I'm Not Diabetic Enough

I have type 2 diabetes. I was diagnosed some time ago, but it’s progressed to the point where I am insulin dependent. This is not the same as type 1 diabetes,though. Right now, I only take a basal insulin. I’m at 25 units per day of Tresiba.

This is not the first insulin I was put on.

Previously, I took a basal insulin called Basaglar. I had a pretty severe problem with it, though. Each dose, which I worked up to 35 units per day through titration, was fairly inconsistent. What I could reliably predict was most doses per pen would have limited efficacy, but at least one dose per pen would cause a significant blood glucose crash. It was as though the fluid wasn’t mixed well and there was a pocket of extra insulin in the fluid, causing the rest to be lacking.

I was able to track this thanks to my doctor prescribing Dexcom G6 for me. In fact, I credit it for saving my life by sounding alarms as my sugar crashed below 50 during some hypo events. I take my insulin in the evening so I was usually asleep when the alarms sounded. Would I have woken up in time to do something about it without an alarm? These are events that can result in hospitalization, and up to and including death.

Using a Dexcom has changed the way I manage my health. It’s so easy to see how my food affects me. I’m working on pretty intense dietary changes right now which requires me to make further adjustments to my insulin dose, so far having taken it down from 30 units to 25, and I’m anticipating more reduction. I forget I’m even wearing it, and it’s been integrated not only into my life where I check an app to see how things are going instead of poking holes in my fingers several times a day. I can get a really good idea of what my hba1c should be when it comes time for one of my regular visits to my doctor.

Cigna, my current insurance provider, rejected my coverage of Dexcom G6.

I had to wait for their rejection letter to get the reason why. It boils down to not being diabetic enough.

Based on the information provided, I am unable to approve coverage for this medication because:

Records do not show that you are using one of the following insulin treatment plans: 1. long-acting insulin (this type gives a slow steady release that helps control your blood sugar between meals and overnight) with mealtime insulin (given just before you eat to control blood sugar highs); or 2. more than 1 shot a day of U-500 insulin; or 3. an insulin pump.

Tresiba is a U-100 basal insulin and I take it once per day. I do not take a bolus or short acting/mealtime insulin. I do not use an insulin pump.

Cigna acknowledges that Dexcom G6 is used by both type 1 and type 2 diabetics.

Dexcom G6 sensor, receiver, and transmitter are considered medically necessary for the management of type 1 or type 2 diabetes mellitus…

So, I’m not diabetic enough.

I want to reiterate that I credit this system for saving my life. I consider Basaglar to be a dangerous insulin system, and if it wasn’t for my Dexcom, it’s possible I would not have caught those problems. It’s possible I wouldn’t have caught the pattern that Basaglar was the source of trouble. I take a lower dose of Tresiba and only had low sugar days when my carbs were especially light.

There are other conginuous glucose monitor systems. Given the response from Cigna, there is no hope of an alternative being approved. All I can do is explore these options. I have about a month of supplies left, so I have about that long to figure out what’s next. I know this is going to make my dietary changes a bit more difficult.