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December 30, 2003

Blood Tests and Insulin Injections, Insurance/Costs

Question from Chevy Chase, Maryland:

My son, 18 years old, aims for very tight control and has been very successful thus far -- his A1Cs have ranged from 5.8%-6.2%. To achieve this, he tests his sugar levels at least 15 times a day, and uses his Humalog bolus injections about 8 times a day. He also uses exercise as another sugar management method when the insulin regimen is not sufficient. His prescription for test strips is for 10-12 a day, which is never enough In response to a request for a larger prescription (15-20 a day) his doctor said that there is no medical justification for an increase beyond the current level. Do you agree? Do you have any suggestions for how he might get a prescription fore test strips that matches his use level? It seems to me that the good results he is achieving is medical justification enough. Whether the insurance companies would agree is a totally separate question. He says that his mental and mood states suffer when his levels reach above 140 or go below 80, thus he also has short term motivation to keep the tight control.

Answer:

This amount of testing is admirable and usually more than is required. You should discuss this with his diabetes team and come to some mutually acceptable conclusion since they will have to certify to the insurance company why he needs more than usual testing. Downloading his meter results may document the difficulty of day-to-day control for an insurance reviewer. Many computer programs now are available to do this. You can do this as well from home if you go to the company’s web site, download their free software and purchase the adapter to connect the meter to your home computer. You may have to provide such information to get a waiver for more than typical testing. You are correct that the results would seem to justify the extra testing and so you should use this as an argument in favor.

SB