CGMS

Together with inspired, who also has type 1 diabetes, I have put together a post explaining the Continuous Glucose Monitoring System.
What it is, what it is not, why it is so important to a person with diabetes, how much the CGMS costs, and what makes my insurance company such idiots.

WHAT THE CGMS IS:
The CGMS is a little device which records a person's blood sugar levels throughout the entire day on night. This is done via a needle inserted under the skin. The needle is removed, leaving behind a little "sensor", which measures the blood sugar levels. The next part of the device is the transmitter, which is attached to the sensor. It take the readings and transmits them (hence the name transmitter-deep, huh?) to the third part if the device: the receiver. This is also named for a very deep and complicated reason. It receives the transmitted data, and displays them on a screen. That way, any time the person wants to know his blood sugar (which they abbreviate as BG, or blood glucose, because the other way doesn't abbreviate as nicely ;) he pulls out the receiver, and there he has it! Great huh?

WHAT THE CGMS IS NOT:
The CGMS is, as of now, not considered accurate enough to replace BG testing. In fact, the newest brand of CGMS, the Freestyle Navigator, had a hard time getting FDA approval, because it is considered very accurate, and the FDA was worried that people would find it accurate enough, and not need to check their BG. So for now, it is simply an excellent supplement to old fashioned blood sugar checking. Why is it an excellent supplement?

WHY THE CGMS IS USEFUL TO A PERSON WITH DIABETES:
Checking your blood sugar to get the picture of your blood sugar is like looking at a picture to know a whole story. It's one snapshot, but you are missing a lot of details. For example, a person could check his BG and see a perfect 100. (An excellent number for someone with diabetes.) But, what he doesn't know is that it is rapidly rising and soon he will be 200. Or, on the flip side, (and this is the more dangerous one) he could be rapidly dropping and he could soon find himself 50, which is a dangerously low number and needs to be be taken care of immediately. With the CGMS, you don't only see a number, you see trends. It will show you a graph, which will show you patterns and trends. More important, it will show you which direction your blood sugar is heading. So, instead of showing you a 100, the screen will display a 100 with an arrow pointing upwards or downwards, to show which direction it's going. If it is heading up or down very quickly, the screen will display a double arrow, to caution you.
Another very useful aspect of the CGMS is the alarms. The receiver will alarm when your blood sugar goes too high or too low, alerting you to deal with it before it gets to a really problematic point. I won't go into details here, if you want to read more about it, read my letter to the insurance company on my diabetes blog. But, to make it short, there is a condition called hypoglycemia unawareness, which is exactly what it sounds like. Hypoglycemia means low blood sugar, so it means that the person doesn't feel symptoms of their low. This can be quite dangerous, as a low blood sugar, if not detected early, can become worse, and eventually lead to unconsciousness (or even death...).
I have occasional hypo unawareness. Take the other day for example. I went to the car to run some errands. Being a good little diabetic, I pulled out my blood sugar meter first, to check.
55? What? That's quite low, why did I feel absolutely nothing? No shakiness, no dizziness. Just business as usual.
Except it wasn't. It could have been dangerous. (Low drivers resemble drunk drivers.)
Now, imagine if I hadn't checked....
But imagine if I didn't need to check. Imagine if I had a monitor that started beeping when it started going low and I didn't need to get there.
Another example: one morning, I woke up with all the classic symptoms of high blood sugar. A quick check confirmed my suspicions. I was super high. (If you really have to know a was about 400.;) as I tried to figure out the cause if this unexpected high blood sugar, I noticed that my pump site had fallen out, and I hadn't gotten any insulin all night. Sigh. Now imagine if I had a CGMS. It would have beeped when my blood sugar started rising. Now most likely I would have chosen to roll over and ignore it, but that would have been my idiotic decision, not the insurance company's selfish one.

WHAT MAKES MY INSURANCE COMPANY SUCH IDIOTS:
The CGMS sounds like an awesome medical advancement, huh? There's got to be a catch, you say. You are right. The CGMS costs an arm and a leg. An insulin pump also costs a fortune, but the insurance company pays for $5,985 of it. I just had to pay the $15 dollar copay. It's not the generosity of the insurance company, rather it's considered the standard of treatment in this day and age. So the insurance companies got smart. They are resisting the efforts to make the CGMS a standard of care, so that they can continue denying it. It's a lovely cycle for them. They deny patients on the grounds that it is not the standard of care. But the fact that not too many patients go on it (because their insurance company doesn't pay for it) prevents it from becoming the standard of care. This is very important to them, because of the high cost of the CGMS. The start up fee for the CGMS (including the transmitter and receiver) can cost anywhere between 800 and 1500 dollars. Then there is the ongoing cost of the sensors. Sensors cost between 35 and 50 dollars each, and they last 3-7 days officially. Meaning, the FDA approves them for 3-7 days, depending on the type of sensor, but patients have left them in for far longer....
So why am I calling my insurance company idiots? I mean, they don't like people like me. They prefer people like MP, who get sick never, and actually have to go once a year for a checkup. But it's their tough luck that they got stuck with me. And I have every reason to expect them to pay for a CGMS. So my doctor wrote a letter of medical necessity. We sent in an official application. And they rejected it. Now I need to appeal. Unfortunately, I've been reading up on appeals in this matter and I am getting discouraged. Yes, some people get coverage, but I think it depends on how well connected you are, or how many letters you can throw at them, or how well read your diabetes blog is.
The parents on that forum that I mentioned in a previous post actually had a great idea. A CGMS does not replace BG checking, but it cuts it down from about 10 times a day to about 3-4. With BG test strips costing a dollar each, that actually can present a significant saving. So, the idea is to save all the used test strips for a year, put them in a box and mail it to the insurance company with a note asking if they are sure they don't want to cover a CGMS.
I was gonna do that, and I was saving my strips, (actually, to make a collage out of them. I love arts and crafts), but the case opened....in my friends car....and spilled all over. And even though she is my closest friend, she hasn't let me back in her car since. :-p
So that idea is out. If anyone has superlative persuasion skills, please let me know so we can brainstorm together.
BTS- does that answer your questions?