My insurance company gave me diabetes!

The BBQ Pit
1

And no, that’s not as silly an accusation as it might seem, nor is it based on changing reference ranges for lab tests.

Short version: Insurance decided that my steroid inhaler, which had controlled my asthma for 12+ years, was no longer on formulary, and made me switch. No explanation as to why.

And within weeks, my blood sugar started climbing.

tl/dr version:

I’m packing a few (!) extra pounds. I’m obese. It is not, therefore, inconceivable that I might develop Type 2 diabetes. In fact, since my blood work has been in the low pre-diabetic range for a few years, it is a distinct possibility.

So when I had a fasting glucose reading that was not just one or two points above normal, but in fact very close to the “full-blown diabetes” range, I took i seriously. Ate a bit better. Got a bit more exercise. Dropped 15 pounds.

Got retested - and blammo. Full-on diabetes per that test: 130-something glucose, 6.6 A1C. Well shit.

Then I got to thinking… and checked my records… and realized that 3 weeks prior to that “close to diabetes” test, I had started a new inhaled steroid. And had been using it for 5+ months when I retested. And elevated blood sugars are possible with any steroid (though considered very rare with the inhaled 'roids).

The change wasn’t done for any medical reason whatsoever. It was done because my health insurer, for whatever lame-ass reason, decided that I had to switch to an alternative that either was less potent, or equally as potent but with added possibility-of-sudden-death-for-no-good-reason fun.

And here’s the real kicker: ALL OF THE ALTERNATIVES COST THE INSURER MORE THAN WHAT I’D BEEN USING.

So: FUCK YOU, FORMULARY COMMITTEE.

On a hopefully happier note: I was retested after switching to another inhaler (old steroid, added-potential-for-sudden-death) and things are improving. No proof, but strong circumstantial evidence.

2

Wow…just…wow.

I sure hope there’s a paper trail to prove your point, correlation == causation and all. But that’s awfully shitty.

So, yeah, fuck insurance companies. For-profit health insurance is such a BS system to begin with…

3

post hoc ergo propter hoc?

4

Yeah imagine how bad it will be when Obama’s death panels decide no one needs an inhaler

5

No. And you can’t make me. I’ll post what I want to post.

6

Oh, absolutely. I’m high risk for type 2 diabetes anyway, and it may well have been sheer dumb coincidence that the bloodwork started going screwy at that point. Inhaled steroids list higher glucose as a “very rare” side effect (and luckily for me, I tend to be more horselike than zebralike, medically speaking).

But in general, if you have a patient whose diet and exercise improve a little, their blood sugar readings are not expected to get that much worse (and usually would get better). And, the temporal correlation is pretty strong in my case, so I’m pretty damn suspicious.

What I’m pitting is the sheer randomness of the change (established drug, well tolerated, standard-of-care for a decade or more, in favor of others that are either weaker, or have additional ingredients, or both, i.e. no expected medical benefit). AND the sheer fiscal stupidity given that several of the alternatives cost them MORE.

7

I’m sorry you have diabetes, but the culpability of your insurance company seems debatable at best. I hope the blood sugar readers do not discourage you from keeping up your improved diet and exercise.

8

Don’t take for stupidity what can be explained by greed. If you changed from one brand inhaler to another brand, it is entirely possible (and probably likely), that the Pharmacy Benefit Manager (PBM) is getting a kick-back from the drug company. Drug companies make a deal with a PBM to use our brand instead of that other brand as their preferred medication, and in exchange we will give you a kick-back.

This has two advantages for the PBM, one, they can bill the actual insurer based on the acquisition cost of the drug, and also get money from the drug company. So they get more money from both sides… and, since the PDM doesn’t pay your doctor or hospital bills, just the drugs, who cares if the change causes more medical problems?

9

I’m so sorry to hear this Mama. Will they let you try going back to the old one?

And can I have your permission to use this example to crush the next right-winger who trots out the “Death-panel” threat in my presence?

10

It’s one of those “very rare” side effects on paper that isn’t very rare in actual people, it seems. I’m not sure what the disconnect is, but either their studies suck ass, or I’ve gotten an exceedingly unlucky crop of patients, because, yeah, it never fails. Inhaled steroids, and the blood sugars go up. Not once in a while, not “huh, maybe we should watch that” but every single time, on every single patient who’s switched (like you, largely because of formulary coverage changes.) I have reams of paperwork documenting this supposedly “very rare” side effect. It’s not just you.

11

Heh yeah u rock bro lol exclamation point

12

If you think that is a fun ride, try the dammed pills. Fracking blood sugar was in Lunar orbit…

13

Oh, I know! Every time someone goes on Prednisone, I call their doctor and say more or less, “So, y’all wanted me to call and alert you when the blood sugar goes over 300…but you just put her on Prednisone. Wanna bump that alert value up a little, or do you like hearing the sound of my voice a lot?” :smiley:

Even non diabetics will sometimes get to know the joys of hyperglycemia on oral steroids. They don’t seem to get that effect from inhaled, but then I don’t use my glucometer much unless we already know the person is diabetic, so I guess I don’t know that for sure…

14

Yeah, I was getting steroid shots and oral steroids pretty steadily there for a while, and I’m pretty sure that this is why I had to start taking insulin. The steroids kept me breathing, but they sure played hell with my blood sugars.

15

…and then the insulin causes a 10% weight gain that requires more insulin, that causes more weight gain…

16

Does your health plan have a process where you can request non-formulary meds to be approved for coverage if you have a medical reason?

17

Can you explain this a bit more? It sounds like you are making an actual statement of fact, tha the kickback actually occurs.

If that’s true, can you tell us in what form the kickback is in? Is it a cash payment directly to the PBM, which is non-reported income, or is it done in a more above board fashion? (I.e. Is what you are saying that occurs actuall legal, if not exactly ethical, or is it completely illegal as well as unethical?)

Thanks

18

Let’s not forget that the steroids cause weight gain, and I was on at least one other medicine (an antidepressant) that also caused weight gain. You know, because I wasn’t depressed ENOUGH, I had to gain weight to become more depressed.

19

Amen to that!

Prior to this, I’ve had blood sugar readings over 105 on precisely two occasions. One was when I’d been on oral prednisone. In fact that time the doctor mentioned it, and said “may be due to pred”. I had it retested a few weeks later and it was normal.

WhyNot: I did some more reading recently and while few people are admitting that there’s a short-term blood sugar increase for most people, there DOES appear to be growing evidence that the steroid inhalers are tied to an increased risk of developing Type 2 diabetes in the longer term. It’s a tradeoff of course: if you quit breathing you won’t develop diabetes (or any other long-term health problems!) but some people think the shorter term side effects of this (death being the main one) aren’t worth it ;).

And the gold standard is the inhaled steroid, which is better than oral, and non-steroid approaches sometimes just don’t do the job. Sigh.

20

Fascinating!! Do you see any particular patterns regarding these switches? As in, if there are major inhalers A(mdi), A(powder), B(mdi), B(powder), C(mdi), D(mdi), a switch from D(mdi) to A(powder) is minor, D(mdi) to B(mdi) is bigger, A(powder to A(mdi) is huge, etc.?

If you do, I’d love to hear about them (PM is fine), and I wonder if some professional groups (AMA, etc.) mightn’t be interested. Sounds like a retrospective study might prove enlightening.