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Doris' Blog
By: dorisjdickson


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 Blog Entries
Islet Cells Generation - Cure? I Think Not! - Oct 01
This article in Diabetes Health discusses yet another new potential "cure."  However, yet again, it requires immunosuppressants which are not an option to me.  ...
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Cholesterol Conundrum - Sep 21
I recently wrote about Red Yeast Rice as an alternative to statins and the fact that it actually IS a statin since they contain the same active ingredients.  You just ...
more
Red Yeast Rice - It is a Statin - Do I Take It? - Sep 10
I receive Dr. Mercola's newsletter regularly.  I don't, however, regularly read it.  My concern is the amount of "stuff" sold on the website.  However, this ...
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Diabetic ketoacidosis at onset of type 1 diabetes remains frequent in children - Sep 08
This article in yesterday's edition of Endocrine Today makes me scratch my head.  First and foremost, had this study been conducted in 1976 in the US and not in Germany, ...
more
Inaccurate Monitors and Strips - Sep 02
Some of you may have read about the FDA's recent warning about the inaccuracy of certain test strips while taking certain medications.  Honestly, I didn't pay much attention ...
more
Islet Cells Generation - Cure? I Think Not!
Posted: Oct 1, 2009 11:19:07 4 Comments.
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  • This article in Diabetes Health discusses yet another new potential "cure."  However, yet again, it requires immunosuppressants which are not an option to me.  Thanks I don't have heart disease or bone deterioration now.  Personally, I don't want to replace one disease with several others!

    So, here was my comment to the Diabetes Health article that I posted yesterday:

    " don't get it. Why is this any better than any other current "cure" that ultimately generates beta cells. You still have to take immunosuppressants - steroids - which are very, very bad. And you can't take steroids forever. You eventually have to stop and then we'll just reject again.

    Please stop coming up with "cures" that aren't cures. For a type 1 there is no cure that doesn't address why we reject the beta cells in the first place. Honestly, I think we're still at stem cells (of some form) that don't need immunosuppressants and that we won't just simply reject again.

    But I'm often accused of being too logical and not emotional enough so ..."

    Another poster responded "first we crawl then we walk."  My response to that is:

    "Seymour, I'm afraid we're at the same place we were when I was diagnosed 11/2/76. How long do we have to crawl?

    They can (and have been able to) get us to make more islets, beta cells, insulin but they can't tell the immune system to stay put.

    I don't know of any healthy (no steroids) progress there. That tells me we still don't know the cause(s) of type 1 and that it is an imperative missing cog in the wheel.

    I also am a firm believer in environmental causes (not food) - chemicals, etc. And who is going to have the audacity to say that? And then, are we permanently in immune overdrive? Is there a fix to that?

    Thus, I focus on my own person responsiblity and fastidious care with the tools we have.

    For me that means - testing 15 times a day, lots of small shots, an insulin cocktail, fewer carbs, normalized target as recommended by Dr. Bernstein, etc.

    It's a choice but it keeps my limbs attached, my eyeballs working and my butt out of the ER. After 33 years, a cure would be nice but not much has changed if they can't fix our immune systems."

    Doris J. Dickson

    Cholesterol Conundrum
    Posted: Sep 21, 2009 14:03:14 1 Comment.
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  • I recently wrote about Red Yeast Rice as an alternative to statins and the fact that it actually IS a statin since they contain the same active ingredients.  You just don't know how much you're getting in an over-the-counter (OTC) product.

    In today's Boston Globe, there is a new article, Cholesterol Condundrum, discussing statins, red yeast rice, and some new studies of both.  They also discuss the fact that people don't tend to consistently take prescribed statins for a variety of reasons.

    Doris J. Dickson

    Red Yeast Rice - It is a Statin - Do I Take It?
    Posted: Sep 10, 2009 11:26:41 1 Comment.
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  • I receive Dr. Mercola's newsletter regularly.  I don't, however, regularly read it.  My concern is the amount of "stuff" sold on the website.  However, this heading caught my attention - Why You Should Avoid Red Yeast Rice.  I know of people using it and have done some research on the product.  I was thinking it would be a good "safe" option to try.  Dr. Mercola has provided some food for thought to the contrary.

    I knew/know the active ingredient in Red Yeast Rice (monacolins) is the same as the active ingredient in lovastatin (a major generic statin).  I also know that the active ingredient has side effects (e.g. muscle pain, liver effects, etc.).  I personally refuse to take statins.  I don't care what the ADA has to say on the subject.  The entire diabetic population does not have to take a drug, that costs money and has some substantial side effects.

    Dr. Mercola, also not someone I take as the gospel according to xxx, provided some valuable "how it works" information.  For example, did you know that the active ingredient in these statins actually DECREASES Coenzyme Q10 (CoQ10)?  Coenzyme Q10 (CoQ10) is actually helpful to the heart and is frequently mentioned as a supplement to take; it's also pretty expensive.  So, why would I take a statin that decreases the effectiveness of another natural enzyme and then need to take more of that expensive enzyme in hopes of negating the damage of the statin?  Seems pretty silly to me.

    Another part of Dr. Mercola's conversation that made me think - and usually does - is the arbitrary designation of HDL, LDL and total cholesterol guidelines.  Again, the gospel according to ... demands diabetics lower their LDL levels to less than 100 even if they have a higher HDL level and very good ratio.  Dr. Mercola recommends taking your HDL level and dividing it by your total cholesterol.  He says that percentage should be 25% or higher.  He also suggests calculating the same ratio of triglycerides to HDL.  That ratio, he says, should be below 2. 

    In my case ... my HDL is normally around 75.  My total cholesterol hangs in the 200 or less area and my LDL is just over 100.  My triglycerides are about 75.  Therefore, my ratio of total cholesterol to HDL is 37.5% and my triglyceride to HDL level is 1.  Well within Dr. Mercola's recommendations (and others I have read).  So, why is it I need to take statins?  Or anything containing the active ingredients in a statin?  And risk side effects?

    So ... I am not advocating statins or red yeast rice or its avoidance.  I am suggesting you read this article and note (or read) the reference material Dr. Mercola provides.  He did not just make arbitrary statements.  The article is fully supported.  I am suggesting you do further research.  I am suggesting you think before trusting the "you must take statins" (in any form) because you're a diabetic recommendation.  Analyze your CVD (cardiovascular disease) risk, your eating habits, your behaviors, your body structure, your family history, etc.  Therefore, you should be able to make a wise and educated decision not just trust someone else as the gospel according to ...

    Doris J. Dickson

    Diabetic ketoacidosis at onset of type 1 diabetes remains frequent in children
    Posted: Sep 8, 2009 10:39:02 0 Comments.
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  • This article in yesterday's edition of Endocrine Today makes me scratch my head.  First and foremost, had this study been conducted in 1976 in the US and not in Germany, I would have been included in these statistics.  Given that, why did they spend money on this?  What do they hope to attain by learning that ketoacidosis in juvenile onset diabetes is frequent?  Do they think somehow they can prevent the phenomenon? 

    I don't think a high incidence of ketoacidosis in true juvenile onset type 1 diabetes diagnosis is particularly preventable.  Why?  Let's start with the fact that the progression of the disease normally goes from 0 to 100 mph very rapidly.  Then continue with the fact that kids normally only go to the doctor for a routine annual physical at most annually.  Then there's the fact that glucose and c-peptide tests are not part of a physical. 

    I would expect that glucose testing due to the high incidence of type 2 might be added sooner or later but the real indicator of juvenile onset type 1 is in insulin production and beta cell destruction which would more likely be seen in a c-peptide test.  When does beta cell destruction start in earnest?  Is it consistent? 

    There's no way anyone is going to mandate a c-peptide test at a routine annual physical AND force insurers to pay for it primarily because the incidence of true juvenile onset type 1 diabetes is so low relative to the total population.  They are truly more concerned with the incidence of type 2 in the total population.  No big surprise - higher incidence means higher cost means more interest in preventing problems. 

    Why do I think that a standard A1C, random glucose or glucose tolerance won't catch juvenile onset type 1 before ketoacidosis?  Because unless someone gets real lucky it happens too quickly for a routine annual physical to catch.  And unlessl you've got a PCP who is really on his/her toes the early symptoms are pretty darn subtle.  That's if you go to one 'just cause.

    I remember being particularly thirsty for about 3 months prior to my diagnosis.  But it was hot and I was 12 and spent a lot of time outside.  I was active.  So, thirst by itself just wasn't going to stand out by itself.

    Then there was the hungry horror stage which quickly ran into the weight loss stage (10 pound loss of a 72 pound child in one week) which only started one week before diagnosis.  The final stage was what we know as the ketoacidosis stage which to the normal average bear initially resembles a flu.  And who on earth takes their kid to the doctor immediately upon flu symptoms?   Who can get an appointment immediately at flu symptoms?  Two days later ... ya, well that's what got everyone's attention. 

    The stench of ketoacidosis, the lethargy and being totally out of it stage.  That was it.  Apparently, I couldn't even walk because I remember my mom carrying me to the car. 

    But I had only missed one day of school at that point.  It really is fast.  My birthday was Thursday.  I went to school on Friday.  We moved on Saturday.  I went to a Halloween party on Sunday.  I was notably drinking soda I didn't drink and eating much more than normal.  But again, we had moved on Saturday and I wasn't the type to wait around for someone to unpack my belongings so I was active - translation - hungry.  Who knew?

    Monday was All Saint's Day and we had the day off.  I was sick.  My sister was getting me tea.  But again, only it was only day 1 of being sick so who would take the kid to the doctor's.  I'm a kid; I get sick.

    Tuesday was the difference.  My sister went to school; Mom went to work and she did not like what she saw when she got home so off to South Shore Hospital she carried me.  Thanks Mom.  Thanks South Shore Hospital.   Thanks Banting and Best.  I felt better in short order.  I remember being quite perky on the trip to the Deaconess/Joslin. 

    I do not think my diagnosis could have happened much more quickly.  The early symptoms resemble nothing important, nothing notable.  I had seen commercials pointing out the symptoms and had mentioned them but to repeat - being thirsty during the summer and being hungry when running around is just not remarkable to the average bear. 

    So do we demand that extensive tests be run on kids at routine annual physicals just in case?  Urine testing as they do in parts of Tokyo (mostly catching type 2)?  Do we demand A1Cs every three months which MIGHT pick something up?  Will more education of symptoms to parents and PCPS/pediatricians help? 

    See I don't think so.  Paranoia is expensive and not all the helpful considering the relatively low number of juvenile onset type 1 diagnoses per year.  (I'm having trouble finding a total number of juvenile onset type 1 diagnosis.)  A 1999 study employing genetic testing and CONTINUOUS beta cell damage testing results in "less severe disease presentation."  Not the word "continous."  There is certainly nothing cheap about genetic testing and there is nothing cheap about continuously looking for autoimmune destruction of beta cells thus rendering the concept unrealistic.

    I just don't think there is a simple, cost effective answer to preventing ketoacidosis.  I'm sure parents will disagree with me.  I hear screaming from the rooftops.  However, if this were your business and you had to determine cost benefit, what would it show?  Not much benefit.  The benefit is emotional and, right or wrong, that just doesn't (usually) count in business decisions.  So, in this world of capitalistic, shareholder or taxpayer owned insurance companies, it's not likely to count here either.  Sorry.

    Doris J. Dickson

    Inaccurate Monitors and Strips
    Posted: Sep 2, 2009 11:06:56 0 Comments.
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  • Some of you may have read about the FDA's recent warning about the inaccuracy of certain test strips while taking certain medications.  Honestly, I didn't pay much attention since I already accept they are inaccurate and I wasn't using any of the interfering products mentioned by the FDA.  However, since it affects anyone receiving dialysis I realized I might be negligent in dismissing the problem.

    Today, Diabetes in Control published more information on the topic including stating that Wavesense (Agamatrix) products are of a new technology and thus do not have this interference problem.  Bayer also says their meters don't use the old technology.  HOWEVER - several meterrs that are used to calibrate CGMSs do use this older, inaccurate technology.  So ... use a product that is inaccurate to calibrate another inaccurate product and you get double inaccurate.  Nice.  This article is primarily about the few number of people affected by the problem but nonetheless being an informed consumer is forewarned. 

    I've always known that many sweeteners (primarily sugar alcohol) can mess up a blood sugar.  This article states particular products that inaccurately skew blood sugar results.

    I've also heard people with kidney problems say their blood sugar drops quite a bit and believe it's because of the kidney problems.  They have different sensitivity levels.  Scratch the head.  Well, apparently that's only partially true.  It seems that the drugs they are taking cause the meters to read incorrectly and thus they OD on insulin in an attempt to correct a supposed high.  So it's not the kidney problems or the insulin or their sensitivity.  It's the inaccuracy of the meters.  Big oops! 

    Again, I realize apparently small numbers of people are affected by this but it is another reason to demand not request that meter manufacturers spend some of that $1-$1.25 per test strip and find new technology that works.  AgaMatrix has .... why can't the others?

    Eli Lilly Increases Income Threshold for Patient Assistance
    Posted: Sep 1, 2009 10:34:16 1 Comment.
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  • Eli Lilly has increased their income threshold for their free patient assistance program (Lilly Cares) from 200% to 300% of poverty level.  The program covers most Lilly products including insulin.  The phone number is 1-800-545-6962.

    Some of the eligibility requirements include:

    • Patients must be U.S. residents
    • Total yearly income at or below 300% of the Federal Poverty Level. For example: $44,000 or less for a family of two.
    • No other prescription drug coverage. For example: private insurance, government: Medicaid, VA, Medicare Part D.

    You will also need proof of income:

  • First page of your federal tax return for prior tax year. (1040 or 1040EZ tax form)
  • Any other source of income (examples include: Social Security income, pensions, unemployment, alimony, food stamps)
  • To complete an application:

    Blank applications may be downloaded from the Lilly Cares web site, or arrangements to receive an application by mail or fax may be made by calling 1–800–545–6962.

    Applications have both a patient section and a physician section, and both you and your physician must complete and sign your individual sections.

    Mail application and proof of income to:

      Lilly Cares
      PO Box 230999
      Centreville, VA 20120
    Thank you Senator Edward Kennedy
    Posted: Aug 27, 2009 13:40:37 1 Comment.
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  • I woke up at 4 a.m. Wednesday morning and switched the television channel to the news to let out a gasp.  As most, I knew Senator Edward Kennedy was very sick battling brain cancer and based on the "hints" over recent weeks, Massachusetts residents knew he was in trouble.  However, I still did not feel ready when I saw and heard those life changing words television telling me Senator Kennedy had indeed died.  I was crushed and immediately saddened by the thought that our Senator was gone.  This was the Senator whose name I had heard and who stood as my representative my entire life.

    So, I wish to say "thank you" to a man who has done so much for the people of Massachusetts and the United States as a whole.  I cannot even begin to list the legislation he has written, endorsed, and gotten passed over his 47 years in office.  I can tell you, there is not a working "shmo" in this country who has not been positively affected by his presence in the United States Senate.  He has stood up for each and every one of us at some point in his career.  If, for example, you have ever been entitled to continue your insurance coverage after leaving a job, you can thank him for the COBRA law.  If you have ever held a minimum wage job, you can thank him for consistently fighting for minimum wage increases.  The list is virtually endless.

    A friend used a word yesterday which can describe how I felt knowing Senator Kennedy was there - "protected."  She said she now feels less "protected" knowing he is gone.  How true that is.  I always felt that, for the most part, Senator Kennedy would protect the interests of his constituents - us - Massachusetts residents - U.S. residents.  Thinking about Senator Kennedy being there was just second nature because he had always been there - since before I was born in 1964. 

    As I sit watching local news coverage at the family compound in Hyannisport, I watch Representative Patrick Kennedy with his cousins, nieces, and nephews and realize I owe him, his sister Kara and his brother, Edward, Jr. a thank you as well.  Thank you Patrick, Kara and Edward, Jr. for sharing your father's time and commitment with us. 

    Thank you, Senator Kennedy, for having a caring heart, commitment and a dream.  Thank you for being the public servant you clearly were.  Thank you for all your hard work and for "sticking up" for us for all these years.  Thank you for being our Senator.

    P.S. – For all of those who wonder what this has to do with diabetes.  Remember, how many diabetics cannot get insurance or good quality insurance for which Senator Kennedy worked his entire career to accomplish.  Let’s make that dream come true and pass Health Care Reform this year.

    Health Care Reform - Part 1
    Posted: Aug 23, 2009 10:15:58 0 Comments.
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  • I have been taking the time to 1) listen and 2) read about the details of the Health Care Reform Act - distortions and fact alike.  So, with the Legislature still on vacation and battling out fact from fiction in Town Hall Meetings, I thought I would take some time to share some of the good, bad and ugly of this bill which is very, very similar to the one Massachusetts enacted a few years ago.

     

    I will address a few of the easy, straight-forward facts first. 

     

    • Similar to Massachusetts reform, the House version of the bill eliminates the ability of insurance companies to exclude potential customers or cancel customer policies due to pre-existing conditions UNLESS you lie to them.  They may only cancel your policy for lack of payment and even that has a restriction with a grace period of about 30 days.
    • In addition, the bill disallows inordinate premium increases to customers because of history or onset of a new condition.  They may not increase the premiums of one person in a group; they must increase premiums for the entire risk group.

     

    • They may of course charge based on plan benefits which for the public option will be classified in three categories, essentially:  basic, enhanced, and premium. 

     

    • The public option, like the Massachusetts will calculate rates based on zip-code which is part of how private insurers currently calculate rates.  For example, at one point when I was a benefits administrator, Greenwich, CT had the highest "reasonable and customary" allowable charges in the country.  This was in the days of major medical plans - when we all paid low deductibles and were reimbursed at rates described as 80/20 or 90/10 (they paid 80%, we paid 20% up to an annual maximum).  These days, providers negotiate contract reimbursement rates and we pay a copayment or coinsurance either with or without a deductible.  I have not found these details yet but I am still reading the document.

     

    • There will be a phase in period much like there has been in Massachusetts.  I have read a 3-5 year phase in proces in different parts of the document so far.  This allows for grandfathering of some non-compliant plans for a  period of time - also much like the Massachusetts bill. 

     

    • Annual and lifetime maximums will be banned.

     

    • Methods of coinsurance will also be banned, leaving only customer-friendly, easy to understand methods copayment methos.

     

    I will keep reading and come back with some more basics soon.

    Insurance Billing Code - V700
    Posted: Aug 21, 2009 9:26:48 0 Comments.
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  • Remember this medical billing code - V700.  Why?  In Massachusetts, V700 is the code to ensure that tests you have performed during a routine annual physical are covered under the Massachusetts mandate. 

    Codes are standard through the country I realize; so, it is the same code used in other states to designate an adult routine annual physical.  However, at least until national health reform is passed, it s the one that designates a number of tests that are covered without being subject to a deductible, coinsurance or multiple copayments.

    According to the representative at BC/BS I drilled earlier in the week, even my A1C and TSH are covered, even though they are not standard routine tests; they are diagnostic.  It is important to share this information with you because frequently tests are separated at the doctor's office and performed by multiple outside vendors. 

    Trust me; providers do not always enter the appropriate code and if they do not (depending on your plan details and potential deductibles) it may appear you are responsible for test costs that should be paid under "routine annual physical."  This has happened to me multiple times because my primary care physician sends blood tests to the hospital lab (at another location) and the lab does not bill the insurance company properly.  Thus, I have received a separate bill for the lab tests. 

    Wrong!  I get a bit testy and send it back with a note stating, "bill properly and you will be paid"!  I do not necessarily remind them what they did wrong.  I should not have to even know what the problem is and the mistake does get a bit old.  After all, this was a selling point of HMO and PPO coverage - not patient intervention, double billing, paperwork, etc.

    Also, if they continue to bill improperly, they can not charge you.  They have a specific amount of time, based on the contract they signed with the insurance company, to properly bill the insurer.  After that, they have to "eat" the unreimbursed costs and they are not allowed to charge the patient for their mistakes.  Their mistakes are not your problem. 

    It is that simple but you need to know it is that simple.  As long as you have provided the caregiver with your accurate provider information, you verified they are an approved provider (if necessary), you have active coverage, etc. you have performed the required "patient responsibilities."  Beyond that, it is up the provider.

    So, the next time you have a routine annual physical and a bunch of separate tests (in some states including a mammography, pap smear, EKG, etc.) remember to pay attention to the code they use especially if you end up with a bunch of separate bills.  The code is V700! 

    BC/BS Massachusetts New CGMS Policy
    Posted: Aug 17, 2009 14:58:13 2 Comments.
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  • Effective June 1, 2009 BC/BS Massachusetts has changed their CGMS policy.  It is a policy change.  It is NOT plan dependent.

    They will cover (with doctor's recommendation) CGMS's without contortions for diabetics.  It is no longer dependent on the things like 1) seizures 2) passing out 3) ER visits 4) gastroparesis, etc.  They are covered period.

    However, they are covered under durable medical equipment which tend to have a limit on them.  My old group PPO which is considered to be the cream of the crop and that I was paying $445 a month for had a $750 annual maximum - obviously not enough to pay for a CGMS or a pump.

    The choices that I debated this time (as direct pay) were PPO/$1,000 deductible - $1,500 annual durable medical equipment max and the one I chose HMO Blue/$500 deductible - $750 annual durable medical equipment max.

    So the good news is they changed the policy; the bad news is coverage is nominal at best. 

    For those who have had their CGMS and pumps paid for/reimbursed, what category were they on your insurance plans?  What amount for the initial equipment?  What amount thereafter?

    Doris

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