Category: Insulin Pumping
Snap Decision
You grab a pack of gum at the checkout counter. It’s an impulse purchase and you don’t think about it. It’s a snap decision, made right then and there.
Choosing an insulin pump is anything but a snap decision. You research all of your options, talk with other people who wear pumps, weigh the pros and cons of each pump, and of course, find out if insurance will cover your pump and supplies.
In my case, my insulin pump choice was a snap decision. With a capital S.
The Asante Snap pump.
After my warranty expired on my previous pump (Of course, it was pining for the fjords five weeks later.) and an opportunity to try the next generation of that company’s pump, I recognized that I needed to do further investigating. I’d only worn two brands of insulin pumps in the over 15 years of pumping. I am still happy with the choices I made back then, but back then, I didn’t have a lot of choices.
I cheer the fact that we have more choices now when it comes to insulin pumps and continuous glucose monitoring devices. Each pump and CGM has its strengths and weaknesses, which of course, means that some people will choose them based on their own needs, wants, and desires.
Here’s why I chose the Asante Snap Insulin Pump.
I Am Ricardo Montalbán
You can’t “test drive” a piece of gum. You buy it and if that new flavor isn’t what you wanted, you throw it away or foist it off onto someone else. It’s gum, right? Costs a buck? Pshh. Get outta here.
But it’s rare (or in some cases, impossible) to test out an insulin pump. This device is going to be a part of your life for a hopefully good, happy, healthy long time. And it’s not cheap. You choose a pump based on what you think it will do for you, go through the hoops (and oh, are there big, flaming hoops!) to get approval from everyone involved, only to find that… you hate it. I know some individuals who have returned their insulin pumps before the “trial” period is over, but it’s a big, ugly hassle and insulin pump companies don’t make it easy.
Asante gets that you should be able to take a pump for a test drive. Feel the rich Corinthian leather seats. Determine if what you want is what you actually get. They offer everyone who is interested in trying the Asante Snap pump a four-week free trial, including supplies, training, and support. I got to sit in the driver’s seat and go for a long drive. I wish all pump companies would do the same.
No More Rebel Yell Time In Range!
The four-week free trial is one thing. It’s another thing entirely when you discover that by not changing a single basal rate or bolus factor, that your time in range with your blood sugar skyrockets. (And when I say skyrockets, I mean supersonic space age shiny skyrockets.) Having the luxury of a Dexcom CGM allows me to see how my blood sugars play nicely (or not nicely) during the day. I was doing a lot of Billy Idol hair spikes. Without changing my eating habits or dosing timing, I saw spikes turn into smoother lines and when I downloaded my Dexcom (Finally able to do it on my Mac!), I was shocked. 80% time in range (for me, range is 70 - 180, but I’m already tightening the higher end).
Less lows. Less highs. All of a sudden, I wasn’t exhausted at the end of the day, chasing the blood sugar dragon. My head was clearer. I had energy. I thought it was a fluke, but after almost 8 weeks on this pump, I’ve come to realize it’s two things: the Asante Snap pump algorithm and the pre filled glass cartridges making this happen. I can’t take any credit for better blood glucose levels.
Heart of Glass
The pre-filled glass cartridges not only help the insulin not degrade and lose potency as quickly as the plastic cartridges I once had to fill; it also cuts down on the time I used to fiddle around with pump set-up. Doesn’t seem like a big deal, right? It’s a big deal. You get that I’m a two-minute sort of woman when it comes to diabetes.
Instead of the elaborate ritual of drawing up the insulin into a plastic cartridge, checking for bubbles, filling the tubing, checking for bubbles, priming the pump, checking for bubbles, I drop the cartridge into the pump body and it auto primes. In two minutes, I can complete an insulin pump set up, including a new insertion set. All that extra time I have now? I can rock out.
(And I don’t have to hunt for a battery in the bottom of my purse. The battery for this pump is built into the pump body. You replace the pump body with the changing of the cartridge. Easy.)
I’m not the only one who thinks this is a good thing. I join Scott Johnson of Scott’s Diabetes, Melissa Lee of Sweetly Voiced and others who have switched from other pumps to Asante. Here’s what some people had to say about how easy it is…
The Little Things Add Up to Awesome
It’s the little things. A customizable color screen. A built in flashlight on the pump for those early morning BG checks. A missed bolus calculation if you stop your pump for a shower. (I never realized how much insulin I had missed even disconnecting for 20 minutes.) The ability to set alarms to NOT go off at 3am to wake you up to remind you to change your cartridge.
Some people prefer an integrated CGM and insulin pump. I tried it. I’ve come to realize that I’m a Dexcom chick, tried and true. The other pump company with an integrated system has not yet updated its algorithm for increased accuracy. Plus… here’s the thing: The Dexcom G5 screen will be accessible to view on my iPhone I won’t even need to look at my pump to see my CGM graph.
When I was at AADE last summer and saw a glimpse of the future with Asante Snap (I sat next to Wil and we got to ooh and ahh at the demonstration, they announced not only would they be partnering with Dexcom for future upgrades, but they were the first company hooked up with Tidepool. (And you know how much I love them!). And then they blew everyone’s socks off my demonstrating bolusing the Asante Snap from an iPhone. I’ve never had a remote bolus device. I am totally ready for this. And when it does happen, it won’t cost me an arm and a leg (or a pancreas) to upgrade, because upgrades are $99. Straight. No chaser.
I got to design my Snap. (Well, I got to have input. The Kid actually decided on the colors.)
No Pump is Perfect
No insulin pump is 100% perfect. (If it was, it would be called a pancreas and this blog wouldn’t exist.) I do miss the vibrating alarm option I had on my previous pump. I am a little jealous of other pumps that do have remote bolusing devices. I am a lot jealous of the current integrated pumps and CGM systems that work well. And I can’t upload my data at home; Asante currently uses the clinic version of Diasend.
I’ve talked with the management team at Asante. I’ve asked questions about their future models. They listen (and they even have a patient advisory board so they can get feedback). I see the Asante Snap becoming more perfect soon.
Time. In. Range.
Oh… that time in range. That blissful time in range that makes me feel more rested, less stressed, and looking forward to getting my A1C done. That makes it all worth while.
My new time in range makes my diabetes management easier and less about diabetes and more about me.
Best Snap decision I’ve ever made.
I talked to Asante so much and gushed about how much this pump has improved my life that I’ve agreed to enter into a consulting agreement with Asante Solutions to write about my experiences pumping on their website. Please check the updated About page for disclosures. Remember: My thoughts are my own. No one can make me write what I don’t feel or believe in on this blog. In fact, I get zero compensation for this - or any - blog posts on this blog. This is MY blog. MY words. MY thoughts. You get to read the uncensored version - always.
How Much Do Diabetes Supplies/Medications Cost in The U.S.?
While everyone’s diabetes treatment plan, medications, and technology may be different, there is one thing we can all agree on: diabetes is expensive. In two previous posts at The Perfect D, I gave some sense of what the bare minimum of care for a U.S. adult with Type 1 diabetes would be and also financial resources and programs to help with the financial burden of living with diabetes.
However, this post is about how much it could cost an adult with Type 1 diabetes if they used the technology and medications that are currently out on the market (and thought of as “the latest and greatest”) and paid out of pocket with no insurance. Research on this topic has shown me that: 1) prices can fluctuate wildly, so it pays to shop around and 2) there is a very big gap (financially, medically, and technologically) between the bare minimum and “surviving” and actually utilizing the tools and latest technology that is out there.
So, the hypothetical person for this exercise is a Type 1 adult in the United States who weighs 60kg, just like the other calculation post I did.
Ground Rules
- These prices are accurate on the websites I have referenced for December 1, 2014. They may change, they may add shipping, they may not offer the services, technology, or drugs on their website after this is posted. These prices are not a guarantee. They are to be used as a reference.
- The listing of prices/websites on this post does not mean that I endorse the company or product or service.
- I have not listed all the products available on the market for people with Type 1 diabetes. I have listed major ones to give you an idea of major manufacturers’ costs for the products that are available for general public viewing.
- I did not call any companies and ask for pricing. Why? Because I believe that we, the diabetes community, should be able to really know how much something costs without having to go through hoops and customer service/sales representatives. Device prices should be listed on a company’s website, knowing that insurance pricing will be different. (We should be able to know how much a drug would cost without insurance, too.)
- Some of the items are only dispensed with a prescription.
- Yes, I know that some people with Type 1 do not use an insulin pump. In fact, only 30% of Type 1s use a pump for insulin delivery. Some are happy and do well with MDIs/pen needles. The cost of pen needles are comparable to using a syringe, so you can refer to this post if you want to do your own calculations. As I say, my blog, my words…
- I used averages. That means that some pump therapies may cost more or less than the average.
Insulin
If you take a total of 30 units per day (hey, adjust for more or less, this is a hypothetical Type 1 adult weighing 60kg), you will take about 900 units per month. You might be able to get by on one vial a month, but this doesn’t factor in correction boluses that might need to be raged to bring down a high blood sugar or a heavy carb meal. So…. two vials per month. If you’re on a pump, it’s two vials of fast acting. (Don’t forget that you’ll need that back up prescription for long-acting insulin if your pump malfunctions…)
Fast-acting:
Apidra vial 10ml = $177.59
Humalog vial 10ml = $217.45
Novolog vial 10ml = $210.49
Average cost per month (insulin pump): $403.68
Average cost per year (insulin pump): $4,844.16
Average cost per month (MDI): $201.84
Average cost per year (MDI): $2,422.08
Basal/long-acting:
If you aren’t on an insulin pump, T1s must use a long-acting insulin in conjunction with their fast acting. This hypothetical (hopefully not hypoglycemic) T1 would use one vial of fast-acting and one vial of long-acting insulin per month.
Lantus vial 10ml = $284.39
Levemir vial 10ml = $216.69
Average cost per month (MDI): $250.54
Average cost per year (MDI): $3,006.48
(So, for those of you keeping a tally for comparison, the total cost per year for insulin using a pump is $4,844.16 and for MDI, it’s $5,428.56.)
Insulin Pumps
This is an early version of an insulin pump. You’d never get a button error with this. Dials!
You know that some of these prices may not be the price you actually pay if you have no insurance. You call the manufacturer and explain that you will be paying out of pocket and ask what the “cash pay price” would be and if they have a financing program. (Some companies offer this; others do not.) But these prices are what’s shown on websites where you can purchase them….so ta-da.)
Most pumps are under warranty for four years. Some have upgrade programs. Others have a “trade your old pump from another company and we’ll give you a discount…) Do your homework before committing to a pump. Please. Some will let you test drive. Others have a return in 30 days policy.
Minimed Paradigm Real-Time Revel 723 Pump = $5655.99
t:Slim Insulin Pump = $5720.00
Omnipod = $800 for the PDM, which is the brains of the pod. The pods are extra. ($337.00 per 10 pod box and 12 boxes needed annually) = $4844.00
Animas Ping = $4977.29
Accu-Chek Spirit Pump = $4,751.07
(I would have added the Asante Snap, but there are no places online to get an actual price. I got estimates from blogs and news outlets that say $700ish, but without a definitive click, I can’t in good faith include it.)
Cartridges
Got pumps? Then you need cartridges. Can’t have one without the other (except if you’re talking the Omnipod, because the pods act as the cartridge and the insertion set.). Cartridges (or reservoirs, if you are Medtronic) are needed to hold that expensive insulin you purchased.
Omnipod = $0.00 because the pod acts as cartridge and insertion set. See below.
T:Slim Insulin Pump Cartridge - 3ml - Box of 10- 10/bx = $46.19
Animas 2ml Cartridge 1200 Pump - 10 Bx = $45.79
Accu-Chek Disetronic Spirit 3.15mL Plastic Cartridge System - Box of 5 = $24.30
Medtronic
- Minimed Paradigm Reservoir 1.8ml - 10 Bx = $38.00
- Minimed Paradigm Reservoir 3ml - 10 Bx = $36.39
- Insertion device for your Medtronic infusion sets = $26.20
- Serter devices for your Medtronic sensors = $25.00/$14.70 (depending on the type of sensor you use)
Some people change their cartridges once per week, while others change every three days. So, you could use 4 per month or 10 per month.
Average Total Cost per month: $41.39
Average Total cost per year (9 boxes): $372.51
Average Total cost per year (12 boxes): $496.68
Insertion Sets
Those pumps and cartridges aren’t enough to get the insulin into your body. You need insertion sets (again, unless you use Omnipod, which are tubeless and incorporate the cannula directly into the pod).
Most people change their insertion set every 3 days. (You should. I don’t judge. Some people change it more frequently, due to inflammatory reactions or the dreaded occlusion.) So, you’ll go through one box per month… if not more.
Most people have a preference of the type of insertion type/tubing length they use. 90º or 30/45º angles, short tubing or long tubing, 9 or 6 mm cannula, metal or plastic… so I’m giving you a few choices. And again, it pays to shop around. Sometimes the manufacturer of the pump is not the cheapest place to get supplies (which confuses me to no end…).
Reference: Omnipod pods (10/box)= $337.00
Inset Infusion Set 23″ 9mm (10/box) = $95.77
Cleo 90 Infusion Set 24″ (60cm)/6mm 10/bx = $112.99
Comfort Infusion Set - Can be used with t:slim, Animas (Box of 10) = $105.99
Accu-Chek Disetronic Rapid D Infusion Sets - 6mm Cannula and 24″ (60cm) Tubing - 15/bx = $94.39
Medtronic
Quick-set 9mm Cannula / 43″ Tubing (10/box) = $136.70
mio 9mm Cannula / 32″ Tubing CLEAR (10/box) = $151.00
Silhouette 17mm Cannula / 43″ Tubing (10/box) /cannula only = $121.19/$117.30
Sure-T 29g 10mm Needle / 32″ Tubing (10/box) = $94.60
Average Total Cost per month: $101.60
Average Total cost per year : $1219.20
Continuous Glucose Monitor (CGM) & Supplies
Dexcom
Dexcom Platinum G4 Sensors (4/pk) = $349.00
Dexcom Platinum G4 Transmitter = $599.00
Dexcom Platinum G4 Receiver = $599.00
(Remember that you need all three of these items to get your Dexcom to work properly. Start up can be expensive. In addition, the new Dexcom transmitter warranty is only good for 6 months and you will most likely need to purchase two each year.)
Initial/Replacement Cost of Transmitter & Receiver:$1797.00
Cost per month for sensors: $349.00
Total cost per year for sensors: $4188.00
Total Annual Dexcom cost: $5985.00
Dexcom Share Cradle w/ Free Service = $299.00
(This is an add-on device that caregivers/loved ones can use to view the graph/numbers on the receiver in another room.)
Medtronic
The Medtronic insulin pumps use integrated technology on their Revel and 530G to show the continuous glucose monitor graphs/numbers, so you don’t need a “receiver” if you are using these pumps. You can purchase a receiver to use the Sof-Sensor sensors, but… why? (And I couldn’t find a place to purchase with a price on a stand-alone Medtronic receiver.) The sensors cost are per month, as the Enlites last longer than the Sof-sensors.
Enlite® Sensor (5 pack) - used with the Medtronic 530G pump only = $473.00
Total cost per month: $473.00
Total cost per year: $5676.00
Sof-sensor® Glucose Sensors (10 pack) = $439.00
Total cost per month: $439.00
Total cost per year: $5268.00
mySentry Outpost (this allows you to see data from the Medtronic pump/sensor in another room) = $500.00
Blood Glucose Monitors/Test Strips
According to the ADA, for Type 1s, self-monitoring of blood glucose (SMBG) is key to diabetes management. They recommend 6 – 8 times per day as a minimum of blood glucose testing. When you read the Standard of Care document, they state:
“…prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normal glycemic, and prior to critical tasks such as driving.”
8x/day minimum = 240 strips per month minimum, so 250 (because that’s easy to purchase in boxes of 50). So, that’s what we are going with, although I know that some people with diabetes use more - and less - than that. We are not going with the bare minimum.
Here’s where it pays to shop around…
Wal-Mart is NOT always the least expensive when it comes to purchasing blood glucose monitors and blood glucose test strips - not by a long shot. Of course, prices always vary given the day, the website, the weather…. you get the drift. SHOP AROUND. (Click the link to be forwarded directly to the website that had the price listed.)
And don’t forget that there are certain meter companies that have “special savings programs“, even for those who have insurance!
Accu-Chek
Accu-Chek Aviva Plus Glucose Meter Kit = $9.97 or FREE.
(Remember, if you use the subscription based Accu-Chek To Program, you get a Aviva Plus Meter for free with your first shipment.)
Accu-Chek Aviva PLUS Test Strips - 50ct = $30.29
Cost per month without Accu-Chek To program: $151.45
Cot per year without Accu-Chek To program: $1817.40
Cost per month with Accu-Chek To Program + regular purchase: $131.77
Cost per year with Accu-Chek To Program + regular purchase: $1581.24
(Remember, if you use the subscription based Accu-Chek To Program, you can purchase 50ct Accu-Check Aviva Plus Test strips for $20.00 and 100ct. for $40.00 per month.)
Accu-Chek Nano Glucose Meter = $5.07 of FREE
(Remember, if you use the subscription based Accu-Chek To Program, you get a Aviva Nano for free with your first shipment.)
Accu-Chek Smartview Test Strips - 50ct = $27.77
(Remember, if you use the subscription based Accu-Chek To Program, you can purchase 50ct Accu-Check Aviva Smartview Test strips for $20.00 and 100ct. for $40.00 per month.)
Cost per month without Accu-Chek To program: $138.85
Cot per year without Accu-Chek To program: $1666.20
Cost per month with Accu-Chek To Program + regular purchase: $123.31
Cost per year with Accu-Chek To Program + regular purchase: $1479.72
Abbott FreeStyle
FreeStyle Lite Glucose Meter/ FreeStyle Freedom Lite Glucose Meter = $10.09
Abbott FreeStyle Lite Test Strips - 50 ct. = $46.99
Total cost per month: $234.95
Total cost per year: $2819.40
Bayer
Free Bayer Contour Next Meter - shipped by Bayer to you. $0.00
Free bayer Contour Next USB Meter - shipped by Bayer to you. $0.00
Contour Next Link Blood Glucose Meter = $89.00
Wireless communication to Medtronic devices enables fast and easy bolus dosing and continuous glucose monitoring calibration
• Built-in USB cable has pass-through feature to allows for easy downloading to Medtronic’s convenient online CareLink® Personal software
(Bayer Contour Next Test Strips (box of 50 strips on Medtronic’s website) = $52.00 BUT THIS IS WHY YOU SHOP AROUND…)
Bayer Contour Next Test Strips - 50ct = $19.09
Total cost per month: $99.95
Total cost per year: $1199.40
LifeScan OneTouch
OneTouch Ultra 2 Glucose Meter Kit = $19.88
OneTouch Ultra Mini Glucose Meter Kit = $17.63
One Touch Ultra Blue Glucose Test Strips - 50 ct. = $74.99
Total cost per month: $374.95
Total cost per year: $4499.40
OneTouch Verio IQ Glucose Meter Kit = $29.99
OneTouch Verio Sync System Kit = $29.99
OneTouch Verio IQ Gold Test Strips - 50ct = $90.89
Total cost per month: $454.45
Total cost per year: $5453.40
But We Aren’t Done Yet
If you’re on an intensive management plan, then you’re strongly encouraged to have a glucagon kit available in case you have a severe hypoglycemic reaction. This item isn’t cheap.
Glucagon Kit = $213.69
Some people with diabetes on intensive management plans (those who are on pumps, microbolusing with flex pens, and/or CGMs are considered intensive management therapies) often see an endocrinologist and other specialists. You might need to include these in your team:
- Endocrinologist/CDE
- Cardiologist
- Podiatrist
- Nephrologist
- Neurologist
- Ophthalmologist/Retinal Specialist
- Orthopedic specialist/surgeons
These specialist costs are higher than just seeing a regular general practitioner. Some by hundreds of dollars. The tests that may be prescribed can cost thousands of dollars out of pocket (say the word “nuclear stress test” and shudder when they tell you what it costs).
For reference, I see a retinal specialist for a dilated eye exam follow up every six months: $335.00 without insurance. My annual cardiologist visit is $430.00 without insurance for the (literally) five minutes I talk with him, including the pleasantries. One orthopedic surgeon office visit was $295 while the second opinion office visit with another surgeon was $180. As with everything else, shopping around if you have no insurance, especially when it’s diabetes related, is necessary.
Then there are the additional medications that might be needed: statins, blood pressure medications, medications for neuropathy, kidney disease, etc. These are too numerous to mention (and quantify), but you know that these are additional costs. Most people with diabetes wouldn’t be taking these medications if they didn’t have diabetes.
In a previous post, I mentioned the costs for treating mild hypoglycemia, for lancets and alcohol swabs, for the little things that all add up. The purchase of a juice/glucose-heavy item at a convenience store because you are low is a cost, but rarely factored in. Parking at hospitals for appointments. Tolls. Wear and tear on a vehicle as you travel to see various physicians to stay healthy. Batteries for the gear that isn’t rechargeable.
So, if you are truly calculating the costs of the latest supplies, technology, and treatments, there are items that you don’t even think about… the small ticket items that leech money from your pockets. They can add hundreds of dollars to the existing cost.
Let’s do some math.
If I am a T1 adult with no insurance who uses Humalog in a new Animas pump and a new CGM Dexcom, checking my blood glucose with a One Touch Verio IQ meter, it could be:
$23,348.47
If you have already purchased a pump and a Dexcom, the out of pocket costs would be:
$16,574.18
If I am a T1 adult with no insurance who uses Apidra in a new Omnipod and a new CGM Dexcom, checking my blood glucose with an Accu-Check Nano meter, it could be:
$14,439.80
If you have already purchased a pump and a Dexcom, the out of pocket costs would be:
$11,842.80
If I am a T1 adult with no insurance who uses Novolog in a new Medtronic (not 530G) pump and Sof-Sensor CGM, checking my blood glucose with a Bayer Next meter, it could be:
$16,917.27
(The price would be greater with the 530G pump and the Enlite CGM sensors.)
If you have already purchased a Medtronic pump with CGM integration, the out of pocket costs would be:
$11,261.28
That’s not counting the physicians (multiple visits), the labs, the other tests that you might need, the glucagon, the back up long-acting insulin, the small items, etc.
That’s just for the technology, supplies, and insulin analog.
Are You Getting What I’m Saying Here?
Without insurance, it is unlikely that you have thousands of dollars under a mattress for this type of intensive management. Even with insurance, many of these items can be cost-prohibitive, with deductibles to be met each year and percentages paid out each month to durable medical equipment companies and pharmacies.
This is not meant to shame medical device manufacturers and pharmaceutical companies. I’ve said before that they are not charities; they’re businesses and they can choose to set their prices and work with insurance companies for discounting.
Who loses in this scenario are those who want the technology but do not have an insurance company adept at bargaining or adept at meeting customer (that’s the subscriber) needs. Or those who don’t have insurance at all and fall into the gap of making too much to qualify for assistance programs but not enough to pay out of pocket for these items.
When someone asks a person with diabetes if it’s a hard disease to live with, they’re often asking about the physical aspects of the disease. Very few people outside of the community understand the financial burden many families face if they want what is the BEST technology and treatment for the person with diabetes.
Until there is a cure (be it biological or otherwise), this is the financial cost of living well with diabetes. Insurance companies can blunt some of the cost through their collective bargaining agreements, but we are still paying through premiums and deductibles and, in some scenarios, an inability to choose the medications or technology that they want, because of contracts.
There is no grand “THE END” to this post. For many people with diabetes, this is the reckoning that we do in our heads, wondering if we spend less now, will we pay more later? The answer is almost always… yes, but if we cannot even afford what the best treatments for diabetes on the market, how can we live long enough to get to that “later“?
I have no solutions. This is more of an academic exercise to see if what the statistics touted by the government on how much a person with diabetes pays for care was correct. It’s not.
People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. - NIH
We pay much more if we want excellent care. What can be done? Beyond a cure? I don’t know. Do you?
Where I’m At With This…
It’s been almost two months since I began the trial with the Medtronic MiniMed 530G System with Enlite. I’d like to tell you where I’m at with this…
Truth?
I don’t know where I’m at with this.
The Medtronic customer service is phenomenal. Mostly phenomenal.* The Medtronic trainer has followed up with me and checked out my Carelink updates, giving me suggestions to improve my experience. The StartRight representative has been helpful.
My graphs and reports are, frankly, abysmal. My weight is up three pounds (and as an individual with food/weight issues, you know that doesn’t make me happy) and my A1C rose 0.2%, which may not be much, but I wanted it to go in the other direction. My CDE’s comment to me when she walked into my appointment was: “What is going on? These can’t be your numbers!”
Threshold Suspend
Here’s the thing I like about the Medtronic MiniMed 530G system with Enlite: Threshold Suspend. It does work.
Except when it doesn’t for me.
There have been nights that the Threshold Suspend feature is activated. My blood sugar is 104 mg/dl when I check. I shut off the suspension and restart my basal. It alarms again. By this time, I’m up, out of bed, trying not to wake John, and angry that the pump is waking me up for no reason.
Twice in the past month, it has legitimately suspended and I’ve treated, thankful that it woke me. I’ve yet to sleep through an alarm. (Man, that alarm is loud.)
But I’m finding, for me, that the noise from the alarms compete with the noise in my head over my blood sugars. I’m questioning constantly whether the numbers I see on my MiniMed 530G insulin pump are accurate. When they are, I breathe a sigh of relief. When they’re not, I breathe a sigh of frustration.
That’s a lot of sighs.
I love my Medtronic MiniMed Revel. I’ve said that before. Medtronic has been very responsive with every issue I’ve had with the Medtronic 530G with Enlite system. (The CareLink issue? That’s another story. Quick side note: I’m hearing from others that I’m not alone in my frustration with CareLink.)
My goal with diabetes management is to keep blood glucose levels within my prescribed range while minimizing the intrusion of diabetes into my daily life. (It’s a Hurculean task some days, but others…) The technology I choose to use is meant to help minimize the intrusion.
The Medtronic 530G with Enlite is designed to help minimize the severe hypoglycemic episodes with Threshold Suspend - and it does when the accuracy of the Enlite sensor is working correctly. I’ve had meter readings of 45 and my Enlite sensor is telling my 530G pump that I’m 82 (and the arrow is not trending down). I’ve had meter readings of 64 and my Enlite sensor is telling my 530G that I’m 64.
It’s Me. But is it?
The rise in my A1C is because I’m over treating when I go low. I know this now. I didn’t over treat quite as frequently before I began the trial, because I could see the fall easily on the CGM transmitter of my Dexcom. It’s not as easy to see that on the screen of the 530G pump.
I’ve had to turn off the predictor high and low alarms and the high and low range limit alarms for my sanity. That, for me, lessens the ability of this technology to minimize the intrusion of diabetes into my daily life.
Others are not having these issues and perhaps it’s because their diabetes management is better controlled or their own diabetes is not marred by delayed gastric emptying or quirky days. I’m still not giving up on getting this MiniMed 530G with Enlite system to work for me.
Anyone have suggestions?
*The customer service issue I had? I called in on a weekend to get a few sensors replaced due to sensor errors. I spoke with technical support, who made some less than supportive remarks regarding how I was trained by my trainer. Not cool.
I was also told that when the pump tells me to “BG NOW” to calibrate, I should wait 10 minutes if I’m not stable… which to me says that the pump shouldn’t say “BG NOW”… and if you’re not trained properly or don’t know better, your readings are going to be inaccurate. But when you get a BG NOW for the first time during the wetting period, after two hours, if your blood sugars are fluctuating slightly up or down, how are you to know? These questions have me up at night…
Need Help With U.S. Diabetes Supplies and Medications?
For anyone who has diabetes, the cost of staying alive is expensive.
This is a current list of currently available programs, co-pay cards, organizations and manufacturers that may help, and the requirements to participate in the programs.
Why did I create this?
Every other “diabetes financial assistance/resource” page that I would visit would give you a link to supposed help - but you had to dig deep to find out if there were exclusions or restrictions. Some of the resource pages had links that no longer exist. Others had a single page that said: “We no longer offer a program.” (And I’m talking major diabetes organizations and manufacturers… they’re not keeping their own pages up to date…)
This page will give you the restrictions/exclusions I’ve found and the contact information and site to get yourself started if you qualify. (And in some cases, all of us will qualify!)
These links are up to date and I will be adding additional resources as they are made available. (If you have links or resources, please list them in the comment section and if they’re legitimate, I’ll add them.)
Right now, you’ll see a glaring absence of blood glucose monitoring supplies. Every link I researched ended with a dead end. Roche/Accu-Chek does offer a free Aviva or Nano meter on their site, but there are no programs currently offered for free/discounted strips. If this changes, I’ll let you know. (And not five minutes after posting this, Megan helped our community by giving us our first program for test strips/meters. That’s what community is all about!)
Hope this helps you.
Share it if you please - no one should be “sick” with diabetes from a lack of medication or supplies - let’s help each other by getting the word out.
Diabetes Medications & Needles
Eli Lilly
Eli Lilly offers Humalog, Humalin, and Humalog Mix under the Lilly Cares program.
- You must be a U.S. resident.
- You must not have prescription coverage.
- You must meet the household guidelines:
Household Income Guidelines:
- The total number of people in the household includes yourself and each of your dependents.
- Total yearly income includes incomes from all earners in your household before taxes and deductions.
- To qualify, your total yearly income cannot exceed the values listed below.
| Number of People in Your Home | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Total Yearly Income (48 Contiguous States and DC) |
$36,000 | $48,000 | $60,000 | $72,000 | $84,000 | $96,000 | $109,000 | $121,000 |
| Alaska | $44,000 | $59,000 | $75,000 | $90,000 | $105,000 | $120,000 | $136,000 | $151,000 |
| Hawaii | $41,000 | $55,000 | $69,000 | $83,000 | $97,000 | $111,000 | $125,000 | $139,000 |
For additional information about Lilly Cares, call at 1-800-545-6962.
*A 120-day supply of medicine will be shipped to your health care provider’s office. Prescription refills will be available during your 1-year enrollment period.
GlaxoSmithKline
Avandia may be available at a reduced cost or for free. Unfortunately, the qualifications are not listed. You must call 1-866-GSK-FOR-U (1-866-475-3678).
NovoNordisk
Novo Nordisk Patient Assistance Program (PAP) provides free medicine (to those who qualify), including: Levemir, Novolog, Novolog Mix 70/30, Novolin, GlucaGen Hypo Kit, Victoza, and disposable needles for FlexPens and Victoza.
The application for Novo Nordisk’s medication assistance program is downloadable here.
- There are several limitations to this program. Review the application for all the restrictions.
- You must be a U.S. citizen.
- Patients must have a household income less than 200% of federal poverty level.
You can get more information by calling the Novo Nordisk Patient Assistance Program toll free at 866-310-7549.
If approved, a free 120-day supply of medicine will be sent to the prescribing health care providers’ office to be picked up at the patient’s convenience. Novo Nordisk will automatically contact the health care provider 90 days later to approve the medication reorder.
Merck Helps
Merck offers a prescription assistance program for Januvia.
- You do not have to be a US citizen. Legal residents of the United States, including US Territories, are also eligible.
- Your prescription for a Merck medicine from a health care provider licensed in the United States.*
- You do not have insurance or other coverage for your prescription medicine. Some examples of other insurance coverage include private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, veterans assistance, or any other social service agency support.
- You may qualify for the program if you have a household income of $46,680 or less for individuals, $62,920 or less for couples, or $95,400 or less for a family of 4.
The application for this program must be downloaded, filled out, and brought to your medical provider. Click here for the Merck Helps application. (It is also available in Spanish.)
If you don’t meet the criteria, you can also try and use the “Januvia copay assistance coupon”.
Januvia’s coupon is for “as little as $5 per prescription” for up to 12 months. Here’s the information on the restrictions and what you’d need to do.
Pfizer
If you use Glucotrol, Pfizer offers a discount card for individuals who have NO prescription coverage. You’ll need to call 866-706-2400 to apply.
- You must be prescribed a Pfizer medicine available at a savings.
- Have no prescription coverage.
- Live in the United States, Puerto Rico, or the U.S. Virgin Islands
They also offer free medication for uninsured individuals through some clinics and hospitals. You can see if there is one located near you by entering your zip code at this website.
Sanofi- Apidra
Those who take Apidra can use the Apidra® No Co-Pay Savings Program with their Apidra® prescription payments. Activate your card by checking this box and you can get No Co-Pay* on Apidra®. If you’re registering someone under the age of 18, please call 855-242-6938.
- The card is not valid for prescriptions purchased under Medicaid, Medicare, or similar federal, state, or other government funded benefit programs.
- Only patients who reside in the United States or Puerto Rico can participate in this program.
- All commercially insured patients are eligible, even those with insurance that places Apidra® on the 3rd tier.
- Cash-paying patients are also eligible for a benefit of up to $100 off per prescription.
Sanofi - Lantus
Sanofi offers a discount card for those who use Lantus SoloStar - pay no more than $25 for up to 3 prescriptions. (Maximum $100 benefit off of each prescription, for up to $300 for three prescriptions.)
- The card is not valid for prescriptions purchased under Medicaid, Medicare, or similar federal, state, or other government funded benefit programs.
- Only patients who reside in the United States or Puerto Rico can participate in this program.
- All commercially insured patients are eligible.
Patient Access Network Foundation
The Patient Access Network (PAN) Foundation, an independent, national 501 (c)(3) organization dedicated to providing underinsured patients with co-payment assistance through more than 60 disease-specific programs that give them access to the treatments they need.
Diabetic Foot Ulcers
Eligibility Criteria
- Patient should be insured and insurance must cover the medication for which patient seeks assistance.
- The medication must treat the disease directly.
- Patient must reside and receive treatment in the United States.
- Patient’s income must fall below 400% of the Federal Poverty Level. (Here’s the handy chart showing you what that is based on how many people are in your household.)
Diabetic Macular Edema
Eligibility Criteria
- Patient should be insured and insurance must cover the medication for which patient seeks assistance.
- The medication must fight the disease directly.
- Patient must reside and receive treatment in the United States.
- Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)
Kidney Transplant Immunosuppressants
Eligibility Criteria
- Patient should be insured and insurance must cover the medication for which patient seeks assistance.
- The medication must fight the disease directly.
- Patient must reside and receive treatment in the United States.
- Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)
Solid Organ Transplant Immunosuppressant Therapy
This will cover pancreas transplants and kidney-pancreas transplants.
Eligibility Criteria
- Patient should be insured and insurance must cover the medication for which patient seeks assistance.
- The medication must treat the disease directly.
- Patient must reside and receive treatment in the United States.
- Patient’s income must fall below 400% of the Federal Poverty Level. (Here’s the handy chart showing you what that is based on how many people are in your household.)
Retinal Vein Occlusion (RVO)
From the Patient Access Network Foundation website:
Central and branch retinal vein occulusions (RVO) happen when the vein at the back of the eye is blocked. This blockage causes pressure build and some of the small blood vessels in the eye may burst and cause fluid to leak into the retina. If untreated the vessels may be able to repair themselves and bypass the blockage but there may be permanent damage to the retina resulting in vision loss.
Eligibility Criteria
- Patient should be insured and insurance must cover the medication for which patient seeks assistance.
- The medication must fight the disease directly.
- Patient must reside and receive treatment in the United States.
- Patient’s income must fall below 500% of the Federal Poverty Level. (You can use the chart and do the calculations for 500%. For instance, if you are a household of one, you qualify if you earn less than $48,350 gross income annually. For a household of three, you qualify if the household earns less than $98,950.)
Healthwell Foundation
For children under eighteen years of age
HealthWell Pediatric Assistance Fund® assists children 18 years old or younger living with a chronic or life-altering condition that their families are struggling to treat due to cost. They provide financial assistance to families so their children can start or continue critical medical treatments, including diabetes.
Families must meet HealthWell’s standard income and insurance eligibility criteria to qualify for a grant. Grants are awarded on a case by case basis. To apply for a grant, call 1-800-675-8416 anytime Monday through Friday, 9:00 a.m. to 5:00 p.m. (ET).
- You must have some form of health insurance (major medical or prescription drug) that covers part of the cost of your medication.
- Families with incomes up to 400 percent of the Federal Poverty Level may qualify. HealthWell also considers the cost of living in a particular city or state.
- If you appear to be eligible for assistance through the Pediatric Assistance Fund, additional information and documentation is required for review and consideration prior to grant approval. Once all information has been received and reviewed by the committee, grant determinations will be made.
- You will be asked to provide the Foundation with the patient’s diagnosis, which must be verified by a physician, nurse practitioner, or physician assistant’s signature. The patient must receive treatment in the United States.
Immunosuppressive Treatment for Solid Organ Transplant Recipients
HealthWell will pay for the following medications for immunosuppressive therapy:
Astagraf XL, Cellcept, Gengraf, Hecoria, Imuran, Myfortic, Neoral, Nulojix, Prograf, Rapamune, Sandimmune, and Zortress.
- You must have some form of health insurance (major medical or prescription drug) that covers part of the cost of your medication.
- Families with incomes up to 400 percent of the Federal Poverty Level may qualify. HealthWell also considers the cost of living in a particular city or state.
You can apply online for this medication grant here. or call 800-675-8416. Agents are available Monday–Friday 9am–5pm EST.
Insulin Pumps
Medtronic MiniMed
The Medtronic Financial Assistance Program offers help to those who:
- Use an insulin pump and/or continuous glucose monitoring
- Meet specific income guidelines
- Have an insurance company that allows for additional assistance
It also provides temporary coverage for specific situations:
- Unemployment within the last 12 months
- Gap in insurance coverage because of a pre-existing condition
- Multiple pumpers in one household
- Permanent disability
You’ll need to call Medtronic 1-800-646-4633 and select option 4 to get specific information.
Other pump companies offer self-funding payment programs. You should call them individually to find out the particulars. (The plans may change based on what you are looking for…)
*** If you have information regarding insulin pump programs, please contact me via email at theperfectd [at] gmail.com - you’ll be helping us all out!***
Equipment
Charles Ray III Diabetes Association
The CR3 Diabetes Association, Inc. is a 501(c)3 non-profit organization.
According to the website, the organization is currently accepting applications for insulin pumps, blood glucose meters, and blood glucose test strips. You must review the following criteria:
- You are uninsured
- You are under insured (which means that your yearly deductible is unattainable)
- Household income is less than $60,000
- Your physician has recommended insulin pump therapy for you
They will only accept online applications on their website. The link to the online application is here.
Supplies for CWD Foundation (For children aged 18 years and younger)
Supplies for CWD Foundation (SCWDF) is a branch of the Children with Diabetes Foundation, a non-profit 501(c)(3) organization, providing short-term (up to three months) diabetes supplies for children with type 1 diabetes who are in emergency situations. (An emergency situation may be defined as: loss of health insurance, loss of a parent’s job, or a local disaster, combined with the family having no other resources with which to purchase diabetes supplies.)
Diabetes supplies is defined as any of the following: blood glucose meter, blood glucose test strips, insulin, insulin pump supplies, blood or urine ketone strips, lancets, syringes, and glucose tablets.
Download and fill out this application after reviewing all the requirements on the website.
Blood Glucose Meters/Test Strips
Freestyle Promise Program - $15 copays and a free Abbott Freestyle meter.
- Co-pay assistance is not valid for prescriptions reimbursed under Medicare, Medicaid, or similar federal or state programs or in Massachusetts.
- Eligible patients are responsible for the first $15 of co-pay under their insurance coverage, and can receive up to a maximum of $50 in co-pay savings. Uninsured patients are also eligible for savings in most situations.
Contour Choice Program - For ContourNext test strips. Eligible patients pay the first $15 in co-pays each month. Insured patients can receive savings of up to $35 per month of co-pays using the Contour Choice Card.
Not valid for patients with prescription benefits covered by federal and/or state government programs (e.g. Medicare, Medicaid.)
Clinical Trials
Do not forget about participating in clinical trials, some of which provide monetary compensation in addition to supplies and medications at no cost. (Some also provide physician/medical visits!)
Please seriously consider participating in these trials - in some, you can get access to pumps or medications that would not be available to you due to cost - or FDA approval. And… you can help others (and yourself) through clinical trials.
Click here for a list of clinical trials for diabetes that are recruiting (general, which include both Type 1, Type 2, LADA, MODY, and gestational).
Any other sites/supplies/organizations/medication programs that might be helpful to others? Help us!
Diabetes & Personal Space
Different cultures have their own idea of “personal space”. I’ve lived in other countries and worked in companies where my own concept of “umm… you’re a little too close…” has been questioned. It’s a matter of how you were brought up and how comfortable you are in your own skin combined with the ability to be perfectly fine with someone standing very, very close to you when having a business discussion.
This isn’t an anthropology blog (although, really, aren’t we all studying human behavior in relation to diabetes, so…), but I am starting to feel like my personal space is being invaded and I don’t like it.
I’m a hugger. A snuggler. A squisher and a giggler and a tickle monster when it comes to my daughter. I am sometimes the instigator but as The Kid has grown older, she wants to attack me with the same happy ferocity and fire the first shot across the bow of runaround shenanigans that I used to incite. And the sensors and infusion sets on my abdomen are getting in the way… and they hurt. And that hurts me.
The real estate I have on my body is limited (seeing as I’m limited in stature and subcutaneous tissue locations). The current trial I’m conducting with the Medtronic MiniMed 530G with Enlite only allows placement of the Enlite sensor on my abdomen. I had three failed sensors last week. Three. Every time one failed, I had to find a new place to put the next one.
I am placing my infusion sets on my upper abdomen to stay out of the way of waistbands that chafe. I’m reluctant to put the sets anywhere else (I rip them out of my arms and legs far too easily, even with taped down tubing), but I’m thinking I may have to rethink things here, because…
I’m running out of my own personal space because of diabetes.
The worst part of this all is the reaction that I have when The Kid comes barreling straight for me, screaming wildly (causing me to have Braveheart flashbacks) for a hug… I tilt my abdomen inward as if pulling away from her. To protect the sites in the small space I have to use, I sacrifice the full body hug that I want to give. Every time I lift her up, I must be careful not to scrape her legs against my abdomen. Tickle war on the bed begins with a “Careful of my pump, sweetheart…”
And of course, I know that I have options. Take all the diabetes gear off. Go back to MDI and no technology. I understand that I am lucky. The technology has kept me alive and healthy so I can complain about not being able to hug The Kid as tightly as I want… and I hope I’ll be able to continue to complain about that long after we send her off to university. By then, I am sure it will be she that complains that I am hugging her too tightly.
But today, diabetes is invading my personal space. The space that is sore from repeated pokes and prods and insertions. How do I tell it politely to step back?
I have no idea.
