# My insurance company gave me diabetes! **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 18, 2013, 3:11pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579 "2013-10-18T15:11:11Z")\ **Posts on this page:** 13\ **Page:** 2
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 22, 2013, 2:36pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/21 "2013-10-22T14:36:09Z")
> [@TruCelt](#): > > 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? 2)Yes! and 1)yes, with a story. I could’ve gone back on it at any time if I’d either paid the extra money, or been able to document that 2 alternatives had failed. Well, the first alternative seemed fine until the whole “except you’ve got diabetes” quibble. And the second alternative (same as the old one, but more expensive and with added “could kill you suddenly” tastiness) is working well as well. It’s hysterical: I called the pharmacy (mail order) to see if they could shed some light on the decision-making process. The person I spoke with could NOT, but said “yes, and xxx inhaled costs you 147 every 3 months”. I said “wait, that’s the one that would have been nearly 300” (because it had gone out of formulary). She said “No, that’s in formulary”. I asked her to check - and it was JUST ADDED BACK. Egad. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [October 22, 2013, 2:44pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/22 "2013-10-22T14:44:52Z")
If someone were to pay me for my notes, and I could get all the HIPAA clearances, they probably could glean that information, but that someone isn’t going to be me. Yes, I would be very much interested in retrospective studies on the topic, too. So far I have a bunch of observations, but I have not the training in research to turn that into a study. ---
**Author:** ![Measure\_for\_Measure](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/measure_for_measure/32/557_2.png) [@Measure\_for\_Measure](https://boards.straightdope.com/u/Measure_for_Measure)\ **Post date:** [October 23, 2013, 3:22am UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/23 "2013-10-23T03:22:02Z")
> [@Mama\_Zappa](#): > > 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. Oh, let’s spread the blame a little… Kevin Drum: [Here’s Why Your Asthma Inhaler Costs So Damn Much](http://www.motherjones.com/kevin-drum/2013/10/heres-why-your-asthma-inhaler-costs-so-damn-much). Short story. Environmentalists noticed asthma inhalers hurt the ozone layer. So they proposed changing over to a new delivery system. Then they realized that the new delivery system would add to global warming and that the quantities involved were pretty small anyway. So they backed off. At this point Big Pharma puts its lobbyists into high gear. They spend half a million dollars on lobbying from 2005-2010. Meanwhile they encase the same old drugs in a new delivery system and encrust them with patents. They succeed in placing CFC inhalers on the ban-train. So generics are no longer available and Big Pharma is charging the public mucho dinero. So it might not be the formulary committee. Your old medicine may be banned by the FDA, thanks to Big Pharma lobbying. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 23, 2013, 5:34am UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/24 "2013-10-23T05:34:56Z")
> [@Measure\_for\_Measure](#): > > … > So it might not be the formulary committee. Your old medicine may be banned by the FDA, thanks to Big Pharma lobbying. Nah - it may be why it costs so much, but it’s not why it was bounced from the formulary - it’s an HFA-based inhaler and has been for over a decade. Fantastic article though and I believe every word of it. Fuckers. Now the switch prior to THAT, was indeed due partly to the lobbying. The old inhaler “was unavailable due to a shortage of the raw materials” or so someone tried to tell me. Bullpucky - it was CFC-based, AND it was going out of patent. There’s now a newer shinier version of the same drug - furoate vs propionate or something. To be a devil’s advocate, supposedly some of the HFA-based inhalers have smaller particle sizes so the dosage may be a little better controlled/accessed (but I doubt enough so to make the cost worth it). And of course dry powder inhalers are coming out and they all have their own delivery mechanism and they’re all dramatically different and some are stunningly hard to use (you open up the mouthpiece, dump out an old plastic capsule, tear off a sealed capsule from a package, pull off some foil backing, rip a fingernail, cuss, push the capsule through the foil, drop the capsule, cuss some more, find the capsule under the couch, decide that a bit of dust and some spilled soda won’t really hurt you that much, put the capsule in the holder, close the holder, press some buttons to pierce the capsule, find that it hasn’t worked, shake things up a bit, then inhale and enjoy the lovely feeling of dust in your throat. OK, I exaggerate. We don’t drink soda so there’s no spilled soda under the couch. The rest, I’m not making up. Well, I am, because the specific inhaler that described, I’ve never tried. But look up Spiriva and Foradil if you don’t believe me. Interestingly, while maybe that HFA is a greenhouse gas, how much greenhouse gas is generated making all the wasted packaging in the dry-powder versions??? AND, the dry powder inhalers a) require you to be able to breathe in deeply and quickly (not always possible if you’re flaring) b) have **lactose** in them. Got a milk allergy? too fucking bad. (OK, allergy is usually to protein vs sugar but it still seems a Very Bad Idea). I noticed something else fun today: Advair - the on-formulary medication that is my “won’t give me diabetes” alternative - is now listed as requiring review for quantity and usage. Now, this _is_ the most expensive alternative of all the choices, but still - jeeze louise, I wouldn’t even be LOOKING at the damn thing if they hadn’t been jacking me around for most of a year. Fuckers. And just to pit someone else: GlaxoSmithKlineKraftBeatriceTarget or whatever your name is now: if you’re going to make such a nifty diskus device, don’t make it so damn hard to take apart and see how it works. I mean, I’ve got two dead units (used up, not destroyed!) and I wanna see what’s inside them and I have tried to pull 'em apart and I’ve tried to pry them apart and I’ve had no luck and I’m afraid of injuring myself. Damn cheesy no-fun-allowed drug companies :::: grumble:::: ---
**Author:** ![VunderBob](https://avatars.discourse-cdn.com/v4/letter/v/839c29/32.png) [@VunderBob](https://boards.straightdope.com/u/VunderBob)\ **Post date:** [October 23, 2013, 11:05am UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/25 "2013-10-23T11:05:10Z")
> [@Mama\_Zappa](#): > > Got retested - and blammo. Full-on diabetes per that test: 130-something glucose, 6.6 A1C. Well shit. Unless you’re prone to typos, I call bullshit. Doctors don’t get excited about blood glucose under 150 or an A1c below 8.0. I’d kill to have numbers that low. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [October 23, 2013, 11:26am UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/26 "2013-10-23T11:26:33Z")
> [@VunderBob](#): > > Unless you’re prone to typos, I call bullshit. Doctors don’t get excited about blood glucose under 150 or an A1c below 8.0. I’d kill to have numbers that low. [They’re using A1C≥6.5 for diagnosis now](http://shp.missouri.edu/vhct/case2600/dx_criteria.htm). Not bullshit. Not a bad number, and yes I’d love it if my patients had those numbers, and consider their diabetes well controlled. But yes, an A1C of 6.6 will earn you a diagnosis from many doctors these days, and probably metformin unless you have a very generous doctor who gives you 3 months to bring it down with diet and exercise. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 23, 2013, 12:15pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/27 "2013-10-23T12:15:10Z")
> [@WhyNot](#): > > [They’re using A1C≥6.5 for diagnosis now](http://shp.missouri.edu/vhct/case2600/dx_criteria.htm). Not bullshit. Not a bad number, and yes I’d love it if my patients had those numbers, and consider their diabetes well controlled. But yes, an A1C of 6.6 will earn you a diagnosis from many doctors these days, and probably metformin unless you have a very generous doctor who gives you 3 months to bring it down with diet and exercise. Yep. If I already carried a diagnosis of diabetes, then 6.6 would have them dancing with joy. If I understand it, they are happy with 7.0 or below if you’ve already got the diagnosis. Since I do _not_ (not yet anyway), a single reading of 6.6 (and/or glucose over 125, I believe) is considered a major league warning shot. As I understand it, two separate readings above those cutoffs gets me diagnosed. They’ve actually lowered the cutoffs for prediabetic. Used to be 6.1 and above was prediabetic (not there but increased risk). Now it’s 5.8 and above or maybe even 5.7 and above. I’d thought the glucose cutoff was 100 for years, though something I read recently suggested that in other countries (I’m in the US) they use 110 and above. Had I not made the inhaler connection, I’m reasonably sure I’d be on metformin by now and probably wondering why the hell it wasn’t **working** :(. Not that this is _necessarily_ a bad thing - some stuff I read about it made it sound so utterly fantastic that they should add it to the drinking water (I exaggerate - but not by much). And I may well need it at some point. But I’d rather not (and not have that scarlet letter on my medical records) until I’ve really earned it. Oh, and VunderBob: I am indeed prone to [typos](http://boards.straightdope.com/sdmb/showpost.php?p=16435220&postcount=92) :D. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [October 23, 2013, 12:18pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/28 "2013-10-23T12:18:58Z")
> [@VunderBob](#): > > Unless you’re prone to typos, I call bullshit. Doctors don’t get excited about blood glucose under 150 or an A1c below 8.0. I’d kill to have numbers that low. My doctor would get quite excited if I pulled an a1c of 8.0. And I was diagnosed with a fasting number of 130 and told I needed to bring it down immediately. Your information is incorrect/outdated and in all seriousness, if you got that info from your doctor I’d find a new doctor. ---
**Author:** ![VunderBob](https://avatars.discourse-cdn.com/v4/letter/v/839c29/32.png) [@VunderBob](https://boards.straightdope.com/u/VunderBob)\ **Post date:** [October 23, 2013, 12:25pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/29 "2013-10-23T12:25:40Z")
> [@Mama\_Zappa](#): > > Oh, and VunderBob: I am indeed prone to [typos](http://boards.straightdope.com/sdmb/showpost.php?p=16435220&postcount=92) :D. :D:D:D ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [October 23, 2013, 12:35pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/30 "2013-10-23T12:35:31Z")
> [@Mama\_Zappa](#): > > Oh, and VunderBob: I am indeed prone to [typos](http://boards.straightdope.com/sdmb/showpost.php?p=16435220&postcount=92) :D. HA! That’s awesome. 😃 ---
**Author:** ![TruCelt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/trucelt/32/523_2.png) [@TruCelt](https://boards.straightdope.com/u/TruCelt)\ **Post date:** [October 23, 2013, 1:53pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/31 "2013-10-23T13:53:02Z")
> [@Mama\_Zappa](#): > > . . . > > Oh, and VunderBob: I am indeed prone to [typos](http://boards.straightdope.com/sdmb/showpost.php?p=16435220&postcount=92) :D. I got such a giggle out of that! Question to those who have seen this effect before in practice: Does the effect go away when the medication is stopped? What about long-term use, does it produce a permanent condition? ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 23, 2013, 4:36pm UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/32 "2013-10-23T16:36:00Z")
> [@TruCelt](#): > > I got such a giggle out of that! > > Question to those who have seen this effect before in practice: Does the effect go away when the medication is stopped? What about long-term use, does it produce a permanent condition? There are a lot of studies out there (now that I’ve gone looking for them) that show that inhaled steroids is correlated with an increased risk of type 2 diabetes in the longer term. Similar relationship with cataracts. The systemic effects are minor but I guess even a teeny difference can cumulate. Correlation != causation, someone with much worse asthma may have trouble exercising/keeping weight down, etc (both of which are protective against it) but it suggests to me that there’s at least a little lingering effect as long as you’re on the 'roids. My own readings _did_ improve after stopping the other med. Not dramatically (OK, the blood sugar did drop a lot and the A1C is a longer-term thing anyway). But on the other hand, I was “only” on the stuff for 5 months. > [@wikipedia](#): > > ["] > Steroid diabetes must be distinguished from stress hyperglycemia, hyperglycemia due to excessive intravenous glucose, or new-onset diabetes of another type. Because it is not unusual for steroid treatment to precipitate type 1 or type 2 diabetes in a person who is already in the process of developing it, it is not always possible to determine whether apparent steroid diabetes will be permanent or will go away when the steroids are finished. More commonly undiagnosed cases of type 2 diabetes are brought to clinical attention with corticosteroid treatment because subclinical hyperglycemia worsens and becomes symptomatic. Generally, steroid diabetes without preexisting type 2 diabetes will resolve upon termination of corticosteroid administration]([URL="[Steroid-induced diabetes - Wikipedia](http://en.wikipedia.org/wiki/Steroid_diabetes)). Sounds to me like it could be transient, OR it could push someone over the edge who was trying to go that way anyway. Something for at-risk individuals to think about anyway - I mean, if it’s a choice of breathe or don’t breathe, I’ll take the damn prednisone. But it may make me personally want to try antibiotics first (don’t jump on me for that: the only time I flare enough to need Big Guns is when I’ve had a cold and developed a secondary infection). ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [November 19, 2013, 4:43am UTC](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579/33 "2013-11-19T04:43:46Z")
Bumpdate: Having failed (we think) to give me diabetes, they’re shooting for cancer instead. OK, that’s a slight exaggeration… but uncontrolled reflux (GERD) can lead to Barrett’s esophagitis, which is a precancerous condition. One of today’s letters proudly announces that they are no longer covering ANY proton pump inhibitors (standard of care for GERD), because there are so many OTC solutions available. Erm, not at the higher dosages… I looked up the generics for what I used to use, and what I use now, and I’d need double or quadruple the OTC dosage, respectively. It’s certainly _doable_, though in one case the prescription version is cheaper even if I pay full price (can’t quite figure that one out…). I actually understand not covering them at the OTC dosages (I was surprised they _ever_ covered that). But prescription-strength??? Hell, they cover prescription-strength **Advil**. The BP medication switchover is fun too. No coverage at all unless I fail at two of the alternatives. OK, done that already (one, anyway - spectacularly, with an ACE inhibitor). And there are generics in the other class (angiotensin receptor blockers). At least this is a case where a switch isn’t quite so mind-boggling. Both letters proclaim “remember, your doctor is the most qualified person to balance quality and cost considerations…”. Essentially saying “So we admit we’re not qualified to rule on quality, just cost”. 😛 It’s actually not going to be an issue for me - I’m switching to my husband’s policy as of next year. It’s got its own peculiarities, but slightly less insanity from what I can tell. [Previous page](https://boards.straightdope.com/t/my-insurance-company-gave-me-diabetes/671579.md?page=1)