Depending on a tool   (February 28, 2008)

I recently received a question via e-mail, and responded. There was an interesting concept embedded in the question, about the role of continuous monitoring of blood glucose, also called CGMS (for Continuous Glucose Monitoring System), and I thought I'd share part of my response to the writer with you today. (I've changed the text of the e-mail slightly, both for brevity and to maintain anonymity.)

"My mother has had type 1 diabetes for over 40 years. She has been using an insulin pump for many years but controlling her blood sugar has become increasing difficult, as she suffers from gastroparesis, which makes digestion and consequently her blood sugar incredibly unpredictable. She has also found it harder and harder to recognize the onset of hypoglycemic events which has led to countless occasions in which she has required assistance. She has been found unresponsive, sometimes combative and always humiliated by these experiences. Just last week she woke up on the kitchen floor with head contusions. My mom is now living alone which has left me and my siblings terrified for her well-being.

"Here is our question: her insurance company has twice denied CGMS as an "experimental or investigational" device. We don't know what to do or where to turn. This is not something we can pay for out of pocket, but are increasingly afraid that we will have no other option. My mother's life depends on this device. Do you have any information that may help us convince insurance that this is a necessity?"

I replied:

"It's unclear from your e-mail if your mother is under the care of an experienced diabetes team; if not, she needs a referral immediately. But assuming that she is, here are some other comments:

"I'm not sure why you feel that your mother's life "depends on" CGMS -- after all, it's only a tool to monitor blood glucose levels frequently. What your mom really needs is the ability to adjust her insulin, meals, and activity levels in face of the risk of severe hypoglycemic events, and CGMS might help a bit more than frequent glucose monitoring by standard meters -- if she's been thoroughly trained in self-management, and if she's completely capable of carrying it out all by herself.

"Indeed, I'd wonder if it's safe for her to live alone, and would suggest that if she continues to, that she should have extremely frequent contact with you kids to verify her status -- clearly much more often than once daily! It could be by e-mail or Instant Messaging, or text mail on her cell phone, or by telephone, or face-to-face -- whichever would work best for both her and for you kids to be assured that her BG is okay.

"And, of course, she should always wear medical identification (either a bracelet or necklace) that indicates she has diabetes."

(For those of you that are curious about my response about the question about insurance companies, stay tuned... I'll answer that this coming week!)