Twenty-first Century Diabetes

Suppose you wanted to drive across the country and I offered to give you a car for the trip. There will be no charge for the use of the car or gas, but there is a hitch: the gar has no gauges of any kind. You will not know how fast you are going, how far you have driven, or how much gas is left. (No problem: every once in a while you can pull over, put a stick in the gas tank and do a calculation as to how much gas you have left and how far that will take you.) 

The car is known to overheat now and again, but you can just pull over and let it cool down then continue on your journey. Sometimes, when it is very cold outside, the car can stall and just quit running. There is no on-board thermometer of the outside temperature. Also, you cannot bring your cell phone and no one is going to be monitoring your progress. It is suggested that you pack food and water for the trip, in case you break down along side of the road since you will be passing through some regions with low population. Oh, and if the car gets too hot, it explodes and you die. If you keep this car very long, you will likely have to replace some of the major parts.

Sounds fun, right? Now, suppose I make you a second offer. For a month fee of $75, you can have a car with gauges, a cell phone, GPS, and an on-board monitoring system so family can track your whereabouts. You will have ample information about how far you've progressed on the trip, will be able to make adequate decisions about fuel, food, and lodging. This car is also prone to difficulties in extreme weather, but with your phone, you'll be able to plan the trip to avoid heat and cold. This car will last for ages beyond the car with no gauges and require less replacement of parts.

If you are fortunate enough to afford the $75 a month fee, it is a no-brainer. Yet, patients will all types of diabetes are expected to navigate through life without any gauges of any kind. They are expected do a periodic finger stick and from that, make all other decisions, just reacting to what is happening instead of planning ahead. Insurance companies are denying continuous glucose monitors (CGM) such as the Dexcom G5, because they are costly short term. I'm sure you can deduce the long terms costs and effects of life without it. 

Many patients are told they cannot have a CGM until they've "proven" themselves to understand diabetes without it. This is like being told we may not use a calculator until we prove we know how to use a slide rule (if you even know what that is). How are we to understand what is happening, how insulin works, without seeing a graph of it in action? When will we discharge patients from diagnosis like the advanced civilization we are with the best medicine has to offer right now?

For the record, we got the Dexcom CGM three months after diagnosis, but not because it was recommended or even encouraged, but because we asked for and pushed for it.

End of rant.