Blog Entries With Tag: Quebec


Posted: Jul 21, 2015

It’s rare for me to compose a #dblog that is not all “chirpy chirpy” … I think the last time I did one that was kind of down was at Diabetes1.org  and sleep apnea testing.  Sleep really is vital to everyone, diabetic or not … without a good sleep … well … we become exhausted, depressed, need I say more?

So, here’s the jist. 

  • Been in our new home now for close to a month.  Yippee!!!  Searching for new team of doctors is a job in itself.   
  • Trying to figure out where to shop that isn’t all “meat and potatoes” food (the grocery stores I’m used to that are more Middle Eastern are so far not to be found here)  … yippee … sigh. 
  • Realising the street you moved on is a major artery when you were told otherwise by real estate agent who sold you the property … sigh (so far my explorer cat has survived not getting hit … very scary).  
  • Trying to motivate your DH to unpack with the limited time they have at home due to their work schedule … having lived with limited things since putting our previous house on the market back in March … it’s getting old. 
  • This promise of a new beginning, yadda, yadda, yadda, in the land of insulin pumping program (ADP) … isn’t all it’s built up to be.

Basically, I miss Montreal … my home for the past 26 years (that the new owners just LOVE …. Urrhhh …. why did we make our house so cute).

The biggest thing that is hitting me for the past few months though is that finally I can admit that diabetes is bringing me down.  I rarely will admit that, and am all smiles (damn they create wrinkles around the eyes … and I’m already feeling like I’ve aged 20 years in the past few months with stress).

My basal rate is almost down to ½ of what it used to be … and still needing to be tweaked.  Why I’m become even more insulin sensitive is making no sense at all with the extra hormonal issues I’ve been experiencing that were making life the opposite.  Has my body gotten used to them?

With the use of the Dexcom CGMS … I am now at least getting a better vision of where to tweak things … but what has finally dawned on me lately is … is with my basal portion of my insulin coverage pretty well covered (I mean … .450 / hr seems to be my average hourly rate) it maybe lowered if I continue in this hypo fairy land I seem to exist day in day out.

limp noodle joke

As we all know, hypos are exhausting, they leave you like a limp noodle, and the things you have set out to do that most people take for granted … get in car, drive to store, do your shopping … get on bicycle, go for a cycle, get active … go for walk … yadda, yadda, yadda.  I think you get the drift.  To do these simple tasks lately, I’m not able to do them.  It’s bringing me down to the point where I had a friend force me OUT OF MY HOUSE, to go out for a trip with her (searching for green bacon along HWY 2 of eastern Ontario). That did help, but sadly, getting behind the wheel, even with my Dexcom alarm set at 4 (72) … is not much help.  I am crashing in the blood sugar area … and luckily it’s not behind the wheel.

So, what dawned on me lately is that my other ratios I have been using are wrong for insulin coverage.  I’ve upped my I:C (insulin to carb) ratio … and giving it a test … I see a few times where it will have to be upped more.  Just like our basal rates are different from hour to hour on a pump … and this is where a pump is VERY handy.  You’re sort of stuck with MDI (Multiple Dose Injections) … once injected … you are the insulin slave.

cat at the wheel

My other fear?  Tomorrow, I am going to visit my family that I haven’t seen since last year.  I’m driving alone which I never used to feel.  It’s not far, but it’s that background fear of going low.   So my CGMS alarm for going low is set abit higher for that drive (I usually have it at 4/72 … for driving I put it to 5/90 … to allow for any variance in the blood meter verification test).  I did this last week when driving back to Quebec to have the Ontario MOT form filled out by my endo to certify me that I’m insane … JOKING … that I can drive a vehicle in Ontario safely.   The form from Ontario really goes into hypo unawareness unlike the form my endo filled out for the province of Quebec last year for me.  This all stems from Allan Makii, a T1D  who caused a TRIPLE fatal crash while driving with a low blood sugar back in 2009.  

 comic look at unpacking

So, as I post this blog, and I’ve missed posting them lately, but life has been whacky as you’ve seen … wish me luck … on sorting out my insulin requirements … getting my new home organised with help from my DH when he’s home … and trying to get out of what I think is one of the worst depression bouts I’ve ever had. 

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Posted: Mar 29, 2014

If only money grew on trees

For some of us - who don't have either private or work medical coverage here in Canada for prescriptions we require - it can be tough to manage the budget between food / rent / and other things that we require to stay alive.

For example, in my case, even though I don't have pump coverage (in Quebec it is for under 18 only - and as long as you remain in the province after that age - you are covered) - my visits to doctors / hospital (ER) they are paid for through our provincial income taxes.  Of course, this is all based on your income.

Wait but currency grows on trees

The same applies for medical coverage in our province - it is all based on your income - and so far - since starting to research where I'll get my best bang for my buck based on cost of living (housing / rent is relatively cheaper here in Quebec than in Ontario which is "next door").  These are things you have to weigh out when having to survive on medications to keep you alive.  

Sadly, when attempting to find out what each province covers via the Canadian Diabetes Association (CDA) - I'm finding no information at all.  In away, this is something I thought they would have shown on their website - to help ALL Canadians figure out what is covered by each province.  Either I'm looking in the wrong place - but this is what lead me to post this blog - incase others are like myself - wondering about their best option for medical/prescription coverage for their diabetes health.

UPDATE: Thanks to Petronella Peach - she sent me this link from CDA - that shows what our provinces cover for diabetes prescriptions.  They're abit out of date (2011) - but better than nothing!

what Canadian funds looks like to a foreigner

Take for example, I move to Ontario (that has insulin pump coverage if I go back to it that is).  You have to pay for your prescriptions until you reach retirement age.  They do not have a similar medical plan like we do here in Quebec - which is a more socialist system similar to France. Ontarians of course - pay less in provincial taxes - so there goes the thinking cap of what works out better financially in the long run to maintain my diabetic health?  Paying out of your own pocket OR paying the province more in taxes to have your drugs covered.  Hmmmm, decisions, decisions. If only money grew on trees.

 

Current Drug Insurance Plan in Quebec

Above it the current public prescription drug in my province (for larger picture go to this link link

How does your own province/state/country compare to mine?  I'm curious - as I prepare to make a move after retirement to a new frontier - perhaps to the east coast (closer to the sea for sailing) - wait - maybe to France!

 

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Posted: Nov 1, 2013

Last week I had gone to my local clinic (CLSC) for my blood work for my endo appointment I had on Tuesday. Two hour wait – fasting – wanting to pee like a horse – but I held fast – and wished I lived in Cornwall, Ontario – where you can make an appointment for a diabetic blood work – no waiting.  Welcome to my province of Quebec – where we diabetics get NO RESPECT !!  It's like lining up for a loaf of bread in Russia in 1915 !

Fast forward to this week – and I’m waiting in anticipation for what my results are.  Don’t we all go thru’ this (well – maybe not for you folks that can get your results the next day).  Here in my province in Canada – unless you go private - $$$ - or have private insurance coverage - you out of luck - you wait).  For some reason, I lucked in on only waiting 10 minutes (usually it’s much longer) – and my endo called my name. 

The first thing he said to me as I entered into his office …. “You’ve put on weight – what’s happened?”

I wasn’t really shocked by that statement – since I know I’ve been gaining weight (thryoid tests are normal - I'm just perimenopausal).  It's not from over eating – my habits haven’t changed - I actually am eating less due to work load – but my emotional state of being over the past year has been abit fragile plus … I’m a lazy cow (the job I do requires a lot of sitting on my behind).

Of course, as I explained this to him, he nodded, saying “Good excuses Anna”.  Onto the scale I went – since my last visit to him in July – I’ve blossomed.  I’ve never ever been the weight that I am – even after I’d had my DKA experience as a teenager – where I’d put on weight (memories of my Mum buying Hefty Boys corduroy pants for me always makes me cringe).  My Mum was often picking on me about my weight, and made me feel guilty about eating – sigh.  Writing these blogs sometimes brings back memories I don’t like to remember.

Promptly he took my blood pressure (BP) and this is sometimes the worst part for me – as I have the well-known ‘white coat syndrome” – my BP is never as good as what I have at home.  His first reading out of the corner of my eye was something like 185 over … at that point he said something that wasn’t good.  Meanwhile, in my brain I’m going WTF???  He retakes it on another machine – the regular wall version (before he was using one of the home versions we can buy) – and this time – it’s abit better – but still higher than my normal readings – 135/120.  Of course, at home, mine are in usually in the 115/70 area – sometimes lower.  I’ve never had a problem with high BP.

Of course, he says this is all to do with my increased weight (jab, jab, JAB) – and then asks – “do you eat a lot of processed foods?”  I tell him no, that I rarely eat processed foods;  when I have time/money I try to do all my own cooking without adding extra salt, etc.  Hmm, but inside my head I think … I DO LOVE CHEESE - which is high in salt!!! 

So, the jist of the whole visit was that I’ve REALLY got to lose weight - especially with his concern over my BP.  He stressed that I become active (he still insists that sailing is a lazy man’s sport – which in away – as a cruiser – it is – you don’t do much – not like he does with his golfing – where you have a goal – to find the hole).

And yes, my A1C despite my DKA episode over my holidays this summer – was pretty good (he says normally A1C will rise due to DKA) – it was abit higher – but still excellent.  And he admitted, if I’d been on multiple dosage injections (MDI) – that probably the DKA would never have occurred – which I totally agree with him.  Pumps do have their benefit - but not when they don't alarm for an occlusion, etc. like George Michael apparently didn't do in my case.  

So, now I’m off to test my BG, hopefully accomplish a 30 minute walk, then test my BG again, and post my results for the Big Blue Test that I partake in every year.  I’m hoping unlike the other day when I did it, I don’t drop in BG to the point of hypo land, and will be reducing my basal rate on my insulin pump abit (thank you Petronella Peach for that suggestion).

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Posted: Oct 24, 2012

I first wish to thank the help of  Marco Bianchi, who is a CDE (and also an insulin pump user) at the Montreal Children's Hospital.  I have been trying to find more information on the insulin pump program established in my province of Quebec where I currently reside back in Spring 2011.  It was like looking for a needle in a haystack, but luckily he provided me with the website  link (only in French which is why I couldn’t locate it on the English section of the Government of Quebec).  I’ve taken the liberty to translate it the best I can (it's in very polite wording when translated to English - almost like we are back in the 1800's with gloves and top hats - which is knd of cute).  Hopefully it will help you understand what is offered and perhaps give you the courage to speak up in the province where you live - to demand the same type of program (e.g. Alberta as of Spring 2013 will have a pump program - no word on what age group it will apply to at the moment).  I know for myself, I will continue to write letters to my provincial government to see if ALL age groups will be covered, but until then, at least this is now in place.

If you need further information about current pump programs set up here in Canada - I strongly recommend checking out Diabetes Advocacy - which I am hoping will link up this blog for their section on insulin pump coverage in Quebec to help those like myself that do not speak/read French well.
 

Description 

This program was put in force in 2012 in the province of Quebec to provide access to the insulin pumps program to obtain a refund for the purchase of the device and supplies necessary for its use. This program is only offered to persons that meet the eligibility criteria and the clinical indications and currently you must be UNDER 18.

Insulin pump 

The insulin pump is the size of a pager. It is programmed to inject insulin as needed. Thanks to its use at all times, this pump allows:

  • Controlling unstable diabetes;
  • Decrease the episodes of hypoglycemia;
  • Reduce the frequency of insulin injections;
  • To relax the timing of meals and the organization of daily activities.

Eligibility

The rebate program is in effect from April 16, 2011. To be admitted to the program, the person must be 18 years old and meet all of the clinical eligibility criteria.

Those who received insulin pump during the project pilot preceding the program are considered eligible.

Once admitted, a person is maintained in the program, even after the age of 18, as long as it meets the clinical criteria of eligibility. An assessment of eligibility must be made annually.

Commitments

To ensure the effectiveness of the treatment, the parents and the child must commit themselves to certain measures:

  • Monitor blood glucose levels hair, at least before each meal and at bedtime;
  • Register or record the results of capillary blood glucose levels on a regular basis;
  • Master the advanced calculation of carbohydrates concepts and apply them in the child’s food plan;
  • Provide the child support, supervision and parental supervision required to ensure a safe and appropriate use of the pump insulin;
  • Participate in a program of training of pump designed by age of the child;
  • Attend regular follow-up in clinic with a multidisciplinary team of care in diabetes at least 3 times per year and participate on a regular basis to update knowledge on care.

Reimbursement of costs

Only insulin pumps purchased under the program are eligible for a refund.

The program provides a maximum reimbursement of $6,300 by insulin pump. The pump can be replaced every 4 years, subject to certain conditions. A maximum of $4,000 per year is granted for supplies. Supplies are, for example, insulin reservoirs or catheters.

For parents with private insurance, the Government program covers amounts not covered by insurance in force.

Membership in the program

Parents should contact their pediatrician, endocrinologist or their child's family physician. The doctor will inform you about the program, assess if the child could wear a pump, and will direct you to a hospital where a designated team will assess their eligibility.

These hospitals are designated for the assessment of children less than 18 years:

Centre hospitalier universitaire de Québec (CHUQ) - CHUL

CHU Ste-Justine

Montreal hospital for children - MUHC

Maisonneuve-Rosemont Hospital

Centre hospitalier universitaire de Sherbrooke - CHUS

Centre hospitalier régional de Trois-Rivières

CSSS-Gatineau

CSSS Chicoutimi

CSSS Beauce

CSSS Vallée - de - l'Or

CSSS de Rimouski-Neigette

CSSS de Rivière-du-Loup

Other hospitals could be added to this list in the near future.

Several hospital centers will be also identified over the next year for the follow-up of participants 18 and older. For now, only the CSSS de Trois-Rivières is appointed for this purpose.

Certification of eligibility

When the child meets the eligibility criteria, the designated licensed physician of the hospital will provide proof of eligibility to program. The parents must then complete the section of the certificate on the current cover of insurance in force, in collaboration with the doctor.

Information to include is:

  • The name of the company;
  • The name of the holder of insurance;
  • The police or contract number.

Later, the form is sent by the physician to the paying agent, which will carry out the opening of the file.

Choice of the model of the pump

Before you can use the pump, the eligible child and his parents should follow a training program on Type 1 diabetes provided by the multidisciplinary team of the hospital on the following components:

  • The food and the advanced calculation of carbohydrates;
  • Rigorous maintenance of a log of blood glucose levels;
  • Basic knowledge on insulin pump therapy.

Then, the child and its parents choose the doctor or a member of the medical team pump model that suits them.

Obtaining reimbursement

For the insulin pump

Depending on the choice of pump, parents will contact the selected insulin pump company in order to proceed with the purchase of the pump. Parents should give this company a copy of the eligibility of the child form.

For supplies

The parents of the child will be responsible for purchase of supplies. To benefit from the refund, they must send the original invoices or original insurance records to the paying agent. A maximum of $4,000 per year is granted for these supplies.

The reimbursement of supplies will be considered by the paying agent to the receipt of the invoice or original insurance records.

For supplies delivered to home

Some supply companies can deliver to the home of the parents. These companies have an agreement with the paying agent; they may receive reimbursement of costs directly by the program, according to certain rules in force.

Pump

The pump will be installed at the designated hospital. The child and its parents must meet with a member of the medical team to receive the necessary training before the start of the insulin pump.  The medical team will monitor the settings of the pump for insulin to ensure they meet the child’s requirements.

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Posted: Oct 20, 2010

I'm once again facing that dilemma of the "seasonal flu shot" in the province of Quebec that I live in here in Canada.  While I read of my American friends and other friends in parts of Canada that have already received their flu shots - it makes me wonder about the province I live in.  Why do they take so long to make the vaccine available?

I know I've told some of my American friends that here in Quebec they are waiting for that perfect formula to incorporate all the nasty flu viruses that they feel will do the most harm to the population.  This was told to me by a nurse on call at the CLSC (that I spoke to on the phone.  Even better, was when I spoke to her about the recent news article about having the flu shot earlier in the season was beneficial to the heart, she seemed abit stumped by what answer to give to me. 

If you haven't opened up the link above to read the news article - in a nutshell - the article states that getting the flu shot earlier in the season rather then later in the fall is actually beneficial to our heart.  A study was done in England and Wales where  researchers found that the annual flu shot was associated with a large drop in the rates of first heart attacks!

It's been a long time since I've had the flu symptoms, but they usually range from running noise, achy muscles, phlegmy cough (gross), but what it also affects is inflammation in various tissues. What the researchers say is that they think the inflammation affects the lining of the blood vessel, which causes plaque to form.  This plaque when it dislodges can block a coronary artery, stop the blood flow and BOOM cause a heart attack.  As we diabetics know, we are already compromised with our blood vessels to begin with!  So, the flu shot has two advantages as far as I'm concerned.

Anyway, it's been recommended by my American friends that I come on over to the border and get my flu vaccination at Walgreens or one of the many pharmacies that offer it.  I have to admit I am HIGHLY tempted to do this, as I'm starting to get annoyed at our so called "free" health care system in the province I live in.

Hopefully the RAMQ (Regie de l'assurance Quebec) is reading this - as I've already sent them an email about my dismay at having to wait until mid-November to be eligible for my flu shot.   To make matters worse, the address they list to go and get the flu shot on their webpage does not exist in my GPS, Google Maps, Map Quest - it's like looking for a needle in the haystack!

Needle in a haystack by Wicked_Kitten_sinz at Photobucket


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