I’m not defeated, and my last posts weren’t intended to convey that impression. Just because you are getting screwed doesn’t mean that you have to keep allowing it. I’m going to lose access to at least one doctor. My PCP has fired me from the practice, so I will have to get a new one. I am not sure yet about my endocrinologist.
I have been talking to some doctor friends, ones who work for my employer, and ones who do not. The doctors who DO work for my employer aren’t going to be able to write me a prescription for the more expensive drugs, and the insurance company says that I *have* to use the company’s pharmacy.
Usually, a provider or pharmacy that is not on the preferred list can still be used, albeit at a higher rate. They aren’t doing that here, and it’s being done that way to force patients onto the cheapest plan possible.
There are several loopholes in the system, and I plan on exploiting those. I will know within a month if I can make that work or not. All I know is that I am NOT going on insulin.
In my case, I need to get a doctor that will work with me, PLUS I need to get at least one refill on my medication under the current insurance, so that I have enough to last me until the open enrollment period for my wife’s insurance in July. I know plenty of doctors, but it’s the double hit of doctor PLUS pharmacy that is making it tough.
The rules and laws here are complex, but in complexity, there are loopholes. The more rules there are, the more holes there are to drive through. I have time to explore those, and even though I am screwed, I won’t be screwed forever. I don’t plan on staying that way.
Insurance companies hate diabetics even more than they hate smokers. The reason for this is that diabetics are famous for not complying with doctor instructions, and the disease is a progressive one. You don’t ever become cured of diabetes, the best you can do is manage or delay it. What manages it today will likely not manage it a year or two from now. It requires constant vigilance on the part of the patient and the providers. It’s a lot of work, and most of those who have it do not manage it well and wind up with complications like kidney, eye, heart, and brain problems. They wind up with nervous system problems, bone problems, and GI problems like gastroparesis. Treating all of this is expensive. The faster the patient dies, the cheaper all of that is from an insurance standpoint.
It isn’t that the insurance company is TRYING to kill you. No, they look at costs, and say “Gee, when we give drug X, diabetics cost us $y over their lifetime. When we give drug Z, they cost us $2y over their lifetime. Let’s only allow drug x.” They just don’t bother looking at anything else, it’s a pure monetary decision.
For those reasons, insurance companies WANT you to keep eating like shit and taking insulin, knowing that this will save them money over the long run. That’s why insurance companies want you to eat a regular diet and take cheap medicines like metformin. It’s up to each diabetic to carefully monitor their A1C, find trustworthy doctors who care about their patients, and keep on your insurance company’s ass. No one cares as much about you as you do.
Normal blogging to resume soon.
26 Comments
JimmyPx · February 9, 2025 at 11:48 am
DM, it beyond sucks what they are doing to you and it happens every day.
This is the problem when PROFIT and lowering costs enters health care.
Since that is how the insurance company is rewarded, that’s all they care about.
Luckily for you it sounds like you make decent money and worst case scenario pay out of pocket for the drugs you need. It’s not fair or right but this is your life that you are talking about and if you had to sell some stuff to pay for it it’s worth it.
DrBob · February 9, 2025 at 12:53 pm
Have you searched for a concierge doctor in your area? I’ve had one for several years and since she’s not part of a group, she’s free to do as she likes. She does not take insurance, but her prices are cheap. The tradeoff is that you take a subscription. Mine was $100/month. But a 12-lead EKG with interpretation was 75 cents, out of pocket. There was never any access limitation. She also found cheaper prices on medications.
Divemedic · February 9, 2025 at 3:07 pm
It isn’t the doctor- it’s the prescription that costs.
Brian · February 9, 2025 at 1:14 pm
I’m concerned from you posts. My daughter is a type 1 diabetic from the age of 2. From what you’re posting it’s a death sentence. Is that your take on it. I’m no doctor or nurse just trying to figure out what you’re saying.
Oh ya I’m a dirty Canadian. 😘
Jimrock · February 9, 2025 at 1:24 pm
“You don’t ever become cured of diabetes”.
False.
Dr. Ken Berry
Dr. Shawn Baker
Dr Philip Ovedia
Dr. Robert Kiltz
Dr. Sean O’mara
Dr. Ben Bickman
A dozen others.
All on youtube.
Try it for 90 days. It WILL change your life.
Divemedic · February 9, 2025 at 6:47 pm
I stand by that statement. If someone had a cure for diabetes, they would be a millionaire.
Jimrock · February 9, 2025 at 8:52 pm
$ are exactly the problem. No money in the cure. You’re a smart fella, you’ll know the truth when you hear it.
Ask any MD/DO on your service how much NUTRITION training they got in med school. Less than a semester i’ll bet.
How to keep comatose patients alive?
Search youtube- Dr. Berry/diabetes cure.
Let thy food be thy medicine. Let thy medicine be thy food.
Divemedic · February 10, 2025 at 10:11 am
LOL. And the guy selling you the nutrition book and helpful vitamins has your best interests at heart and isn’t trying to make money from your desperate search for an easy cure?
Chris Nelson · February 9, 2025 at 9:02 pm
I follow Dr. Baker and he’s referring to Type 2 being reversed, not Type 1.
Diligent Type 1’s that monitor their levels and watch their diet, may benefit from Keto or Carnivore diets, but it’s absolutely not going to cure them.
Of the Type 2 and Pre-diabetic people in my circle, strictly following a better diet with fewer carbs has the most benefit because excessive poor diet is usually what got them to that condition in the first place.
Divemedic · February 10, 2025 at 10:08 am
That’s a misconception. There are plenty of people who are overweight and eat a poor diet who do not have DM2, and there are skinny people who do. There is a genetic component there.
A bit of anecdote here- I am diabetic, as is my sister. There is family history there with my father, his mother, and his father all having had diabetes. On my mother’s side, there isn’t any history of DM there.
I believe, and there are studies that back this up, that society has the cause and effect backwards, and it is the diabetes that drives the increase in weight and not the other way around. The endocrine system is complex, and we still don’t understand what is happening completely with what drives appetite and weight gain.
At the end of the day, DM2 is caused by insulin resistance, which causes a number of things to happen, and there isn’t going to be any sort of a “magic cure” as many diabetics like to believe.
Still, people who are diagnosed with a disorder or disease like to think that there is a quick and easy fix, and there are plenty of hucksters out there who are quick to take advantage of that. See Suzanne Somer’s book on how you can beat cancer with diet and exercise.
Chris Nelson · February 10, 2025 at 11:08 am
Yeah, genetics is the big factor that is hard to deal with.
Combine that with all the crap in the US food and the bullshit USDA food gospel and we have generations of health issues.
Vlad the non-Impaler · February 9, 2025 at 1:25 pm
I still don’t understand how any insurance company can force you to *not* self pay for anything from Botox to tirzepitide.
Same as buying a gun, house or anything else – my business not yours.
Compounding pharmacies abound with the semaglutide I’m taking. It has to be the same in your state.
PACU is still an option if you want to do an end around and switch jobs that require your skill sets.
Barring that, a couple of no-shows in the ED should be enough that your employer would gladly can you, along with not covering The Pump Lady pts.
Keep hammering them!!
Stefan v. · February 9, 2025 at 2:22 pm
“find trustworthy doctors who care about their patients”
It was at this point the undepants gnomes’ plan began looking weak. Have you considered offshore sources for vital supplements to bridge the gap?
Divemedic · February 9, 2025 at 6:46 pm
They are out there, but you have to remember that doctors have employers and want to keep their jobs like anyone else does.
Doug · February 9, 2025 at 3:04 pm
Look into Dr Jason Fung. He has cured people of type II diabetes.
You’re absolutely right about staying off of insulin. Diabetes is insulin resistance – treating it with more insulin is like treating alcoholism with beer…
I wish you the best in navigating the horrid bureaucracy.
Divemedic · February 9, 2025 at 6:45 pm
I will say that I disagree with his opinions and the studies that he quotes don’t say what he claims that they do.
Ray Jones · February 9, 2025 at 3:39 pm
A friend of mine recommended:
“The author needs to give up the standard western diet and traditional medicine and go Keto or Carnivore. I did it a year ago and am in the process of reversing my type 2 / metabolic syndrome. My A1C is down to 6.4 and I’ve lost 75 lbs. I went from 7 prescription medicines to 1 in 6 months. I did it all with diet / lifestyle.
I was on semaglutide for a year prior with poor results and my endocrinologist wanted me on insulin. I said no way.
Look into Adapt Your Life Academy, Dr Westman and The Proper Human diet with Dr Ken Berry.”
Not sure you haven’t tried this but it is a thought.
Divemedic · February 9, 2025 at 8:49 pm
Did an ultra low carb diet for the first few years. It works until it doesn’t.
Curious · February 10, 2025 at 1:49 pm
Why does it stop working DM ? Did it stop working or was it simply that you could no longer make yourself stick to it? Not trying to be sarcastic, just trying to roadmap my path forwards.
Divemedic · February 10, 2025 at 8:23 pm
DM2 is a progressive disease. It begins because you are insulin resistant:
Your cells use glucose for fuel in a process called the Kreb’s cycle. (Medical peeps- I know that there is more, but trying to keep it simple and not write a complete textbook) Sugar can’t cross the cell membrane. Insulin binds to receptors in the cell membrane, unlocking it like a key, causing the glucose to be transported into the cell.
Insulin also does other things like control appetite, fat storage, and protein synthesis.
In people who are insulin resistant, their cells don’t respond correctly to insulin. The cells complain that they are starved for fuel, so the pancreas releases more insulin in response.
This causes a cascade of effects as the rest of the body responds to the wild swings in insulin. Appetite increases, the person craves sweets, and the result is climbing blood sugar levels, increased fat stores, and weight gain. Diet isn’t the only way that blood glucose can increase- the liver can do so as well by making sugar out of other substances like fat and protein, and it does so when insulin and sugar levels fluctuate. One of the molecules that the liver converts into glucose is a peptide called glucagon.
Eventually, the body can’t compensate for all of this, and the person’s blood sugar levels are high enough that they meet the definition for DM2.
Going on a diet isn’t going to cure the underlying cause- insulin resistance.
What going on a diet WILL do is lower your blood glucose levels. For awhile, but remember that the insulin resistance is going to eventually overcome even that.
After awhile, your pancreas wears out, and your body can’t make enough insulin, making you an insulin dependent diabetic.
That’s how it went. Until GLP1 agonists came along in 2022, that is. The one that works best for me (and many other people with DM2) is a combination agonist- tirzepatide. Not only is it a GLP1 agonist, but is also a GIP agonist. What this means is that it does a list of things, including causing the body to release more of its own insulin, reducing the amount of glucagon that the body produces, reducing appetite, and reducing the speed with which the body digests food.
This in turn causes blood sugar to drop, the person to lose appetite, get full faster, and thus lose weight. It also reduces the risk of heart disease, kidney disease, vision problems and a host of other issues that diabetics are very susceptible to.
This drug is so effective that the American Diabetes Association will likely be making it the drug of choice for the treatment of DM2 within the next few years.
Red State Bunker · February 9, 2025 at 6:37 pm
Although off insulin for 5 years it (diabetes) causes the high blood pressure that I have to take meds for.
I never thought to check blood pressure when losing 150lbs. over 6 years.
All of this from walking after each meal and watching what I eat.
Now I can’t eat anything except some fruits and nuts. LMFAO!
No pasta, pizza, sugar water pop, in six years.
Hang tough in there, you’re still here, keep it that way.
Anonymous · February 9, 2025 at 8:26 pm
Have you looked at Medishare
Anon · February 9, 2025 at 10:42 pm
That sound more like the you I am used to!
NP · February 10, 2025 at 12:11 am
Are you taking creatine? https://europepmc.org/article/med/20881878
Boneman · February 10, 2025 at 7:16 am
It becomes rather involved. My Mrs. has any NUMBER of issues… a LOT of it stemming from an MVA many years ago. She has been long time disabled/retired and what with working between Medicare and Workman’s Comp… simply managing all that and the numerous (some life threatening) conditions is almost a full time job.
That she also manages the same for her 93 Y.O. mom… well there you have it.
The ins and outs, loopholes and the number of MISTAKES that are made by the “Medical Staff” as to what is in her chart is jaw dropping and aggravating. Trying to get ANYTHING in the “Chart” rectified is almost impossible.
I suppose that’s the double-edged sword of having online “portals”… you actually get to SEE the mis-management.
I digress….
My point was, managing Diabetes IS a job. No small part of that is managing the Insurance BS that comes with it apparently.
Yourself has the advantage of knowledge of your condition and the best way to treat it. How many out there just blindly accept and follow what they’re being told?
Sad. Hang in there man! Love and support your tenacity!
Rob · February 10, 2025 at 8:15 am
It isn’t that the insurance company is trying to kill you.
It’s that they simply do not care.
Their core mission is to maximize shareholder value. The system is broken, corrupt when it focuses on cost savings instead of what is best for people.
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