- With Mayo Clinic diabetes educators
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
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Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
Nancy Klobassa Davidson and Peggy Moreland
Nancy Klobassa Davidson, R.N., B.S.N, C.D.E
Nancy Klobassa Davidson is a registered nurse who has worked in diabetes education for 17 years. She is a certified diabetes educator (C.D.E.) and is currently in graduate school working on a Master of Science in nursing (M.S.N.) and health care education.Nancy works with adults who have type 1, type 2 and other forms of diabetes. Nancy is coordinator of the Diabetes Unit's intensive insulin therapy program within the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn. Nancy has worked extensively with insulin pump therapy and continuous interstitial glucose sensing.
Peggy Moreland, R.N., M.S.N.
Peggy Moreland is a certified diabetes educator (C.D.E.) in the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn.Peggy graduated with a Master of Science in Nursing and Health Care Education from the University of Phoenix and is a member of the American Association of Diabetes Educators and the American Diabetes Association. A certified diabetes educator (C.D.E.), Peggy enjoys working with patients to set and achieve diabetes self-management goals.
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Living with diabetes blog
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Feb. 4, 2011
Diabetes prescription challenges
By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
As a nurse educator, I'm not a medical provider, and I'm not able to write prescriptions for diabetes supplies. But I've witnessed the hassles that patients experience with diabetes products. You may need to continuously address these types of issues with Medicare or Medicaid, with multiple insurance plans who provide varying coverage, and with different types of pharmacies. It can be challenging.
Here are some examples of the challenges I've witnessed with diabetes supplies and prescriptions:
- Mail order pharmacies often require a 3-month supply of a prescription. You might have to wait a number of days for the order to be filled, and meanwhile you go without the prescription. Alternatively, you can get an additional prescription for a 1-month supply to be filled locally. However, this option may be more expensive or may require you to pay out-of-pocket. As another option, in some cases, your doctor might be able to give you some medication samples to cover the gap.
- The doctor may be uncertain of various types of diabetes supplies and products and may recommend the wrong item or one that your insurance doesn't cover. Check your health insurance plan for specific coverage of durable medical devices. And ask a certified diabetes educator (CDE) at your health clinic if they know the preferred providers in your area for diabetes blood glucose testing supplies.
- You might be asked by your doctor to test a certain number of times a day, and the insurance company may not cover that amount. For example, if you're on an intensive insulin program, you might be asked to test six to 10 times per day, and an insurance company may only cover three to four test strips per day. Your health care provider can sign a medical waiver to cover extra blood glucose testing supplies if medically necessary. Many insurance companies require proof of extra testing and may request copies of blood glucose meter downloads or record books.
- Diabetes mail order companies may switch products on you — and it may be to an inferior product. Try calling the company ahead of time to be certain you're given the product you want.
- The cost of diabetes supplies and medications, even with insurance coverage, can be expensive. You may want to ask about whether a generic option — or two, if replacing a brand name combination drug — are appropriate for you. You also might ask if insulin is an option instead of multiple oral diabetes medications or other non-insulin injectable drugs, which may be more expensive.
- Pharmacies may require a single dose for the insulin prescription. This doesn't allow flexibility for you to adjust the dose to goal-range, adjust for illness, or adjust for differing insulin-to-carbohydrate ratios. Ask your health care provider for an initial insulin starting dose with a range, so dose adjustment is feasible.
What have your prescription challenges been, and do you have any coping tips to share?
Have a great week,
Nancy
9 comments posted
May 10, 2011 11:40 a.m.
Jay, please note there is an RSS feed you could subscribe to on this page: http://www.mayoclinic.com/health/rss/rss If you look in the lower left of this page you'll see RSS Feeds. Thanks again
- MayoClinic.com staff
May 6, 2011 8:42 a.m.
Jay, thanks for your interest. You can't subscribe to the blog itself, but if you sign up for the free weekly newsletter Housecall on the left side of this page you will see every diabetes blog posting as they publish. Thanks.
- MayoClinic.com staff
May 5, 2011 1:40 p.m.
How do I subscribe to this blog?
- Jay
March 29, 2011 1:55 p.m.
Cynthia, there are several oral diabetes medications that have side effects of gastro intestinal symptoms; gas, bloating, nausea, and diarrhea. Take these medications with food. Usually with time, 1-2 weeks, the symptoms will get better, if not talk to your healthcare provider about an alternative medication for your diabetes.
- No name given
March 23, 2011 3:53 p.m.
I have been diagnosed pre-diabetic and meds given to me so far cause severe diarrhea...I have a public job and cannot risk uncontroleld diarrhea.
- Cynthia
March 17, 2011 12:43 p.m.
Get to know your pharmacist on a first name basis if local. I had some problems going from injections to a pump and my pharmacist saved me on many problems including insurance. I buy some of my supplies via the company that makes my pump, and others at local pharmacy. My Pharmacist knows me and my struggles with insurance at times and always helps me if she can...
- pumper
February 15, 2011 3:25 p.m.
My doctor recommended a Diabetic Clinic when my diabetic situation was discovered. At the clinic a nurse provided me the materials for checking my blood sugar and instructed me how to use them, put a paper to sign in front of me (which I signed) and gave me the schedule for 9 hours of instruction. She checked my blood sugar - 460. I was on metformia at the time. In my confused condition, I had signed with an out-town company to supply my diabetic materials. So the meter, etc. given me was not free. The next day I received a call from the company about sending my supplies, found they did not take my insurance, and I could not understand the speaker. Before these out-of-town supplies could arrive I was hospitalized -6 days of hospitalization and 14 days in a medical center. My message - take someone with you when you go to a health facility who can understand what is happening when you are not functioning very well. I got off to a very bad start in addressing my illness.
- Lee
February 12, 2011 1:27 p.m.
Another way to keep diabetes costs down: enroll in a Flex Spending Account at your workplace. This allows you to use pre-tax income to pay for supplies, prescriptions co-pays, glasses, deductibles etc. It can most of us about 20% on these things that insurance may not cover. Check with your HR office.
- Deborah
February 4, 2011 12:30 p.m.
My husband and I both have Type 1 diabetes, and we both use insulin pumps. We are very intentional about getting insurance through jobs. One of us has to obtain coverage through our job. Starbucks and UPS have good insurance for diabetes. We use meters/test strips that are preferred by our insurance company. We use local pharmacies that our insurance preferres. And we use mail order pharmacies our insurance preferres if necessary. We also ask about preferred medical providers. This makes medical visits less expensive. I ask about our general practitioner, our endocrinologist, and my OB-GYN. We ask the same thing if the insurance covers vision and dental too. Sometimes paying extra to see a good specialist is worth it though. It has happened more than once that our endocrinologist is not covered. We just bring the list of preferred providers from our insurance, and ask the specialist we like to make a recommenation/referral from the insurance list. We ask our endocrinologist to write insulin scripts at the highest level of insulin each of us has used in the past 6mo. to a year. This takes a lot of stress off if one of us gets sick. I only speak to customer service reps from insurance with these kinds of questions. On-line or automated systems rarely have up-to-date info. And there are answers to all these questions. :) It can be frustrating so I make sure I have time for a long conversation.
- Vanessa
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