surge/insulin spike merry-go-round can be stopped. Most people are not aware of the negative impacts of hyperinsulinemia. Look into the correlative information on high insulin levels and cardiovascular disease. Keep exogenous sugars (stuff we ingest) down, keep the insulin levels down, wash rinse, repeat. Carbs are everywhere, so most people do better with an app and a food scale for a few months until becomes second nature. Congrats on your success thus far.

I don’t think that’s true. If I have a huge steak with none of the trimmings except butter, from a critter that I personally raised, I’ll still read 140 or more a couple hours later. I’m pretty sure protein can also metabolize to sugar.

Indeed, extra protein will ultimately be converted to glucose. That is why a ketogenic diet relies on high fat content, pretty low protein, and scant carbohydrates. Ratios about 80%, 15%, and less than 5% respectively. This essentially forces us to convert fats for calorie needs which is ketogenisis in a nutshell. Fatty acids break down and supply the keytones, then we actually burn the keytones as fuel. It is a pretty cool process with many positives. That being said it certainly can be seen as rigorous. Depends on one’s views whether it is worth it. More meds or a frameshift mutation in eating habits? It is at minimum a very effective tool to have in the toolbox.

I did a study when I was in grad school on ultra low carb diets, to see whether or not the high fat content resulted in unsafe levels of cholesterol. These sorts of diets become popular every generation or so.
In the early 1900s, it was the “Banting” diet.
In the 1920s, it became the “Hay diet” and the “Slimming for the Million” diet.
Then in the 1930s, it was “The 18 day diet.”
The entire dieting thing went away until after the second World War. Then in the 1950s and -60s, low carb dieting really took off with the “crash diet,” the “third-day diet,” and the “daffodil diet,” which claimed would “give you the slim trim figure of a Spring Daffodil.”
During the 1980s, the shift went from low carb to low fat.
More recently, it has been Adkins, the South Beach diet, the Paleo diet, Keto, and others.

Nothing new under the sun.

You are where I was 10+ years ago. When I was first diagnosed, I lost a bunch of weight and was able to control it with just diet and exercise. My A1C was good.
After five years or so of that, A1C began to climb, so metformin had to come into the picture. Under control again.
Six more years, here comes the rising A1C, so Actos was added.
Now here we are, two years later, and my A1C is up again. As I said, the disease is progressive.

Just keep an open mind Divemedic. I have patients that have been dealing with Type 2 DM for more than a decade. The ones that follow the plan have reversed much of their manifestation of disease and either trimmed or ceased taking meds. Everyone is different of course and so might be their responses on some levels. I just know it works. Be well.

Atkins (Keto before Keto was cool) helped for the first few years. That’s how I lost so much weight. It only went so far.

I found the same thing. I had to cut protein to basically zero for several years to get a handle on things. A small hamburger or a few strips of bacon once a week was about it.

Not a fun lifestyle, but I was willing to do that if it meant I could see my kids graduate college and maybe meet my grandkids. (Still waiting on that.)

That’s worrisome to be sure. Thank you for posting on this. It is personal, but also incredibly helpful for the rest of us who got #2.

On a lighter note, if there is one for these comments, I now eat beans/legumes as my primary meal about 3-4 nights a week. I would not have considered eating such as a diabetic food without your suggestion. Thank you!

So sorry to hear this… I was prescribed a heart failure med that costs $700 per month and we have no insurance….

BUT, we are in the sweet spot financially… Make too much to qualify for Medicaid, but income is still low enough we get all the charity, assistance, and grants out there. Three months ago I had a complex open heart surgery that cost $171k. Cost me nothing.

I should note that our medical assistance is all non-profit and faith based foundations… No government programs at all.

Have you tried a ketogenic diet, yet? I’ve been eating paleo/keto for over two years now, have lost c. 60 lbs, and I love it.

You won’t need the injected insulin if you eliminate the grains and added sugars from your diet. I’m sitting here drinking french roast with heavy dollops of heavy cream. It’s beautiful. I feel full, very clear headed.. I don’t plan on eating anything today, I’ll probably drink between a gallon to two of extremely cold triple filtered water on top of the two liters of coffee I just had..

I ate and drank a ridiculous amount thus weekend, fasting for a few days is going to clear my metabolic pathways right the heck up..

It seems to me that the “expert” guidance on nutrition they’ve been giving us since about WW II has been completely – and I suspect maliciously – wrong.

My experience – to include my bloodwork – these past two years seems to prove it: natural non industrially rendered fats, vegetables and animal protein are our metabolic friends. Added sugar and refined grains are our metabolic enemies. Fasting intermittently, even for three to five days at time, is very good for us. Maybe you should give it a shot, if you haven’t already? It might work wonders, possibly add a healthy decade or two to your life.. ?

retired navy. my prob is psoriatic arthritis. my skin is worse than the joints but there is always some pain. tried different treatments but otezla manages it best. insurance said no. the dr is working through the appeal process. to say my initial response was hostile is an understatement. I kept mostly peaceful but I now really get how people can become “unmanageable” when they have played by the rules but the system DGAF and flips them off.

I really hope you can find a workable means of managing the progression of type 2. My dad had it, and while he was morbidly obese which made things that much worse for him health wise, he passed at 53. Further, his quality of life for the preceding 2-3 years was complete crap.

Consider too that not just the cost (assuming you can afford it or get it covered) is not the only downside to relying on drugs to manage it. There is the no longer insignificant matter of maintaining a supply of a critical drug, as manufacturing and logistics are now subject to problems that will break the ability to replenish the supplies of such drugs on demand at some point.

Going carb and sugar free is a tough adjustment (I’ve tried it simply to manage my weight, though I’m not diabetic, or at high risk of same) but it has shown greaf potential in stunting the progression of diabetes in many people. Difficult as that adjustment may be, it is preferable (in my mind anyway) to being a slave to pharmaceuticals, and having to pay the high cost of such drugs in perpuity.

Find somebody that can get you the meds from outside US. Normally, medication they sell here for $600 a month is less than 50 in Mexico or South America. For a 3-6 month supply a vacation there pays for itself in the medication savings…
Really sad but true…

Please, look up Dr Norman Shelley in Missouri, he does tele visits, and at least have a phone consult. Ill dig up his info and send it. Piss on a spark plug if it helps. Hang in there. Im fighting thyroid cancer at 50 from being at K2.

Remember the promises of obama care not having any preexisting conditions limitations? Sounds so good. The insurance won’t cover the meds I’ve taken for years before the Affordable Care Act. I can’t get my Pentasa anymore.
Same story with anyone who’s going to have to take expensive meds lifelong. The phrase no longer is “preexisting conditions”. It’s now sorry but those medications are not on our “Formulary” of covered drugs. Same story for lots of people I know who tried to fight the insurance denials. It never works out.
The pot of money is only so big, and those high priced drugs aren’t going to be included.

It’s extremely short sighted. They “save” $1000/month denying your medically necessary medication, then pay tens of thousands when you relapse and have to be hospitalized.

I worked on the payment side of health insurance for 30 plus years prior to retiring a few months ago. I’ve seen it happen time and again that sometimes the squeaky wheel does get the grease. As planned most folks give up after the first or second turn down by Medicare or other insurance. Go through the appeal process, contact the carriers chief medical director, contact the CEO, your states Insurance Commissioner. If you are dealing with Medicare (whether traditional or Medicare Advantage) file congressional inquiries with your senator and congressman. May be worth a try.

That’s a total bummer.

My son is in his late 20s and was diagnosed with type 1 diabeetus.

I feel your pain with the insurance. After throat cancer, I have a number of collateral damage issues. I squabble with insurance monthly it seems.

Just as bad is my FSA. I had an upper GI scoping last month. Now they are squealing for more documentation (as if I bought a case of beer at an endoscopy practice).

I had a climbing blood sugar. But my A1C was ok, but in the upper range. My endocrinologist said keep carbs under 30 G per meal. Really isn’t hard. I have type 2 in my family, so I’m trying to avoid what’s happening to you.

Beer has no carbs…right?

There are things that call themselves beers that have low(er) carbs but not no carbs.
I have friends in the same boat (type 2 wise) and try to go as close to zero carbs as they can manage, just so that occasionally they can ‘drink their bread’, so to speak.
Diabetes sucks – it’ll probably (eventually) take my sweetheart from me. (Heavy sigh).

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