March 4, 2011

Other Problems in Diabetes Management

These problems in diabetes management can be completely out of your control. The medical insurance industry which follows very closely the actions of Medicare can really hamper the management of diabetes.

First, even though Medicare has small programs when they reimburse doctors for screening elderly patients for diabetes, the medical insurance industry will not. In addition, the medical insurance industry and Medicare will not reimburse for expenses that do not diagnose diabetes. If the HbA1c is less than 6.1 or less than 126 mg/dl, blood sugar reading, insurance will not pay for prescriptions and anything relating to the potential advice that could help you prevent or delay the onset of full diabetes. This is the sad part of our insurance industry.

Then in the area of testing strips, most insurance companies are limiting them to just two per day that they will reimburse for. A few are even getting bolder and limiting the number to 50 test strips per month for people on oral medications. This makes learning what different foods do to your blood glucose levels very expensive after diagnosis and until you have gained confidence in the foods that you may consume.

This also is true when you add new foods or have unusual times like eating out a lot when it would be wise to know what the foods are doing to your blood glucose levels. This is why I can understand people that have a creep up in A1c's. We are being forced by our insurance to not manage our diabetes and maintain daily controls.

This in turn encourages doctors to discourage testing and doing what is necessary to manage our diabetes. The doctors then say that the A1c give us a quarterly reading to tell us how we are managing. I say this is not good enough. By being able to test as needed, we can more readily see how a food is affecting our blood glucose so that we can change the serving size or eliminate the food from our menu.

If a person is on insulin, there are a few more strips, but sometimes not enough. For those that are on oral medications, make sure that you know whether the medication can cause hypoglycemia. For oral medications alone, the amount of test strips should be allowed an increase, and medical insurance should cover them.

To me, Medicare and the medical insurance industry actions are counter intuitive and more harmful for patients than practicing a little preventive medicine. Granted there are always those individuals that will never manage diabetes and give the rest of us headaches because they have participated in the surveys that the medical insurance companies send out showing that there is little or no need for larger numbers of test strips. The medical insurance companies also find them for the studies to back their cutback of testing supplies.

This is making it harder and more difficult for those that wish to tightly manage their diabetes to accomplish this unless they are able to afford the additional test strips out of their own pocket.

March 2, 2011

More Tips for Caregivers of the Elder Generation

Do you have a parent that needs care, or older relatives needing to be cared for. This can mean many challenges for the “in-between” or sandwich generation. No, this is not a repeat of the last blog.

What are the problems that you will face if you take on the care of a parent or older relative? How will your children react? How will the parent(s) react? These are just two of a multitude of problems and hurdles you will face. Many problems may be financial and others will be dealing with human nature. When I speak about a parent I put the (s) after to indicate possibly both and I want you to understand this could also be an older relative like an aunt or uncle and even a distant relative that has been close to you or your family.

Decisions need to be made and sometimes there just does not seem to be enough hours in a day. Will the parent(s) be able to completely care for themselves, only care partially with some or many limits, or will they be totally unable to care for themselves.

Decisions need to be made about where the parent(s) is going to live. Will they be able to stay in the home, and will it be necessary to have round the clock supervision or just a daily visit or someone only during the day? If it is just one parent, do you have room for an additional person living in your house? Or will an assisted living facility or nursing home be necessary? How is the person going to be able to get to and from doctors and other appointments?

These are just a few of the decisions to be made concerning the parent(s). Will you be able to handle the finances for their care or does the parent have the money available? If you are a single parent, how will this affect you and your children? Even if you and your spouse have a stable marriage, looking after a parent can place a burden on the marriage.

This is the reason for the prior blog to provide sources of assistance. Always consider talking to a pastor or minister of your church as they also can often provide resources.

Finally, if the parent(s) will talk about this and make plans before something happens, then many steps can be saved and everyone will know what is expected.

February 28, 2011

Tips for Caregivers of the Elder Generation

Do you have a parent that needs care, or older relatives needing to be cared for. This can mean many challenges for the “in-between” or sandwich generation. This term, “sandwich generation”, was popularized in the early 1990's by Carol Abaya, an eldercare expert and columnist.

This is more a listing of organizations that may provide guidance or assistance for eldercare of your parent(s), or other close relative. Even though I will be listing several caregiver resources, do not forget that many eldercare religious organizations exist and may be good resources. Just because I use eldercare, many organizations have other names, “aging services”, and “elder homes” are just a few of the terms.

The following list of caregiver resources is not complete, but will give you ideas and may provide what you are looking for. Some people may not need this if their parents have planned properly.

The National Association of Social Workers ( can assist you in locating social workers specializing in geriatric care.

The National association of Professional Geriatric Care Managers ( makes referrals to eldercare professionals, who (for a fee) will assess your parents' needs and help coordinate care. lists federal, state, and local benefits (other than Medicare) for which you parents may qualify.

The American Health Care Association and National Center for Assisted Living ( can walk you through long-term care and assisted living options.

The National Academy of Elder Law Attorneys ( is a source for legal information and eldercare attorney referrals.

You may not need many of these services, but you should have a list available. The next thing that is necessary, before your parents are not legally able to do this, is talk to your parent(s) about having a lawyer draft two documents of importance. The first is a durable power of attorney for finances and the second is a durable medical power of attorney for medical decisions.

Have the parents keep the documents up-to-date and in a secure place like a safety deposit box. Family members should know of their location. Have the parents check with the financial institution and notify the institution of any changes to prevent complications when they go into effect. Also check with the institution to find out if they have any additional requirements that need to be addressed.

If you are the trusted person for your parents, you may be present for all of this. If there are other family members, they need to be notified to avoid future conflicts and hurt feelings. Not all families members are accepting of this, but most will work with the family member chosen by the parents.

If you are a parent with children, consider doing this for your children to avoid future problems as well.