In my last post, I mentioned that I would be wearing some Continuous Glucose Monitoring Systems (CGMS) and deciding if any were right for me. 

I tried both the DexCom and the Navigator.  My decision was this: there is simply no way a separate device is going to work for me.  This was proven by the HOURS worth of dead zones - where I'd accidentally left the device behind.  Further evidence, the fact that I regularly leave my cellphone behind when I leave my house in the morning - and that since childhood I've been known as someone who "would lose their head if it weren't tied on."  Really, I think I'd lose my pump if that weren't tied on!  

So, I am starting the process of trying to get a Minimed Real-Time System.  I've got new insurance with my new job- so the pump part shouldn't be too great a struggle.  But the CGM to go along with it is a different story. 

I enter Round One of this boxing match today - with my doctor and me writing letters to request coverage.  

Here is my first go - wish me luck!

February 20, 2009

Blue Cross & Blue Shield of Rhode Island
444 Westminster Street
Providence, RI 02903

To Whom It May Concern:

For more than twenty five years, I have lived with type 1 diabetes.  For more than twenty five years, my loved ones have lived with type 1 diabetes.  The road diabetes has taken us down has been difficult.  When I was a child, my parents were taught to carefully monitor my food intake, test my blood sugar, and inject insulin to keep me alive.  As a family, we were taught about the complications of my disease and how the toll it takes on my eyes, my ability to fight infections, my kidneys, and my heart - just may end my life.  We were also taught that if we made every effort to control my diabetes, we might stave off these complications – if only for a little while. 

My life since diagnosis hasn’t been easy – precariously balancing the food I eat, the insulin I take, and my level of exercise.  Thinking every minute of every day about how to best manage the trials diabetes presents.  Watching my parents faces, filled with fear and worry as I suffered repeated convulsive hypoglycemic reactions as a child.  Waking from semi-conscious low blood sugars, my long-time partner at my side, with fruit juice all over him, all over me, and all over the walls of our home – and me not remembering a thing.  Being told that the first signs of retinopathy had appeared in my eyes.  All the while, maintaining A1Cs that are clinically, very good, ranging from 5.4% to 6.7% in the past three years.

But those ‘good’ A1C numbers, the numbers that since childhood, I’ve been told are the key to living well – living complication free with diabetes, come at cost.  For several years now, I have been unable to feel low blood sugars.  I can drop to 20-30 mg/dl and talk, walk, and function as if my blood sugar were 90 or 100 mg/dl.  When I finally do feel hypoglycemic, I am often close to losing consciousness, or I’ve become combative, or I’m too confused to even speak.  The irony of this shouldn’t escape you – because I have worked so hard to stay in control of my diabetes for so many years – I am left at risk for undetected low blood sugars that could very well kill me. 

Over the past year, I have made compromises.  I run my blood sugars slightly higher than I have in the past, bringing my A1C from the mid 5s to the mid 6s, but it hasn’t done much good in alleviating my unawareness.    Low blood sugars sneak up on me like an enemy combatant, leaving me physically and mentally exhausted in their wake.  I have had low blood sugars at work, at home, in my car, at the gym – everywhere.  I have been hospitalized because of undetected low blood sugar and overnight low blood sugar.  I have been injured during a particularly severe low blood sugar, breaking my wrist while trying to fight those people who were trying to help me. 

For all of these reasons, and because I am, more than two decades after diagnosis, still committed to controlling my diabetes in the best possible way, I am requesting that Blue Cross & Blue Shield of Rhode Island approve for me a Minimed Paradigm REAL-Time Continuous Glucose Monitoring Kit.  Having more data and an early warning system will allow me to maintain a healthy A1C without the constant fear of undetected low blood sugars and the rebound hyperglycemia that often follows these incidents.  Beyond piece of mind, it will be a vital tool in preventing hypoglycemia and other complications and the short and long-term monetary costs they bring. 

Blue Cross & Blue Shield of Rhode Island has a tagline that I like - “Your Plan for Life.”  I hope that in my case, you’ll live up to that tagline and help me to live the best, healthiest, and most productive life possible.     

Thank you in advance for your consideration.

Sincerely,
Nicole Purcell