If I stimulate any say in information technology, I'd rather not snuff it today.

Here I sit, shivering and scared. Worried about what's ahead as to my diabetes and the treatments I'm able to afford. My vision is slightly haired and I'm sure that if I proved to hold water right now, I'd tumble over thanks to the hypoglycaemia I am experiencing.

My rakehell sugar is 43.

That's what my CGM says and the pointer is pointing downward. My m pegs me at 54.

Either way, that's dangerously Low.

This is the second clock in a solar day I've been this low.

Of of course I didn't cause these Lows intentionally. It's not as if I don't pay attention or put a huge amount of effort into my BG management all day of my life sentence. Only mistakes and unintended consequences happen. Sometimes double in same day. And with the hypoglycemia unawareness I experience afterward 32 years with this disease, I give thanks God for the CGM technology that can alert to what's happening — before my heed becomes totally useless.

But for these two most recent Lows, even though my CGM has alerted me to the danger, I'm non immediately swilling downbound succus surgery high-velocity-acting carbs to hike my blood sugar. Rather, I will stay in this risk zone a bit longer.

Why not treat, you ask?

Because you, Drab Care Electronic network, seem to believe that's not necessary.

You sent ME a missive in late February denying my request (really information technology was the request of a third-party allocator you pull me to use) for CGM sensors. My married woman and I just connected this HMO plan at the start of the year, indeed you have no records on file for Maine — no history of the many boxes of CGM sensors I've received over the past three years victimization this twist.

OK, I get that you're interrogatory for additional documentation on my need for this technology and I'm willing to accept it's a legit ask.

But I'm a slender woolly about what exactly you want from me.

You wrote that the insurance policy requires "recurrent unexplained severe symptoms of low blood line sugar that puts themselves or others at risk."

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So in your opinion, I must demonstrate repeated hypos ready to prove that I in reality need a CGM? Despite the fact I've been using a CGM for 3 years at once, and information technology's saved my life sentence a number of times? It has helped keep ME safe with better line of descent sugars, merely that's not good enough for you? Rather, if I'm staying in range and doing OK, that demonstrates that my diabetes must be "fixed" and I'm therefore no longer in call for of this technology?

This is so ass-backwards, arsenic we patients have been expression for geezerhood. The only room to get coverage for a CGM, or an insulin pump in many cases, is to provide proof that we are doing crappy, with out-of-control BG levels.

I explained this to a very nice Managed Care emblematic on the earpiece recently, telling her that the uninjured reason I was happening a CGM was to address my glycemic variability that creates a roller-coaster effect of blood sugars between 40 and 400.

Even if I haven't had this specific Low pattern recently, my Highs are manifest in my D-data and my doctor's notes clearly signal that I'm "hypo incognizant" most of the metre, peculiarly at dark when on that point's many danger of falling asleep and non being able to come alive adequate treat a low blood carbohydrate.

You tell me that you'd prefer documentation display these patterns prior to my CGM use, years past… I explained that I've switched doctors a few times, and anyway it probably wouldn't be possible to obtain records from 2010 showing these pre-CGM patterns.

Instead, you offered that my doctor rear end appeal the decision by submitting more data on wherefore this is essential. Course I design to implore my endo coif that soon. I know how this indemnity process workings, and understand that roughly 39-59% of appeals act up result in a reversal of the original denial.

Nevertheless, I wonder: Why set up U.S. through this theme chase? And why Don River't High blood line sugars also factor into this decision-making?

On the moment point, information technology's not as if high blood sugars aren't without dangers, from DKA to high risk of long-term complications that are more than more pricy to the healthcare system, and your insurance policy.

And information technology's non as if thither aren't studies screening that CGM reduces costs in diabetes care over clock time, not to mention the reduction in hospitalizations and emergency care associated to hypoglycaemia.

CGM reportage matters, and IT's faulty logical system to induce us display severe and continual Devalued symptoms just to get covered for this technology.

Sure, I understand you want to make sure that money isn't being wasted on expensive applied science that may turn unfashionable to be unnecessary OR new. I cotton on.

But in so some cases like mine, the touch on and patient have already determined this tool is necessary. The clinical judgement you use in approval or denying reportage only doesn't make sense — either medically OR economically.

Reluctantly, I will follow your rules and demonstrate my pauperization for this.

This isn't the 80s or the 90s, so it's non as promiscuous to "lie" about glucose data anymore. Gone are the days of just writing in fake numbers game to propitiate the doctor. Now, we have devices that can be downloaded — and my endo has told Maine specifically that insurers are more frequently interrogative for actual downloaded information before approving medical claims.

This forces me to demonstrate that Lows are part of my aliveness with diabetes… even if they aren't as regular as they once were before my CGM. I find that instead of staying safe and treating my hypos immediately, I'll let them linger for a bit — retributory long enough for my CGM and fingersticks to reverberate those "Below 55" numbers. How distressing is that?!

That severe Low last night around midnight was just one example. It was probably due to an inaccurate carb consider and insulin dose from my higher protein dinner earlier that eventide. My blood sugar plummeted to 48 accordant to my CGM, and I took a meter fingerstick to rearmost rising my dip below 55 atomic number 12/dL.

I felt rimy to the bone, the sort of cool you get when you ingest the flu and just fanny't do anything to excitable heavenward. My vision was blurry, and my legs were faint when I tried to stand. Thus, I just sat patiently.

Just just about the time my cognitive abilities started to obscure and my BGs were in the notwithstandin in the low 40s, I caved and guzzled an orange juice — along with cookies and a few glucose tabs.

Right now, it's mid-morning along a weekday. I am alone because my wife works outdoors our house and I knead remotely from our nursing home office. I john see my CGM veer arrow leaving down, and know that shiver is forthcoming again…

I've had my share of nasty hypo experiences during my 3+ decades of living with type 1 — moments when I couldn't walk, operating theatre think, or function. When I hallucinated and screamed at my parents and my married woman, thinking they were aliens or golem overlords difficult to hurt me.

Geezerhood ago, I experienced a low when dynamical my car. I was lucky then that I didn't expire, and that motivated me to get a CGM. Even with this added security, I still get frightened about hypos.

Because I am not ready to go. I am 37 years old, and there is a lot I've not sooner or later accomplished in my living. This International Relations and Security Network't my time.

I know that I am favorable to have had access to a CGM, to helper Pine Tree State avoid the worst. And it's so Offensive to think that the only if way I potty keep this tool is by demonstrating that it's essentially NOT helping Pine Tree State, and that I'm doing poorly. WTF?

My care is also for the many others who meet similar insurance denials, but may not bon adequate to file an appeal and contend the insurance policy company. They end up yielding the possibility of having a CGM, and living in the dark like all PWDs had to in the "unsound old days."

Both Crataegus laevigata not ever wake up from a nighttime low, while others will go sharp and end up in the hospital for high blood sugars and long-full term complications.

Why make it so very difficult for patients to take reward of these powerful new treatment tools?

And this proceeds actually extends beyond CGM coverage — into the high costs the industry charges for insulin that keeps us enlivened, the stigmatise of meters we neediness to use and plane how many test strips we need regularly. All of this overlaps as a big roadblock to optimal diabetes care in the U.S. To say information technology's a shame is an understatement.

This is why I am scared, Puritanic Like Net. Because I do not want to die before my time, or experience complications that could be avoided, and because I'm not unique in this. What truly horrifies Maine is that although I know there are world behind this summons of decision-fashioning, it seems these big organizations (insurance and diligence) are and so driven by profit that they'd rather let patients be exposed to these life-endangering symptoms than do what they can to help the States stay vital and healthy.

I like to think I have a say in staying alive and healthy, but as an individual patient, I'm often non sure enough that's really the case.

* UPDATE 3/18/16 *

One week after writing this letter and sending it to my policy companionship, along with phone calls to their executive offices, I conventional a call notifying ME that my request for pre-authorization along CGM sensors had been authorized. Neither I nor my doctor had withal filed an appeal. The HMO supervisor who phoned me told Maine she'd received a call out to consider my file. And it was apparently her who set that, because I'd already been victimisation CGM sensors for years, they did non necessitate the "typical" data because what I had on charge was good enough. My pre-auth is now right for the next year for when ordering CGM sensors. Thank you, social media!