Saturday, January 13, 2018

Health Insurance: A Rant

Ray and I ended last year with the jolly news that our insurance premium was going up by $200 per month. Yippee!! You need to know that this has nothing to do with politics or what our Federal Government is doing or not doing in regards to healthcare. We are in the most expensive group possible when it comes to healthcare costs. We are not yet old enough for Medicare and we are in a group through the Arizona State Retirement System. Catch that? Retirement. There are no young, healthy people in our group that would offset the high cost of keeping us alive and as healthy as possible. (I don’t want to get political in this post but this should be a wake-up call to show what will happen when people can choose to not be insured, and they will. Costs are going to go through the roof!)

We’ve been dealing with rising costs for a few years now but it has now reached the point where I’m contemplating taking my Social Security early just to survive. It sucks. It pisses me off. And yet, I am so thankful to have said insurance, whatever the cost. We could be bankrupt by now if it wasn’t for insurance. Sigh.

Now let me rant. Our insurance company has added a new twist to our coverage; one that our group admins didn’t do a very good job of explaining. We have a passive enrollment, meaning that if we are “happy” with our coverage then we don’t need to do anything. It wasn’t until we received our new cards that I saw the change. The company has now begun to “rate” doctors and has put them into “tiers”. IF we see a doctor that is in the tier 1 group, then we pay a $30 copay or $60 for a specialist. That’s how it was last year. However, if the doctor you want to see isn’t a “tier 1 doctor” we pay double. Yup, $60 to see a primary care physician and $120 to see a specialist. Someone like say, Ray’s cardiologist or his primary care doc. Excuse my language, but FUCK THAT SHIT!

I get it. I understand that the insurance company is trying to cut costs where they can, however, they are forcing us to go to certain doctors. They are MAKING OUR HEALTHCARE DECISIONS FOR US! I know that there are perfectly good doctors out there that, for whatever reason the effing insurance company has decided, don’t make the cut. Maybe they're fairly new, maybe they ask for more tests than the almighty insurance company likes. Maybe they didn’t fill out some freakin form! Whatever the reason, I hate it. It makes my blood boil. (Too bad that boiling blood doesn’t reduce blood glucose levels.)

As many people have experienced, ad nauseum, I have bumped up against “preferred prescriptions”. When I went to fill my RX for Lantus I was told that my insurance company prefers that I use Levimir. Of course they do. As it so happened, Sanofi (makers of Lantus) have a savings plan that allowed me to get my first prescription free, instead of over $500. (Isn’t that how drug dealers work? Give you the first bit free so you’ll come back?) That was nice but, why can’t they just make the stuff more affordable to begin with? Anyway, I filled it (Hello, free!) and will talk with my new doctor on Monday to see about Levimir or possibly Basaglar which is remarkably cheaper and has been mentioned by a couple of my friends. I know that I shouldn’t complain. I am remarkably lucky to have insurance (even though it’s costing us upwards of $18,000 per year to have it, BEFORE copays etc!)

I hate health insurance, and I have felt this way for a very long time. I feel that these companies are a huge part of why our healthcare system SUCKS. I hate that they are telling physicians how to care for their patients. I hate that they are making us choose from an even narrower list of providers, which is extra difficult when you live in rural America. I know that no one who can do anything about this is listening but I just had to get this off my chest. I had to rant. Thank you for allowing me to do that.

Tuesday, January 9, 2018

We Have Lift-Off!

Have you ever cried at the doctor’s office, in front of a new doctor who doesn’t know you from Alice? I have. Yesterday. I didn’t ugly cry or sob, just tears. I apologized to him and explained that “no one has ever listened to me before.” Guess what he said! “I’m sorry that happened to you but we’re going to get this worked out.”

Yup, tears.

Let me back up a bit. Yesterday I had my first appointment with my new HCP, who happens to be 35 miles away. As I’ve said in previous posts, I’m tired of my concerns being ignored so I’ve changed doctors. I had planned to see a doctor who was suggested to me by someone in the DOC. I called last week and was so disappointed to find out that he is no longer taking new patients. Damn my luck! However, there is a nurse practitioner in his office who could see me. Yes, he could help me with my diabetes. I figured, what the heck, let’s give this a shot. I went armed with data and determination. I explained that I’ve been living with diabetes for over 12 years. I acknowledged that my A1c is still very stable but I had provided him with numbers, both fasting and pre/post prandial that I had gathered when preparing to see the dietician in November, that I hoped would explain my concerns. I said, “I know my A1c is good but I don’t think that fasting numbers in the 160s or post prandial numbers above 200 are a good thing.” You will never in a million years guess what he said to me. “You are absolutely right.” What? Really? (This is where I teared-up).

He told me that I had options, including more oral meds and Lantus. HE OFFERED ME INSULIN!!!!!!!!! Deep breath. I indicated that I didn’t want to take more oral stuff, but wanted something faster and more predictable. This is where he told me that he wasn’t used to seeing patients who actually asked for insulin. He said he has patients with A1cs of 10 and 11 who refuse insulin. That made me sad. He applauded me for realizing that things were progressing and wanting to jump on it before things got worse.

I cannot adequately explain to you how all this felt. My concerns were validated, a HCP listened and we came up with a plan together. I had fasting labs done this morning and I will return next Monday for a more thorough looking-over as well as instructions on how to poke myself with Lantus. Oh, and he has referred me to a CDE which is another thing I’ve never had…in 12+ years.

I feel more hopeful. I’m a bit worried about weight gain but the doctor said we’d keep an eye on that and adjust as needed. I’m concerned about the cost of the Lantus. (More on this and an insurance rant on the next post.) No matter the cost, it’s ok because I GET TO USE SOME INSULIN!!!!! I be happy, can you tell?

Oh, and please learn from my experience. Don’t EVER let a doctor tell you that your concerns aren’t valid. Don’t continue to see a doctor who won’t listen to you. Stand up. Speak up. Do whatever you need to do to get the healthcare you deserve. Please.

Friday, January 5, 2018

The Dietician

This is a story about an old dog and a stubborn mule. No, I’m not saying that the dietician is either of those animals. I am both.

I made an appointment with the dietician and met with her in late November. My initial opinion of her from our phone call held. I like her. I went armed with 3 weeks of food journals along with all the blood glucose checks surrounding those meals. It was a lot of work but worth it since I could show her what I’m doing and not just try to explain. She was glancing over my numbers and said something totally shocking! You might want to sit down for this: “I don’t see any fasting numbers below 130. You might need some long-acting insulin.”

YES!!!!! Someone paid attention!!!!! I was so excited to hear that. Now, she isn’t a doctor but, dang, she outta know!

WOOT! Happy Dance!!! My concerns felt so validated. Phew!

Now to discuss the rest of the appointment. We talked about carbs and fiber and she feels that I need more of both in my diet, as well as maybe more fat. This was completely expected on my part but I had decided to go into this appointment with an open mind. Many of her suggestions were ones that I had shunned over the years after copious testing on my part. Oatmeal, whole-grain bread, potatoes etc. She would like me to shoot for 30-45 grams of carbs per meal. I didn’t believe that I could eat that many carbs without ridiculous numbers on my meter but I was determined to follow directions and see what happened.

We also discussed fiber. I have long known that the Standard American Diet is woefully lacking in fiber and that is most likely causing lots of health issues for all of us. I have never gone about seeking more fiber, I just assumed that if I ate more real food and less processed that I’d be getting enough fiber. Well… She wants me to slowly work up to adding 25-30 grams of fiber per day. (Slowly so as not to cause my guts to rebel.) That didn’t seem like such a daunting task until I started actually looking at how much fiber is in food. For instance, one would assume that broccoli contains a boat-load of fiber. 1 cup of chopped broccoli has 2.4 grams of fiber. You do the math: I’d have to eat SO MUCH BROCCOLI to reach my daily goal! Granted, the carb to fiber ratio is good, it’s just that a lot would have to be consumed. Beans seem to be a good choice for added fiber and I have also been drinking a fiber supplement every morning for a few years. Needless to say, reaching my fiber goal will not be easy simply because I don’t eat that much food.

She encouraged me to continue “experimenting” and paying attention to how my blood glucose responds to the “new” foods. I discovered some amazing things! I was able to eat a seedy, whole grain piece of toast and my bg didn’t freak out! Unheard of. I had about ¼ cup of baked potato and the roof didn’t fall in. I was also reminded that not all bread is created equally when I ate a white dinner roll and the outcome was horrendous.

Other things to work on: eating something within 2 hours of rising. That one is so hard! I’m just not hungry in the morning. Do some yoga-type stretches (or other exercise) within 10 minutes of eating a larger meal and/or 4-5 hours before bedtime.

All in all it was a good appointment. I have fallen off the experimenting wagon since I got the flu in early December and then the holidays happened. I’m hoping to get back on the program now.

I was and old dog who thought I couldn’t learn something new. I was a stubborn mule when I allowed myself to think I could no longer eat carbs. This doesn’t give me carte blanche to eat whatever I want, far from it. I have continued to see some awful numbers on my meter and have been reminded why I stopped eating certain foods. However, I have already learned that I need to be more open-minded when it comes to food. It is not the enemy.

Oh, and I have an appointment with a new doctor on Monday. Wish me luck.

Sunday, November 12, 2017

The Almighty A1c

I’ve been quite whiney lately. I’m sorry. Diabetes hasn’t been playing nicely for a while now and I just can’t seem to get my HCP to pay attention to my concerns because my “A1c is so good”. I saw him again and my A1c actually went back down a bit. WTF? Makes zero sense to me, but oh well. He said “no medication changes, see you in 3 months”. No comment about a 198 fasting or a 171 before dinner. I guess I’m just supposed to shut up, not worry and trust my doctor. Bullshit.

I posted my concerns/questions on Facebook about something the doctor said: “A1c is a better predictor of future complications than individual high numbers.” It made me think that maybe I’m just worrying too much, but some of the answers I received made me feel a lot better about my concerns. High individual numbers should be a concern and someone ought to be helping me figure out how to “fix” this. This gave me the desire to stop feeling sorry for myself and DO SOMETHING! (The old Kate may be back.)

About the only thing the doctor suggested to me was that I see a dietician. Meh. Although I’ve never met with one, I have spent the last 12+ years figuring out what I can and can’t eat. I have been in group meetings with dieticians and the things they suggest are so far from anything I can do (whole grain, cereals with more fiber, sweet potatoes instead of white, brown rice instead of white…) that I was never impressed. I am NOT dissing dieticians, I think they are a valuable resource, I’m just not convinced one could help me. We’re about to find out.

A very nice woman called me to discuss my referral to see her. We talked for a bit (I liked her) and decided to wait a couple of weeks before I see her. The reason? I want to go armed with data (she liked that). I have spent the last 2 weeks documenting everything I eat and when I eat it. I indicated amount of carbs (if it is processed at all) and my pre/post prandial numbers. I have been poking the crap outta my fingers! I haven’t been avoiding foods, I’m just eating like I normally do, occasional binges and too many carbs as well. I am going to call her back tomorrow to set up an appointment. I’m actually excited to meet with her! This exercise has been eye-opening. I’ve learned a lot about myself and how my body is reacting to food (spoiler: not too well). Wish me luck. I’ll keep you posted.

Oh, and I’ll be making an appointment soon with a new doctor, one who was recommended to me by a fellow PWD who just happens to be a nurse. Score!

Friday, October 20, 2017

Jimmy Kimmel Doesn’t Care

It happened again. Big surprise. A comedian tried to be funny and diabetes was the punchline. He doesn’t care that it upsets those of us with diabetes and neither do most of the people on this planet, unless they are touched by diabetes. Of course, our community is up in arms and shouting to the world that sugar doesn’t cause diabetes and it certainly isn’t sweet to live with this disease. I get it. It always pisses me off too but it makes me angrier when some folks in the T1 community throw those of us with T2 under the bus, yet again. You’d think they would be more compassionate. Yeah right. You know what? I’m beginning to think that my ability to be appalled and outraged has been depleted. (I blame this on the political climate.) I find that I don’t care either.

Before you get all “But Kate, we have to fight back!”. Do we? Really? What do we gain from yelling at comedians who don’t give a flying flip? I kinda think we look like a bunch of whiners. I get the need to defend your child who is ill with a horrible disease that they didn’t cause. I get the need to defend yourself when others point fingers at you and blame you for developing a horrible disease that isn’t your fault. I get it. I do. But maybe we are railing against the wrong people. Maybe our methods need fine-tuning. Maybe our energies need to be focused on where they will count.

Who needs to care that sugar doesn’t cause any type of diabetes? People who actually have diabetes or are in danger of developing it. Kids with T1 need to know the facts and be able to arm themselves against the bullshit. They need to know how their insulin works with the foods they eat so they can be healthy. They need to know not to feel guilty or ashamed when the stigma is thrown at them. People with T2 or pre-diabetes need to understand that it isn’t just sugar that gives them blood glucose issues. They need to be taught how to check their blood glucose and make changes to their lifestyle in order to keep things under control. They need education…BIG TIME. (I have a friend with pre-diabetes who had no idea that crackers with sugar free jelly before bed might cause her issues.) They need to realize that diabetes can progress and they have to stay vigilant. They also need to understand that the stigma is bullshit and to stand tall in the face of bullies and well-meaning people.  Who else? Our elected officials. The people who make laws pertaining to healthcare etc. Those people need to know that diabetes isn’t self-inflicted and that we don’t deserve this crap. Heck, even healthcare providers need to understand diabetes better! The rest of the world doesn’t care and I’m not convinced that they need to.

I am not the type to stay silent and I don’t think our community should either. I just think that our message needs a little tweaking. I’ve been trying the more subtle, less angry approach when replying to idiots online who spout nonsense or hurtful things. “You are allowed your opinion but the facts are that diabetes is a very complex disease and the person who develops it is not to blame.” “Too many highly processed carbs can be just as damaging as sugar. Have YOU eaten a lot of pizza in your life?” “I understand that you’re angry on behalf of your T1 child but could you please stop blaming those of us with T2? We don’t deserve that either.” I feel better using this approach and it works in real life too. It seems to take the wind out of sails and doesn’t start an argument that no one is going to win. (Although I’m still apt to vent/spew venom on my own FB or Twitter pages. That is a safe place.)

When we do fund raising we should definitely try to educate the masses in order for them to understand our plight a little better and, hopefully, donate. We shouldn’t stop trying to educate but I think our efforts would be better served if we stopped YELLING AT THE WORLD! Think about this: You’re walking down the street and there is a person collecting donations for diabetes research. They are calm, pleasant and equipped with informational pamphlets. Or. You’re walking down the street and there is a person collecting donations for diabetes research and they are screaming at you that it isn’t our fault and what baby deserves a million needles! Who do you suppose will collect the most donations? Food for thought.

Friday, September 29, 2017

Dear Diabetes: It’s not me, it’s you.

Dear Diabetes,

I felt that it was time you and I had a little talk. You see, I’m a bit weary of you. Why, you ask? Let me count the ways.

 Many, many people feel it’s their right to accuse me of inviting you into my life.  They can do it in a joking manner or are downright rude!

I think about you way too much. You don’t deserve that.

You cause me to feel guilty about things that I shouldn’t feel guilty for; things like eating or reading a book instead of going for a walk.

You make me feel bad.

You cost me a lot of money.

You make me anxious.

You cause me to worry about my future.

I could go on and on but I don’t see the point. I wish this was a Dear John letter; a way to get you out of my life, but alas, I’m stuck with you. I just needed to say to you that I’m going to make every effort to remove some of the control you’ve had over me. You see, I forgot for a while that it’s you, not me. I am not the problem, you are. I wish you’d bugger off but I can deal with you hanging around. It’s not like I have a choice. What I can choose is living my life and using whatever tools are at my disposal to keep you in the background where you belong.

It’s not me, it’s you. You are the problem in this relationship. I am the shining star.


Every Person with Diabetes

Tuesday, August 29, 2017

Reality Check

I remember an instance as a young girl when I stubbornly refused to do what I knew was right because I wanted things to go my way, and I paid the price. My family was going to go to the Orange County Fair and I was SO excited! I grew up at the beach where I rarely wore shoes if I didn’t have to. I insisted that I was going to the fair barefooted, despite the fact that it was all asphalt and HOT! Of course, Mom said no way. I said yes way. The upshot was that Mom told me that if I didn’t put my shoes on, they would go without me…and they did. I missed the fair because I was stubborn and wasn’t willing to change my ways. I feel as if that young girl has returned.

Yesterday was a really tough day. I ate some stuff that I know isn’t good for me because I wanted it, dammit! The result was a whopping 315 on my meter nearly 3 hours after the meal. Wow. I have NEVER seen a number that high on my meter. Never. I was so appalled and shocked and scared. Then and there I decided to call and make that appointment with a specialist 35 miles away; an actual specialist in diabetes. She would be able to help me straighten this mess out! I called and was told that I had to have a referral and that the soonest I could see said doctor was January. Ugh. The remainder of the afternoon was filled with tears, remorse, self-loathing and pity. Pretty ugly. I felt so sorry for myself and railed against this damn disease. After I settled down a bit, I realized that I was going through stages of diabetes acceptance, very similar to stages of grief. Really? I was dealing with acceptance of a disease that I’ve had for 12 years? It was eye-opening.

When it comes to diabetes, I’ve been pretty lucky. I have been able to adjust my lifestyle and meds slowly and keep my numbers mostly in line. I would have periods of feeling deprived but I was proud of the changes I had made and eventually didn’t miss a lot of the foods I used to crave (except potato chips). Things were rocking along pretty ok and I didn’t have to think about my diabetes much. In fact, I wrote that very thing back in November. In that post I also said: “Someday my blood sugars could go south and my current plan may not work as well. Maybe. If that happens I feel like I’m prepared to deal with it. I feel like I can make adjustments because I already have. I’ve already proven to myself that I can do this.” Reading those words now, only 9 months later, kicked me out of my funk and gave me a little hope.

My doctor wants to “wait and see” and is reluctant to make med changes until things worsen. (ugh). I can’t just go see the specialist like I wanted and fix this issue. That barefoot little girl wants things her way and it ain’t gonna happen right now. It’s time to put my shoes on and get on with it.

I had become too complacent about my diabetes. I let other issues get in front of it and failed to adequately pay attention. Even when things are going well with diabetes, it’s important to watch that you are following your plan. I wasn’t. I slowly fell back in to an eating pattern that made it too easy to eat what I shouldn’t. I was somewhat in denial and thought I was normal. Ha! I’m never gonna be normal and will always, always have to pay attention to what I’m eating. Sad but true.

My body has decided that it’s going to change the game and I need to pay attention. I started yesterday with a slow, short walk on the treadmill to help mitigate that damn high number. I ate reasonably at dinner (my wonderful shrimp stir fry). Today, I’m going to try to get back on track. I will eat lower carb, not highly processed foods. I will get back to regular exercise. I will bake low carb goodies to satisfy me when I need a treat. I will do this, shoes or not, because I’m all growed up now and can make the decisions that are best for me. Decisions that will hopefully allow me to live a longer, healthier life. I’m not going to wait until October for someone else to fix this. I’m going to do whatever I can on my own now and insist on a medication change in October, because quality of life is important. I deserve that. I still hate to wear shoes but I don’t want to miss the fair.