the cost of knowing more.

I've been having a lot of lows at night lately and I'm thinking the sensor would be great at a time like this. I'd love to know more of what goes on with my bloodsugars throughout the day and especially at night. The night bloodsugars have always been the hardest for me to control consistantly. I hate the ongoing unknowns of my changing insulin needs. The dosage I'm on has worked for months. It doesn't seem to be anymore. Time to experiment to figure it out, yet again. Not fun.

Yet I also hate the idea of more technology attached to me, more to have to deal with, to buy. And that's the conundrum.

In the spirit of at least knowing more about what my choices are I've started to do some research. I've looked at the dexcom, and wasn't exactly thrilled with their set up at this point. For now, the having to carry around a receiver the size of a tv remote coupled with the less than perfect software, are deal breakers for me. More stuff to deal with, a clumsy system to manuever, a new company that isn't an industry leader. Hm.

So I checked into the medtronics paradim real time, which is designed to work in conjunction with my medtronics pump. It makes sense to me to go with the company I know, the industry leader, the one who has the most incentive to make it work with the pump I already have. So I called up the customer service line and waited over 25 minutes to talk with someone in person. Waited, waited, waited. When I finally did get a live person, they turned out to be very helpful and friendly. We went on the website together and walked through their sensor program and what it would entail for me to get one: an upgrade of my existing pump ($399), a starter kit ($999) that would include 1 battery (that would last between 6 and 9 months and then have to be replaced for $900, because it's not rechargable) and 1 months worth of sensors (at $35 a pop, to be used up to 6 days at a time), all for the grand total of $1298 just to get started.

Gulp.

Once upgraded, if I were to use it all the time, the sensors would cost around $350 a month and the battery, around $900 every 6-9 months, this time adding up to a grand total of about $5K a year, out of pocket, not covered by insurance.

Gulp again.

She assured me that the price would probably come down in the future because the batteries are being hand made, not manufactured, at this point in time. She also said that I wouldn't have to wear the sensor all the time if I didn't want to. Maybe once every couple of weeks for a few days, calibrate my pump accordingly and then check back a few weeks later. Or use it at times like now, when I don't exactly know what's going on. Or when I'm traveling (though I can just imagine the joy of having to explain a battery cell taped onto my body as I try to make it through security). The point is, that I could reduce some of the costs if I didn't wear the thing every day, week in and week out. Sounds good to me on all counts. Less "being attached" to more technology, less money too.

Beyond the obvious financial challenges that this scenario poses, I am still a bit unsure of the whole proposition in general. It still feels like a big tradeoff: all this money, the addition of another thing stuck in me, plus a big ass battery taped to my body, all to get a better idea about what's happening at night. Don't get me wrong. All things being equal, of course I want more information. That goes without saying. But are the costs to get that information worth it? The financial costs, the physical invasiveness, the added complication of more technology to live with. Is the promised benefit enough incentive to overcome my reservations and reticence? Do I wait for the next iteration of the technology that might be more streamlined and affordable? Or do I just take the leap and figure it out as I go? No easy answers here. At least not yet.

Gulp.

Comments

[Chrissie in Belgium]

Hi Ruppert,

Nights are my big problem too - I am most worried about hypos, but it is the erratic night time bg values that prevent me from adjusting my night basal. I have been waking up pretty much twice EVERY night for years! Sometimes you get so sick of it. Sure I go back to sleep again, immediately, most of the time that is! But if it is the inconsistency that is the problem, why would a CGM help? Of course the alarm system would help! Maybe one could sleep if you knew the alarm would beep so I wouldn't have to "check" all the time. Then there is the HUGE cost and the fact that b/c the CGMS are new there still exist problems to be worked out. I really do not know either - but b/c my docs here in Belgium say it is just NOT to be considered yet. Patience they tell me over and over and over. How can they talk about patience - they do not have to wake up every night, as I have for years and years and years. I have decided to wait ahile - just b/c it is simpler than FIGHTING to get one. Boy is that a stupid reason for waiting - but isn't it hard always fighting for stuff! JUST my thoughts!

[Beth]

Well said. You voiced a lot of my concerns with the CGM, and also the things that piqued my interest about it. I look forward to hearing more about your decisions and experiences. Hopefully insurance will start picking up the tab in a few years...

[Scott K. Johnson]

I agree that there appear to me so many benefits from using either of the CGMS systems available - but as you point out, the cost is prohibitive at this point for many people (including me).

I don't have any choice but to hang tight and watch this new technology mature and their developers & existing patients to work with their insurance people. I hope that in the near future the costs will be covered, at least partially, by insurance.

And you know - come to think of it - I had the exact same reservations about pumping, back before I started it. I wonder if it is a similar thing? You know - after wearing it you get "hooked" on the information and the ability to fine tune your control, so much so that it makes the issues more like non-issues.

The technology is still very young, and we will see some very exciting improvements in the next few years. I am anxiously watching and waiting for it all to happen.