On Falling in Love and Climbing Mountains with Diabetes

This content originally appeared on Beyond Type 1. Republished with permission.

By Siobhan Casey

The Catalyst

“What if you got ill, what would you do then? Who would you call? How would you get home? Why don’t you start with a smaller trip?”

While my counselor posed reasonable questions, my answers convinced me, after twelve years of self-doubt and physical struggle that no, my identity was not “Type 1 Diabetic” or “Thirty-Two Year Old, Unmarried Woman.” Instead it was introspective adventurer, writer, childcare provider, and admirer of all things beautiful.

So that Friday, I compiled well-marked maps and packed my bags for the next five days. They overflowed with insulin pens, needle tops, cliff bars, glucagon pens, bags of Swedish Fish, bottled water, continuous glucose meters, glucose gel, old fashioned glucose meters, test strips, a hiking bag… As most traveling type 1s know, the list is far too long to enumerate. But I woke up in the spring of 2019 with the desire not just to survive and be helpful to others, but to head south and climb a great height. My destination: the Blue Ridge Mountains. This was no impulse. No, this was a conviction.

The Journey Begins

My palms were sweating as I set out on the scenic route, taking back roads in lieu of the more efficient highways. As with any good trip, nothing went quite as planned. For one thing, I got lost on my second day in Virginia, and my phone picked up no bars. But as soon as I found my way to a safe trail, I felt at home among the bugs and canopies of trees. Truthfully, I felt much less alone, in solitude and cloaked in Shenandoah National Park’s shades of blue, than I did among most people.

Siobhan Casey

Image source: Beyond Type 1

After meandering through and taking many breaks to eat the glucose and lunch I had packed, I found my way back to the main road. I stopped at each overlook to spread my arms and become a part of the staggering landscape. When I arrived back home, something small but essential shifted inside of me. I felt different, lighter, and more confident. I began to take my bike on longer, solo trips through the park. And I began to entertain the idea that my next trip would be far better with a companion. But I hesitated because my romantic relationships over the past decade had been fraught with oversharing or hiding how much I struggled with type 1 diabetes (T1D).

Things changed on a rainy spring evening. I decided to meet Roy mostly because he seemed like he knew something I didn’t, smiling and sipping out of a coconut in the photo in his dating profile. On the phone, we both liked to think and laugh in equal amounts and we loved the same Indie band and the same eccentric meditation guru. When I stepped through the door of the bar, I caught sight of him before he saw me. His dark hair fell to one side of his thoughtful face and unlike most people sitting on their own, he wasn’t scrolling through his phone but looking at the world around him. We hit it off, and in typical fashion, I didn’t trust it one bit.

The Rare Type

For one thing, he seemed like an impossible burger of a person! He was completing a fellowship in Cardiology and had very little ego. He worked long hours caring for patients in heart failure but rarely became exasperated. He played music, could write like a boss, and genuinely appreciated my varied pursuits of art and childcare. He was honest without being hurtful. I didn’t trust how beautiful this could become and so by the end of the first month of dating, I compiled mental notes of any small signs that he couldn’t “handle” my diabetes. It was a difficult task because he never once judged how I managed my numbers. Instead, he wondered aloud how I functioned on so little sleep.

By that August, he acknowledged that type 1 diabetes was nowhere nearly as straightforward to manage as he had previously thought. But he remained undeterred, and we took a week-long trip to the west coast, traveling between San Francisco and Monterey, stopping in solitude and solidarity to watch the Pacific roll in between coves and cliffs along Big Sur. He often said, “I don’t think of you as a sick person, you know…” and this assertion aligned with my own stubborn belief that in spite of the relentless nature of type 1, I could do so much with my life. As it turned out, I woke each day before he did, more than ready to take on Highway 101 and hike the heights of Pfieffer State Park, the trip I had always dreamed of making.

As type 1s, most of us wax grateful for strangers who help when we are having a low sugar in a public place. But in a relationship, what counts is not the fact that someone brings you juice. It’s that they do it, as Roy still does, at five in the morning three days in a row without any outward irritation. And that they genuinely believe you can do most things for yourself. They treat you as strong as you actually are inside but understand when you are worn down and could use a hand. Looking back, the first month together was a mountain of growing pains for me, of learning that, yes, this person has existed in the world this whole time and even if my pancreas is defunct, I am not. This love has been both as attainable and as rare as climbing the side of the Blue Ridge mountains with insulin on ice in my backpack before heading home – the journey never easy but always good.

Source: diabetesdaily.com

Keys to Long Term Success and Preventing Complications

Contrary to popular belief, you can live a long, healthy life with type 2 diabetes, without developing complications. In its 2010 report, Diabetes UK found that someone with type 2 diabetes is likely to have a reduced life expectancy by up to 10 years, and someone living with type 1 diabetes is likely to have a reduced life expectancy by up to 20 years.

However, with advanced technologies and therapies, people are living longer and healthier than ever. Results from the University of Pittsburgh after a 30-year longitudinal study found that people with type 1 diabetes born after 1965 had a life expectancy of 69 years — longer than any study had ever previously found.

In part four of our four-part series on living well with type 2 diabetes, we will dive into the keys to long term success managing your condition, and how to prevent complications over the long term.

What Causes Complications?

It’s important to know what causes complications in people with type 2 diabetes. Not everyone living with diabetes will develop complications, but the occurrence of chronic hyperglycemia, or high blood sugar, can lead to heart disease, kidney failure, nerve damage, and retinopathy (the most common complications of diabetes). It’s important to keep your blood sugars in range as much as possible to help prevent the onset of these complications.

Keys to Long Term Success

A number of factors have been shown to help slow the progression of (or completely prevent) complications in people with diabetes:

  • Keep HbA1c in range – Studies have shown that keeping your HbA1c lower than 7% can prevent the onset of complications, and closely monitoring your blood sugar (testing regularly) can help tighten your control. Talk with your doctor about the ideal number of times she would like you to test per day, and make sure you always test before and after meals.
  • Take your medications as prescribed – Some people think that insulin is “bad” or they just don’t like the thought of taking a pill every day. You’re prescribed your medicine for a reason, and you should follow all doctors’ orders to take them as prescribed. Rationing or skipping doses can quickly lead to complications or even premature death.
  • Follow a sensible diet – You don’t need to go completely paleo or keto to have better blood sugars, but speaking with your doctor or seeing a nutritionist can help you develop an eating plan that will work for you that you can sustain. Be sure to include plenty of fresh vegetables, protein, and water. Eating similar foods, eating a low carbohydrate lunch (of 20 grams or fewer) and limiting meals at restaurants has also been shown to help improve blood sugar management in people with diabetes.
  • ExerciseExercise is one of the most important things you can do to prevent complications. Not only does it lower blood sugars, but it gets the heart working and the blood pumping, increasing circulation and strengthening your whole cardiovascular system. Exercise boosts your immune system, and increases serotonin in the brain, making you feel good and helping to prevent the onset of depression. According to our Thrivable Insights study, people with type 2 diabetes who have an HbA1c <6.5% are more likely (20% vs 8%) to exercise 4-6 times per week than people living with type 2 diabetes who have an HbA1c of 8% or higher.
  • Surround yourself with support – Diabetes is a marathon, not a sprint, and the journey can be lonely at times. A study from the University Hospital in Denmark found that loneliness may actually cause premature death by damaging the blood vessels of the heart, which can be compounded with a diagnosis of diabetes. Long term success with your diabetes care is much more likely if you surround yourself with supportive family and friends, or if you can find a community who will understand. Sharing your thoughts, worries, and feelings will help lighten your load, and you may just learn a thing or two that you didn’t previously know about diabetes and how to better care for yourself!

Have you had diabetes for a long time, and are thriving without complications? What are some of the best strategies you’ve employed to achieve success? Share this post and comment below!

Source: diabetesdaily.com

Traveling Abroad with Diabetes: Have Your Dolce and Eat It Too!

This content originally appeared on diaTribe. Republished with permission.

By Maria Horner

Maria shares her experiences and strategies for managing blood sugar levels while studying abroad

Like many young adults, I love to travel and will take any excuse to do so. Going into college, I knew that I wanted to study abroad; the moment I learned about my university’s semester program at their Rome campus, I was ready to go. However, traveling with diabetes isn’t always easy. The longer the trip, the more complicated it can be, and especially a trip to Italy, a country known for all of its carbohydrates!

What’s someone with diabetes to do about managing their diabetes while living in Italy?

Preparation is key!

One of the most important things I did to ensure my trip went well was put a lot of time into preparation. This means figuring out the quantity of diabetes supplies you’ll need, ordering them in advance, and finding space to pack it all. On my blog, I created a handy spreadsheet that helps you calculate exactly how much of each item you’ll need. You should start refilling your prescriptions as frequently as possible months before you travel, to make sure you stockpile enough supplies to last the whole trip. When I was preparing to go to Italy, my insurance only allowed me to order three months of supplies at one time, so I had to wait a few weeks before refilling my prescription. If you’re short on time, ask your healthcare professional if they can help you order extra supplies.

Preparation also means making back-up plans in case anything goes wrong, like talking through solutions to possible challenges. I have a great team of people that support me at home, including my parents, friends, and healthcare professionals, so before I left, I made sure I had several ways to contact them while abroad. Once I arrived in Rome, my host family, my friends, and the staff at my school became the people who could help me if I needed assistance.

Here are some things to talk about with your support team before you travel:

  • If I run out of a diabetes supply, what will I do? Can I get this supply abroad? Is having it shipped to me an option, considering what can be sent through the mail, what is allowed through customs, and the reliability of the mail system?
  • If I need to see a doctor or go to the hospital, can I find English-speaking doctors? Where is the closest hospital?
  • How does insurance work? Do I need to get special insurance while I am abroad?
  • How can I get in contact with my doctor? Can someone from my support team contact my doctor if I can’t?

Here’s a little story about how back-up supplies and my support team saved the day while I was in Rome:

About halfway through my semester, I was returning from Venice on an overnight trip and I arrived back in Rome early in the morning. I must have been sleep deprived, because I left my phone on the train! To anyone else, that would be very frustrating but manageable; most of the things people use their phones for, like email and messages, can be done on a computer. For me, it felt like a disaster, because my Dexcom G5 continuous glucose monitor (CGM) was tied to my phone. I love being able to check my blood sugar with just a glance at my phone, but without my phone, I couldn’t use my CGM. Because I’m used to constantly knowing my blood sugar, not having readings for an extended period of time was hard. Long story short, it was two days before I could get my phone back, and only with help from my support team in Rome. Thankfully, I had plenty of test strips and a blood glucose meter (BGM), so my back-up supplies came to the rescue.

Enjoy new foods, but do so in moderation.

After all my preparation, living in Rome still brought different challenges my way. Even though I wanted to experience all that Rome had to offer, I still had to keep blood sugar management in the back of my mind, especially during mealtime. Italian cuisine is full of carb-heavy foods, from pastries for breakfast to sandwiches, pizza, and pasta for lunch and dinner. Unfortunately, all these unknown carbs can make it hard to keep one’s blood sugar in range.

I didn’t want to deny myself all of the delicious, yet carb-rich, Italian foods. But I also didn’t want to drive my blood sugars out of my target range. I found that my best option was to eat these foods in moderation (just one or two bites), and fill myself up with delicious lower carb options, like vegetables and meat.

To prepare for a meal that may contain many carbs, make sure to dose extra insulin before the meal. If you end up eating more carbs than expected (which can easily happen with Italian food), the sooner you’re able to dose additional insulin – even if it means stopping in the middle of the meal to take insulin – the more quickly your blood sugars will respond.

Do some research and know what to order at restaurants.

When eating out at a restaurant, a good tactic is to order a meat, seafood, or vegetable-based dish as your main entree. Before you’re faced with ordering low-carb food in a foreign country, it’s helpful to know what you can expect from a local menu. Here’s what I learned in Italy:

  • Italian meals consist of several courses, including antipasto (appetizer), primi (the first course, typically pasta), secondi (the second course, usually meat or seafood), contorni (a side dish, usually a vegetable), and dolci (dessert).
  • Most people order either a primi or secondi as their main dish.
  • You can find the best low-carb options in the antipasti, secondi, or contorni sections of the menu.
  • If you have diabetes, ignore the primi section – it won’t be helpful for keeping your blood sugars in range.

One more tip: when you’re not sure what something is on the menu, it never hurts to ask the server or look up a picture online. This was important for me in Italy, since some of the meat dishes are breaded. I’ve included a list of my favorite low-carb Italian orders at the end of this article.

Share food with friends and family!

If you don’t want to miss out on experiencing all the pizza and pasta, get your friends to help you out. If they order a high-carb dish, ask if you can trade a few bites of your food for theirs – that way, you get to taste some pizza or pasta, while still keeping your meal low-carb. The same thing can apply to desserts, like gelato: ask a friend for a few bites, or offer to split one.

No matter what you decide to eat, just make sure you watch your blood sugars carefully, especially when trying new foods and guessing on insulin doses. Don’t let your diabetes stop you from exploring all the wonders of a new cuisine and culture, but also, don’t let impulsive food choices throw your blood sugars off. That balance can be hard to find, but do the best you can and enjoy the experience. Mangia bene (eat well)!

For more details, tips, and advice on studying abroad with diabetes, visit my blog, Winging It.

Here are some of my favorite low-carb Italian food orders, classified by course.

Antipasti (appetizers):

  • Insalata caprese (mozzarella, tomato, basil salad) – if you’re lucky, they’ll use fresh mozzarella di bufala, the most delicious cheese I’ve ever tasted!
  • Verdure grigliate misti (mixed grilled vegetables)
  • Affettato misto or salumi misti (mixed cold cuts)
  • Prosciutto (ham)

Secondi (entrees):

  • Tagliata/bistecca/filetto di manzo (beef)
  • Salsiccia (sausage)
  • Petto di pollo (chicken breast)
  • Vitella (veal)
  • Bollito alla picchiapo (beef stew in tomato sauce)

Contorni (side dishes):

  • Carciofo alla romana (roman artichoke)
  • Peperone (bell peppers)
  • Spinaci (spinach)
  • Insalata (salad)
maria horner

Image source: diaTribe

Maria Horner is a college student from Northern Virginia. She was diagnosed with type 1 diabetes at age seven, but she hasn’t let that hold her back! She had the incredible opportunity to study abroad in Rome during the fall of 2018, and recently started a blog about her experiences, to help and encourage other people with diabetes that are interested in studying abroad. When she’s not in class, you can find her taking a dance course or trying out a new recipe in the kitchen. She also loves travelling and going on adventures, one of her most recent adventures being skydiving!

Source: diabetesdaily.com

Recipe Roundup: 4 Protein-Rich Recipes from Dietitians

Many people with diabetes follow a high-protein diet for good reasons. It’s low glycemic, which means it doesn’t cause abrupt sugar spikes. It also makes you feel fuller for a longer time, which can help you sustain your energy until your next meal. Studies have also proven it’s good for weight loss, building muscles, and bone health.

All these health benefits made us think of reaching out to dietitians and nutritionists for recipes that are not only protein-rich but also palatable. Here are their suggestions:

Pizza Chicken Foil Packet

pizza chicken foil pack

Photo credit: Abbey Sharp

Insulin dosing for pizza can be tricky, due to its combination of high carbohydrates and high fats, so if you’re craving for some but want to ditch the carbs, this savory meal can be a good substitute. Registered dietitian, Abbey Sharp, says it’s easy to pull this off and can be readily modified depending on what’s in your fridge or what you or your family like on your pizza. To ensure that it’s low in carbs, be sure to use sugar-free sauce.

Salmon Burgers

salmon burger

Photo credit: Alexis Joseph

Packed with omega-3 fatty acids, this salmon recipe is a sure hit for everyone in the family. Hummusapien registered dietitian, Alexis Joseph, offers options to keep the carbs low. Instead of using breadcrumbs to keep the patties together, you can use almond flour. Instead of serving it in a bun with greens, you can chop it up and devour it in a loaded salad. The best part is that these burgers freeze well, making your dinner on busy days a breeze.

Easy Blackened Shrimp

blackened shrimp

Photo credit: Kaleigh McMordie

Is it possible to cook something healthy within 5 minutes? Yes, Kaleigh McMordie, the registered dietitian at Lively Table, proves this with this shrimp recipe. Just place the shrimp in a bowl, toss some lemon juice and blackening seasoning, and cook the shrimp in a non-stick skillet for 2-3 minutes each side. You will have extra blackening seasoning from this recipe, so be sure to store it in an air-tight container for future use.

Miso Chicken – One Pan Meal

miso chicken

Photo credit: Natalie Brady

Baked chicken and vegetables can be boring, but using a delicious dressing or sauce can make a huge difference in your meal. Registered Clinical Nutritionist, Natalie Brady offers her miso sauce as one of your options. Miso, a thick Japanese paste made from fermented soybeans, is rich in protein and nutrients.

What protein-rich recipe do you serve at home regularly? Share them in the comments – we would like to know and try them out!

Recipe Roundup_ 4 Protein-Rich Recipes from Dietitians

Source: diabetesdaily.com

How Type 1 Diabetes Brought My Father and I Closer Together

This content originally appeared on Beyond Type 1. Republished with permission.

By Samuel Frank

Lifelong Reality

I have no memories of my father without diabetes. My father was diagnosed with type 1 in 1989 when I was 3 years old. Diabetes and Papa Frank were always hand in hand, one and the same. As a chemistry professor and academic, he seemed to get a thrill from stable numbers and consistent control and he would never shy away from talking about it.

My father is incredibly loving, especially to his family. He loves to share a story or an exciting idea. I’m blessed to have grown up with such a loving, kind-hearted father — at no point were aggressive assertions of masculinity expected from me nor my brother. He is also very particular, specific, and regimented — presumably from having type 1 for so many years, or maybe, that’s just how he is.

Growing up, my father would work as a professor and come home around 5:00 p.m. And he had a list of maybe ten meals he would prepare, with occasional variations. He developed a “square meal” that was his baseline, average, expected, protein-and-vegetable rich meal. No snacks or sugary beverages, caution and restriction while eating out — all told, a marvelous diabetic. As a child, I don’t recall a moment when his health was in danger or his diabetes management was questioned. And it wasn’t a mystery; my father loved to disclose his diabetes management. A dinner out would often end with a round of, “Guess what my blood sugar is?!” And as a child, I knew enough about the symptoms of hyper- and hypoglycemia to make a prediction. When my father was on target after dinner, he was almost elated. The 115 mg/dL was a symbol of harmony for me. If my father was happy, I was too.

Kindred Spirits

I always saw myself in my father and he was always quick to relate to me. We both had one older brother, which created a powerful and unique dynamic of understanding. But it wasn’t just this. My father loved identifying our similarities and I loved being recognized, being seen, and losing that feeling of being alone. Today, I am 33, and this has remained ever so consistent. There have always been physical and emotional similarities between us. So, echoing my father, throughout my life, I imagined what it would be to have type 1. The poking and prodding of needles appeared horrific. And I often wrote it off, as he would be the first to remind us that he was 44 — later in life — when he was diagnosed. It happened the same way with his aunt and grandmother.

Samuel

Image source: Beyond Type 1

But it happened to me at 27, earlier than the other members in my family. I was in my second year of graduate school for social work and marvelously stressed. I went into DKA on December 27, 2013 while visiting my family in Fresno for the holidays. At one point in the weeks prior, I recognized some of the symptoms but attributed them to stress from graduate school and chose to ignore them. My family didn’t recognize the DKA since no one they knew had experienced it before, but they followed their instincts and my parents took me to the ER as I continued to get worse.

While traumatizing, it couldn’t have happened at a better time of year. After 3 days in the hospital, I took a week off from my internship in San Francisco and stayed home with my parents, acting as my father’s diabetes mentee. It was emotional and challenging and confusing, but I was so thankful not to have to do this alone.

So during that week, I dove into diabetes management, meals, and lifestyle adjustments. After meeting with a few endocrinologists and health educators, I learned about carb counting and daily totals. My father doesn’t carb count; since he has such a solid meal regimen, he knows how many units of insulin to take to maintain a functional rhythm. As I was learning how to bolus, he would lean over my shoulder, look at my plate, and create an approximation. My father owns his decision to use his square meal method instead of carb counting, stating, “I see it not as a calculation, but as an art.” I don’t think he’s wrong, but it felt divergent from the messaging I received from medical professionals. The nurse would tell me one thing but my Papa would tell me something else. I needed to make my own way.

The Same but Different

We were never apart, but diabetes brought my father and I closer together. To this day, it gives us something to talk about. I’m often captivated by his stories of obscure blood sugars at an inconvenient time, and I can share mine. When I’m fed up with abnormalities, my father is always there for support and advice. We learn together about modern technology to help our management and share information. Plus, most importantly, by growing up with a diabetic parent, he normalized the subject matter. I speak about my disease, my insulin pump, and management style with glee to my coworkers and friends. I think I notice a little bit of my father come through when I speak with good friends about a successful bolus for a carb-heavy meal.

Don’t get me wrong, we are also different people. I’m now 33 and don’t have children, so my lifestyle remains much more variable than my father’s ever appeared. My mealtimes are quite inconsistent, and my diet often fluctuates; I drink, I travel, I stay up late. But to this day, when he and I are eating the same meal and the same portion, it’s nearly the exact same size bolus that we give ourselves. I truly have my father’s disease. And that means I carry my family line ever so truly.

It always meant so much that I didn’t have to learn this alone. I wish for every parent of a child with diabetes to not just have compassion, but empathy and robust understanding, to normalize frustrations of the disease and its limitations for that child. I learned recently that type 1 isn’t always genetic, and often diagnosed earlier in life. The Frank family pancreas seems to just give out after a while, leaving us diagnosed later in life. But that makes our situation all the more unique, rare, and maybe even, special.

Source: diabetesdaily.com

Was Your Medicare Claim Rejected? Here’s How to Appeal

This content originally appeared on diaTribe. Republished with permission.

By Kara Miecznikowski and Eliza Skoler

Learn how to appeal a Medicare claim rejection under traditional fee-for-service Medicare, a Medicare health plan, or Medicare prescription drug coverage

A health insurance claim is a bill for your healthcare services, medications, or medical equipment that you think should be covered by your insurance plan. If you have Medicare health insurance, your healthcare practitioner will usually submit claims directly to Medicare for payment. If Medicare decides to reject the claim, you can challenge the decision. This is called an appeal.

In the United States, people have the right to appeal a denied claim for up to six months after hearing about this decision. Appeals can often be successful – a 2018 report showed that 75% of Medicare Advantage denials were overturned in the appeals process – which means that challenging a denied claim could save you money. This article will explain how to appeal a Medicare claim rejection.

To learn more about the appeals process in the United States – especially if you have a different health insurance plan – read our article, “When Insurance Gets Turned Down: Appeals Explained.”

How do Medicare appeals work?

You can appeal a decision made by the national Medicare fee-for-service program (Parts A and B), your private Medicare health plan (Part C), or your Medicare Prescription Drug Plan (Part D). Learn more about the different types of Medicare here.

Click to jump down to:

Appeals under Medicare Part A or B (“Original Medicare”)

Appeals under Medicare Part C (Medicare Advantage health plan)

Appeals under Medicare Part D (prescription drug plan)

Here are some common situations for appealing a claim rejection:

  • If you have already received the service, medication, or medical supplies. Example: your doctor gives you lab tests during a visit, but then Medicare rejects the claim.
  • If your doctor requested the service, medication, or medical supplies for you. Example: your doctor says you need an insulin pump and Medicare decides that is not medically necessary.
  • If you and your doctor request a change in price for your medication, based on what treatments work for you. Example: generic drugs do not work for your condition, so your doctor asks for a discount on the more expensive drug.

The appeals process is different under Medicare Part A, B, C, or D. There are five levels to the appeals process. If you disagree with the appeal decision at level one, you can continue to appeal the decision again at every other level.

With each appeals processes, write your Medicare number on every document you submit for your appeal, and keep a copy of all the materials you send in.

Filing an appeal under Medicare Part A (hospital insurance) or Part B (medical insurance), often called “Original Medicare:”

  • Your bill will be sent directly to Medicare.
  • The appeal must be filed within 120 days of receiving the Medicare Summary Notice (MSN) that shows that your claim was denied.
  • If you disagree with a Medicare coverage decision in the MSN, you can appeal the decision.

A Medicare Summary Notice (MSN) is a summary of the health care services you have received over the past three months, sent to you by mail.  It shows what Medicare paid for each service and what you owe for the service, and it will show if Medicare fully or partially denied a medical claim. The MSN also contains your appeal rights and step-by-step directions on when and how to file an appeal for a claim rejection.

Did you sign an Advanced Beneficiary Notice of Noncoverage (ABN) before you received the treatment? An ABN is a notice that your healthcare provider will give you if they think the health services they are recommending might not be covered by Original Medicare. Your ABN will list the items that Medicare is not expected to pay for, as well as the estimated costs of those health services. The ABN can help you decide if you would still like to receive the treatment, and if you will pay for it if Medicare declines to cover the cost.

When you sign an ABN you can ask your healthcare provider to submit the claim to Medicare (before billing you), asking Medicare to cover the cost. If Medicare rejects the claim, you can appeal the decision. If your healthcare provider did not give you an ABN before treatment, you might not be responsible for paying for the health service. Learn more ABNs and appeals here.

There are three different ways to file an initial appeal under Original (Part A or B) Medicare:

appeals

Image source: iStock Photo

  • Fill out a “Redetermination Request Form” with information from your MSN; send the form to the address provided on your MSN
  • Follow instructions on your MSN for filing an appeal without using the form:
  1. Circle the claim that you disagree with on your MSN
  2. On a separate piece of paper, explain why you disagree with the decision
  3. Write your name, address, phone number, and Medicare number on the MSN, and sign it
  4. If you have any other information that will support your case, include it; you can ask your doctor or other health care provider to help you
  5. Send all of the above materials to the address listed under “Appeals Information” on your MSN
  • Or, send a written request to the company that processes Medicare claims. Include:
  1. Your name and Medicare number
  2. The item that you disagree with on the MSN
  3. An explanation of why you disagree with the decision
  4. Your signature
  5. Send all of the above to the address provided under “Appeals Information” on the MSN

You should receive a decision within 60 days of your request, unless you submit extra information after you first file the appeal (which may delay the decision).

For more information on the Original Medicare initial appeals process, see the Medicare webpage. If you disagree with the appeal decision at the first level, you have 180 days to file an appeal at the second level; information on the appeals process beyond level one can be found here.

Filing an appeal under Part C (Medicare Advantage health plans):

  • The initial appeal must be filed within 60 days of receiving the claim rejection.
  • You must send a written request (unless your plan allows you to file a standard request by phone, fax, or email instead).

In your request, include:

  1. Your name, address, and Medicare number
  2. The item you disagree with, the date that you received the service, and an explanation of why you disagree with the decision
  3. Any other information that may support your case

You should receive a decision about your appeal within 60 days, unless Medicare needs more time to obtain information from your healthcare provider. If waiting for a decision will hurt your health, your appeal decision will be made within seven days.

If your appeal is rejected (fully or partially), your request will automatically be sent to level two of the appeals process. More information on the initial appeals process under Medicare Part C can be found here. For information on the process after level one, click here.

Filing an exception request or appeal under Medicare Part D (prescription drug plans):

  • Reasons to request an exception to your Part D drug plan:
    • If your plan decides not to provide a medication you think should be covered.
    • If cheaper versions of your medication don’t work for you, you can ask for a discount on the more expensive medication.
    • If a drug you need is not on your plan’s drug list, you can ask for an exception.
  • An exception request must be submitted first; if your exception request is denied, you have 60 days to appeal the prescription drug claim rejection.
  • You must send a written request (unless your plan allows you to file it in another way).

An “Evidence of Coverage” document explains your rights with your Medicare prescription drug plan. You have the right to ask your plan to pay for a medication you think should be covered, and you have the right to request an appeal if you disagree with your plan’s decision to provide it.

appeals

Image source: iStock Photo

Before appealing a claim rejection, you will request an exception:

  1. Fill out a Medicare Prescription Drug Coverage Determination request form through your insurance plan sponsor
  2. Ask the healthcare provider who prescribed your medication to write a letter explaining why you need this medication
  3. Send the documents to your Medicare health plan

You should hear back about your request within 72 hours. If your exception is denied, you can appeal the claim rejection. To submit a written appeals request, include:

  1. Your name, address, and Medicare number
  2. The drug you want your plan to cover
  3. An explanation of why you are appealing the coverage decision.
  4. Any other information that may support your case, including medical records
  5. Send the documents to your Medicare health plan

You should receive a decision within seven days. If waiting for a decision will hurt your health, your appeal decision will be made within 72 hours.

More information on the initial prescription drug appeals process can be found here. If your request is not met (fully or partially), you have 60 days to appeal the decision at the next level; learn about further appeals here.

How can I get help filing an appeal?

You can have someone else file an appeal for you. This can be a family member, friend, lawyer, doctor, or anyone else that has agreed to be your representative. For more information and the representative form, see the Medicare website page on how to appoint a representative. For prescription drug appeals, your doctor or prescriber can request an initial appeal for you; you do not need to first fill out a form.

For more help with appeals, especially appeals beyond level one, contact your State Health Insurance Assistance Program (SHIP). SHIP is a network of free counseling services that help people navigate Medicare; find the SHIP program in your state here.

diaTribe Series

Image source: diaTribe

This article is part of a series on access that was made possible by support from AstraZeneca. The diaTribe Foundation retains strict editorial independence for all content. 

Source: diabetesdaily.com

Diabetes Love Letter: An Ode to Mandi’s Late Parents

By Mandi Franklin

To my late parents:

It was the winter of 1990 and I was spending the week at my aunt and uncle’s house while my parents were chasing sunsets in the Caribbean. I loved sleepovers at their house – we would play “grocery store,” paint my fingernails, and stay up late.

This time was different…

“She’s drinking so much water. She can’t seem to quench her thirst,” my aunt said to my mother when she called to check on me.

I was so thirsty that I would climb on top of the bathroom sink and gulp water from the faucet like a parched cat. My aunt and uncle knew something was wrong.

Photo credit: Mandi Franklin

My parents caught the next flight home and I was rushed to Sinai Hospital in Baltimore, Maryland.

This is when the perfect world we once knew changed for me and my family.

“She has juvenile diabetes and we need to give her insulin,” explained the ER physician to my parents. Imagine hearing that your little, previously healthy 3-year-old now has a permanent disease that will need to be managed with multiple fingersticks and numerous injections daily.

Confused. Angry. Sad. Guilty. Numb. These are things that I am sure my parents felt at this moment.

Over the next few days, we learned how to cope with my new life with the help of the medical team, nurses, dietitians, child life specialists, and of course family support.

From that day on, my parents vowed to never treat me differently and promised that I would live a “normal” childhood.

Photo credit: Mandi Franklin

Looking back, I admire them for how they tackled this diagnosis and disease. I never felt like I couldn’t do something due to my illness. I was able to dance, play sports, go on vacations, and have sleepovers.

I have been living with type 1 diabetes for 29 years. There are days when I want to throw in the towel and say “OK diabetes, you win.” The other days are just like yours, except with a few extra pokes and a special ability to count carbohydrates.

My parents taught me to live my life and never let my disease get in the way. Because of this, I do what I love and continue to chase my dreams.

In conclusion, don’t ever give up.

Thank you, mom and dad, for raising me to be a strong, independent, resilient, goal-crusher who just happens to also have type 1 diabetes.

Love you always,

Mandi

More about the author on her website and Facebook Page.

Source: diabetesdaily.com

My Dos and Don’ts for People Without Diabetes

This content originally appeared on Beyond Type 1. Republished with permission.

By Erika Szumel

Managing type 1 diabetes (T1D) means insulin calculations, getting plenty of exercise, and making strategic meal plans. But it also means awkward moments, unnecessary advice, and lots of looks from people who don’t live with diabetes.

While we might be well-equipped to take care of our disease, we aren’t always ready for these awkward moments with strangers, friends, and family who might not understand what we live with.

Here are the dos and don’ts of diabetes etiquette for those without diabetes, written by a T1D.

Do Ask Questions.

If you’re speaking to someone with type 1 diabetes, ask questions about the condition. I believe that 9 times out of 10, when the question is asked kindly, that the T1D will be happy to answer you. At the end of the day, we’d rather you understand better than continue to walk around with misconceptions.

Don’t Ask Loaded Questions.

Is it the bad type?
So you just have to watch your diet, right?
Did you eat too much sugar as a kid?

When people with T1D hear questions like this, it can be enlightening and frustrating at the same time. Enlightening because I am surprised to hear people still make these assumptions or have these ideas. Frustrating because these people still make these assumptions or have these ideas. Try phrasing a question like, “Can I ask you something so I understand type 1 more clearly?” or “Do you mind telling me more about it?”

Do Be Supportive.

What does being supportive really mean to you? For someone with type 1 Diabetes, it’s nice to know that others sort of understand what’s going on and that they are willing to help if needed. This could simply mean checking in on your friend or helping them find a snack when they are low. Showing your support displays itself in various ways.

Don’t Tell Us Horror Stories About Your Relatives.

The general public tends to have the idea that telling someone with T1D about your grandfather who lost his foot because of diabetes is, I don’t know, helpful? Most patients diagnosed with T1D are aware of the possibility of complications and their effects on the body caused by T1D. Please do not feel like it is your duty to remind us of the things that can happen to us (or may have already started) when you don’t know! Bring this into the conversation if the person with T1D has started talking about it or asks you a question.

Do Help Us Be Prepared for Lows.

Whether you’re a spouse, friend, or coworker, helping us be prepared for lows is such a kind gesture. That simply means knowing where snacks or low treatments are in the home or office and helping us get them when we need them.

Don’t Shrug Us off Simply Because What’s Happening Is Invisible.

Type 1 diabetes is an autoimmune disease that can have some serious consequences. The scary part: it’s mostly invisible. Other than my insulin pump and continuous glucose monitor (CGM) and their respective sites, you cannot tell that people with T1D are any different than you – with the exception of seeing us test our blood sugar or give a manual injection with a syringe or insulin pen.

I think one of the worst feelings I encounter having this condition is feeling like it means nothing to those around me – and this is usually solely because of ignorance or lack of understanding. Please don’t shrug it off as the “take insulin, watch what you eat” disease, because it is so much more complex. Be mindful of those with T1D, and be willing to offer a helping hand if they need something.

Do Help Us Stop the Stigma.

If you’ve been around a T1D for some time and have learned enough about it, then help us stop the stigma. When you hear comments or jokes about it, do your best to raise awareness for what is true about this condition.

Don’t Ignore the Jokes.

I think a huge part of raising awareness for type 1 diabetes is simply stopping jokes and memes dead in their tracks. I think people will remember when you stop them in that moment and say “Hey, that actually isn’t how it works” or “It’s actually a lot more serious than that.”

At the end of the day, there are a few things you should and shouldn’t do as a good friend, partner, or stranger to the millions of people affected worldwide by type 1 diabetes. Hopefully, this list will help you do just that.

Source: diabetesdaily.com

Ways to Save Money on Diabetes Expenses

Diabetes is an expensive disease. According to the Journal of the American Medical Association (JAMA), diabetes is the costliest disease in the United States. In 2017 alone, over $327 billion dollars was spent on people with diabetes and their needs, and that number has only increased since, as prevalence and incidence of the disease have risen as well.

Diabetes is also expensive, personally. Between medications, doctors’ appointments, time off work and school, buying healthy foods, and committing to an exercise routine, it can be troublesome to keep on top of all the bills and expenses. A landmark Yale study recently showed that as many as 1 in 4 people with diabetes have rationed their insulin, simply because it’s too expensive.

So, how do you prepare for the cost of a new type 2 diabetes diagnosis? In part 2 of our 4-part series, we dive into how to protect yourself from the high costs of diabetes.

Prescription Assistance Programs

Talk with your doctor or pharmacist about prescription assistance programs. They can help you get free or lower-cost drugs, especially if your income is low or you don’t have health insurance. Online resources, such as RxAssist, can also point you in the right direction towards prescription drug cost relief.  You can also get lower-cost care at a Federally Qualified Health Center, if you meet certain eligibility requirements.

Take Advantage of Your Employer’s Section 125 Plan (If They Have One)

These flexible spending arrangements let you contribute up to $2,650 per year (pre-tax!) to spend on out-of-pocket expenses for things like prescription drugs and copays for doctor visits. These plans usually adhere to a “use it or lose it” policy, so make sure you’re spending down anything left over in these accounts towards the end of your enrollment year (usually in December every year).

Enroll in Medicare

Many people 65 and older are not enrolled in Medicare, but if you’re diagnosed with diabetes, it’s highly recommended that you take advantage of this program. Medicare Part B covers a portion of bi-annual diabetes screenings, diabetes self-management education classes, insulin pumps and glucometers, and regular foot and eye exams. Medicare Part D covers insulin expenses. Learn more about the Medicare application process here.

Mail Order Your Supplies

If you’re able, use mail order to get recurring medications and supplies (you can sign up through your existing pharmacy). Oftentimes, you can buy a 90-day supply of your medicine for a single copay, instead of three separate copayments for three separate months. Mail-order supplies are bulk packaged and shipped to your home. This can be an excellent alternative if it’s hard to leave your home, and if you know you’ll need the same medication consistently, for months at a time. It’s also helpful in saving you money. Additionally, a lot of (over the counter) supplies can be bought in bulk from online retailers like Amazon for a fraction of the price you’d pay at a traditional pharmacy.

Ask Your Doctor About Generic Drugs

Although there is no generic form of insulin, many pills taken for type 2 diabetes are available in generic form. A bottle of Glucophage (60 tablets) costs around $80, but the generic form (metformin) will cost you about $10. Talk to your healthcare provider about generic options that are available to you.

Taking these small steps can add up to big savings over time, and can help you to live a long, healthy life, without the threat of complications. Plus, saving money on your diabetes supplies can help you invest in other (more fun) areas of life!

Have you found ways to better budget for your diabetes? How have you saved money for this costly condition? Share this post and comment below!

Source: diabetesdaily.com

Advancements in Treatment: The Use of Adjunctive Therapies in Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Paresh Dandona and Megan Johnson

Read on to learn about the research around GLP-1, SGLT-2, and combination therapy use in type 1 diabetes. Dr. Paresh Dandona is a Distinguished Professor and Chief of Endocrinology at the University of Buffalo, and Megan Johnson is a fellow on his team

For people living with type 1 diabetes, new treatments are finally on the horizon. The University at Buffalo (UB) Endocrinology Research Center is helping to revolutionize the treatment of this condition. Among the most promising new therapies are two non-insulin medications currently used in type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists.

SGLT-2 inhibitors, such as Farxiga, act the kidney to help the body excrete more glucose in the urine. Meanwhile, GLP-1 receptor agonists like Victoza work in several different ways: increasing the body’s natural insulin production, decreasing the release of the glucose-raising hormone glucagon, slowing the emptying of the stomach, and curbing excess appetite. Some people with type 1 diabetes take these medications as an addition to insulin treatment as an “off-label” drug. To learn more about off-label, check out the article: Can “Off Label” Drugs and Technology Help You? Ask Your Doctor.

Why consider these medications?

In people without diabetes, the body is constantly releasing more or less insulin to match the body’s energy needs.  People with type 1 diabetes do not make enough insulin on their own and have to try to mimic this process by taking insulin replacement – but it isn’t easy.

People with type 1 diabetes often have fluctuations in their blood sugars, putting them at risk for both low blood sugars (hypoglycemia) and high blood sugars (hyperglycemia). Many individuals are unable to manage their blood sugars in a healthy glucose range with insulin alone. In fact, less than 30% of people with type 1 diabetes currently have an A1C at the target of less than 7%.

Can GLP-1 agonists be safely used in type 1 diabetes?

Over the past decade, the endocrinologists at the University at Buffalo and other research groups have been conducting studies to see whether GLP-1-receptor agonists can safely be used in type 1 diabetes.

  • The first of these was published in 2011 and showed a decrease in A1C within just four weeks of GLP-1 agonist treatment. Importantly, people given GLP-1 agonists plus insulin also had much less variation in their blood sugars, as measured by continuous glucose monitors (CGM).
  • Another study involved 72 people with type 1 diabetes who took GLP-1 agonist or placebo (a “nothing” pil) in addition to insulin for 12 weeks. The GLP-1 group had decreases in A1C, insulin requirements, blood sugar fluctuations, and body weight. People in this group did report more nausea – a common side effect of GLP-1 agonists.
  • Since then, multiple studies, some involving over 1000 people and lasting up to 52 weeks, have shown that GLP-1 treatment in people with type 1 diabetes can reduce A1C and body weight, along with insulin dosages.

Many of these studies, but not all, have suggested that GLP-1 agonists can do this without increasing the risk for hypoglycemia or diabetic ketoacidosis (DKA). There is also some evidence that GLP-1 agonists can improve quality of life in type 1 diabetes.

Who should consider GLP-1’s?

The effects of GLP-1 agonists seem to be especially strong in individuals who are still able to make some insulin on their own, although it also works in people who do not.

In one notable study, researchers gave a GLP-1 agonist to 11 people with type 1 diabetes who were still able to produce some insulin. To get an estimate of insulin production, they measured levels of a molecule called C-peptide, which is produced at the same time as insulin. In these 11 individuals, C-peptide concentrations increased after GLP-1 treatment. By the 12-week mark, they had decreased their insulin dosage by over 60%. Incredibly, five people were not requiring any insulin at all. Even though the study was very small, the results were exciting, because it was the first study to suggest that some people with type 1 diabetes had sufficient insulin reserve and thus, could – at least temporarily – be treated without insulin.

Can SGLT-2 inhibitors be used in type 1 diabetes?

SGLT-2 inhibitors like Farxiga have also shown tremendous potential. In two large studies called DEPICT-1 and DEPICT-2, adults with type 1 diabetes were randomly assigned to take either placebo or SGLT-2 inhibitor in combination with insulin. Over 700 people from 17 different countries participated in DEPICT-1, and over 800 people with type 1 diabetes participated in DEPICT-2. At the end of 24 weeks, people taking dapaglifozin had a percent A1C that was lower, on average, by 0.4 compared to people who had received placebo, and it was still lower, by over 0.3, at 52 weeks. The number of hypoglycemic events was similar in both groups.

As with GLP-1 agonists, people taking SGLT-2 inhibitors had weight loss and decreased insulin requirements. People taking SGLT-2 inhibitor, however, did have an increased risk of diabetic ketoacidosis (DKA). If individuals consider this therapy, they should be cautious about not missing meals or insulin, and not drinking large amounts of alcohol, as these behaviors can lead to increased ketone production.

Several other research groups, in trials recruiting up to 1000 individuals, have seen similar results when using this class of medications.  Researchers have been conducting additional studies to try to determine how best to minimize the risks associated with them. Farxiga (called Forxiga in Europe) has now been approved as the first oral agent as an adjunct treatment for type 1 diabetes in Europe and Japan.

Promising Combination Therapy

Now, endocrinologists are also looking at whether GLP-1 agonist and SGLT-2 inhibitor combination therapy could increase the benefits of each of these treatments. A study conducted on a small number of people showed that GLP-1 agonists can help prevent ketone production, so it is theoretically possible that this medication could reduce the risk of DKA that was seen with SGLT-2 inhibitors.

In an early study involving 30 people with type 1 diabetes who were already on GLP-agonist and insulin were randomly assigned to take SGLT-2 inhibitor or placebo, as well. People who received both drugs saw an 0.7% reduction in A1C values after 12 weeks, without any additional hypoglycemia. People on the SGLT-2 inhibitor did make more ketones, though, and two individuals in the combination group experienced DKA. Larger studies are now being conducted to expand on these results and learn more about how to give these drugs safely. The hope is that non-insulin therapies will soon be approved for type 1 diabetes. By unlocking the potential of these therapies, we can do more than manage blood glucose levels – we can improve people’s lives.

Source: diabetesdaily.com

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