Monday, April 14, 2008

Oh, for crying out loud!

Even though there is another blog post I’ve been meaning to write for weeks.. um, months … now, in honor of Raise Your Voice Day, I figured this one would be more appropriate. I’m not going to do a “type one 101” session, as you can find many good examples here at Kerri’s blog. And, in previous posts I’ve covered my diagnosis, a 24 hour log of life with diabetes, and a short humorous summary of the impact of this disease. So for today, I will instead write about being a Type 1 in a world trying to cut Type 2 costs – fun with health care chronic illness “support”. My snide comments on the Q&A will be in italics, their questions in bold.

My new health care plan at work has this wonderful (this word should be dripping with sarcasm by the way) perk for people with chronic illness: your own personalized version of the “diabetes police”. Just what every diabetic needs – a “friend” to call you up and chat about your diet (don’t have one) your weight (doing fine, thank you) and remind you to test your blood sugar (I’m pretty compulsive about this - as my Number Three Son has observed “Just like the dog leaves black hair everywhere, Mommy sheds those little test strips”).

A few years ago I had inadvertently been signed up for one of these and hated it. The first call wasn’t too bad. Do you know what a hemoglobin a1C test is? Yes, I had one last week. Every three months, in fact. Do you know it’s important to keep your a1C below 6.0? Actually, given the huge fluctuations in my BG, like dropping 150 points in an hour for no reason, trying to get my a1c below 6.0 would probably kill me. I already have to treat two 50s a day to keep myself in the sevens. How often do you test your blood sugar? Ten times a day. [dead silence on the phone]. Then: “Oh. Keep up the good work then.”

From there on in, the calls got more annoying. Next was the 6pm call on Halloween. Yeah, sure, maybe it’s a tough day for diabetics, but it’s not like I’m sitting here contemplating eating the whole bag of Almond Joys. I’ve got three kids to get into costumes, a dog having a nervous breakdown (she’s scared of flapping robes but loves barking at the door) and I live in a development where my doorbell is guaranteed to ring no less than 150 times tonight. I do not want to discuss the exchange diet with someone who tells me if I don’t control my weight I could wind up on insulin.

After the second call, I started just saying “If you really cared about improving my health you would pay for my continuous monitoring system.” When the next year’s health care flavor showed up, I made sure they did not sign me up. I don’t return the messages left by various perky sounding people, offering to tell me of an exciting new benefit free with my healthcare plan. I considered issuing the callers a test to see if they even know there is a chance they could be talking to a person with type one. You know, “can you explain the significance of a positive GAD64 antibody test?”….but then I decided that took too much energy.

Last week at work, we were told that if we completed an online health survey, we would get a few bucks taken off the cost of next year’s health care plan. OK, so it wasn’t much money, but I figure they are at least trying to do something good, so I should play along. Even though I knew what I would be in for.

To start off, I resolved to be as honest as possible with the thing. Honesty is the best policy, right? I did fine with the gender, age, height, weight, non-smoker, non-drug-abuser, teeth-brusher, exerciser, seatbelt-wearer, single-partner, occasional-drinker questions.

The general state of my health? Well, excellent is out. Good, I guess. With one glaring exception. I smile a bit, remembering my favorite great-aunt saying "For the shape I’m in, I’m healthy."

Have I missed more than one day of work in the past month due to illness? Well, considering I had strep throat and a 102 fever the week before, spent two days home asleep… Yes. Yes I have.

Have I ever been told by a doctor that I had diabetes or pre-diabetes? Um. Yeah. How long ago? Within the past 5 years.

Have I seen a doctor since that time? What are you smoking? Yes. (duh!)

Has my doctor ever told me my blood sugar was high? Is a bear Catholic? Does the pope shit in the woods?

Have I tested my blood sugar in the past three weeks? Yes. They only ask yes or no, so I can’t put “over 200 times”.

What was it? Excuse me? My choices are “80-110”, “120-140”, “150-180”, or “above 200”. No “All of the above”? No “below 40”? No “above 400” (thank you, strep throat!) I decide in the interest of honesty here to go with my most recent reading. “120-140”.

OK, I am now booted out of the information collection stage and into the “diabetes for idiots” stage. I’ll try and reproduce the gist of the canned messages here, cleverly tailored with personal data from the collection stage inserted in so I know they really care…

Diabetes can be controlled through diet and exercise. Hooray! I’m throwing out my pump! You indicated that you exercise 5 times a week. You should exercise at least 3 times a week for 30 minutes. I should cut down? Exercise doesn’t have to be tough. Try starting with a brisk walk for 15 minutes and work your way up.

Maintaining a healthy weight is important also. Your BMI is 21. An ideal BMI is 19-24, so yours is in range. Dieting is an effective way to control your weight. Don’t get discouraged if you don’t see results immediately. Remember that controlling portion size is important to losing weight.

Your fasting blood sugar was 120-140, which is above the ideal range of 80-100. It’s also not a fasting BG, you morons, it was dead-on after lunch! You never asked for a fasting reading. Elevated fasting blood sugar can lead to crippling complications. Yes, I know that. This may be a good time to speak with your doctor about changing your medication to something that may more effectively control your diabetes. Yeah, fine. I’ll tell him I want to stop insulin and switch to something more effective. Should give him a good laugh.

Controlling your blood sugar is easy with proper diet, exercise, and regular doctor visits. Obviously written by a person without diabetes, any acquaintances with diabetes, or any knowledge of diabetes – of any type. Contact your doctor for more information and help and directions on how to manage this illness. Oh, yeah, maybe I should call every time my BG is out of range… Remember, it’s all up to you. And that is the exact kind of blame-the-victim bullshit that makes ANY TYPE of diabetes so hard to live with. It is NOT just up to me. But now I’m going to be haunted by those perky phone idiots who call during supper to ask what I weigh. I just know it.

The final page of the survey asked if we had ever been the victim of a medical error. And for once instead of a multiple choice we could actually write in 250 chars to explain. So of course I put in that my medical error was being misdiagnosed as a type 2 diabetic when I was type 1 and would die without insulin. I’m hoping if my answers get spit out to their telephone police, maybe they’ll actually glance at that and decide not to call.

If not, I’m compiling my own list of questions. Maybe I’ll ask my personal policeman what they weigh and how often they exercise. If they test their blood sugar at least eight times a day. If they have tested their basal rates recently. How many abstracts they have read on PubMed. If they have noticed different insulin sensitivity at different times of the day. If they re-evaluate their insulin to carb ratios periodically..........


meanderings said...

Me too!! Thank goodness for caller ID! I ignore the calls now. I especially loved it when I described a medication side effect. The "nurse" I was speaking with figured out her husband was having the same problem with the same medication. I told her he needed to speak with his doctor. Duh!

Lili said...

I always wanted to give them a test, too.

Anonymous said...

Thank you for writing this ! My insurance co. sends me these annoying "wellness" letters on diabetes.
Not just type1 or tyoe2 just diabetes.
Just follow these wonderful suggested guidelines ( if you still want to be insured by us ) and your life will be wonderful ! Last time I checked I have had T1 for 32 yrs. But im just waiting for that call or letter for someone to let me know that either I dont have Type 1 or I just have diabetes.

Anonymous said...

We got the same goofiness from Aetna. I had a 45 minute conversation with some 'nurse' on Saturday. I explained that my daughter tests 10-14 times a day, and she was flabbergasted. Then she tried to tell me that my daughter shouldn't have sweets, and I asked what decade her information was from. Then I explained that the only reason I was interested in the program was to have an Aetna 'nurse' who might advocate for approval of the CGMS, and she didn't even know what that was. She said that was a different part of the company and she didn't have anything to do with that.

So I politely told her that weren't interested. Well maybe not so politely.

Thanks for wrting this; great blog entry.


Ashley said...

Great blog! You're really funny, I'm enjoying you.

My insurance company gives us those lovely calls too, I try to field them because if i don't pick up the caller stands a good chance of being verbally abused by my dad! I'm not much more patient but I don't make them cry. Haha.

Thanks for posting this!

Anonymous said...

Great write-up on that test! You really did a bang up job on bringing out the absudities!!

Unknown said...
This comment has been removed by a blog administrator.
Alyssa said...

I can't choose whether or not I want the morons from my insurance company calling me, they just do. But my father and I enjoy making up answers for them. Neither of us has diabetes, but the insurance morons think that we both have Type 2 because they don't have a coding system that covers reactive hypoglycemia.

I also periodically get calls from them offering coverage for my diabetes medications and shipping them to our house. Well, considering the fact that EVERY SINGLE TIME I speak to them, I tell them that I'm not on any medications for my "diabetes", no, I'm not on any medications.