Contributor: Molly McElwee-Malloy, RN, CDE

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We aren’t born with innate skills to masterfully negotiate life with a chronic illness, but we do adapt and learn. Hopefully, and especially if you are new at this, my life lessons will speed things up for you. Keep in mind that although my tips may sound easy, they were learned through years of brutal lessons, which I’m sure you have had your fair share of thus far. Hugs, we’re all in this together!

Navigating insurance: Zero and I mean absolutely nobody has all the tricks to navigating each and every insurance situation. However, there are some tips that can save you time, money and heartache.

1. Call your insurance and ask them who your preferred mail order DME (durable medical equipment) supplier is. This would be for test strips, sensors and pump supplies. Example, I had a patient that was paying a 40% copay rather than a 20% copay because he was using a mail order supply company that HE previously used but was not “preferred” by the insurance. That’s a lot of $$.
2. The pre-authorization. Many of us have to fight year after year for a pre-authorization for a specific insulin or supply that we and our doctors know works best for us. Why this doesn’t carry over year to year is beyond reason, however for the most part it doesn’t. Save your documentation (device downloads, notes from your doctor, description of symptoms and problems experienced) in a safe place so that you can scan, copy, fax or mail them each year when requested. Start organizing your filing system – either electronically or physically so you can easily find this each year or any time you change insurance. Are we having fun yet?
3. Anticipate denials. The rule of thumb here is that most of the time what you are asking for is denied. When it isn’t, celebrate and enjoy the time you got back in your life not having to deal with this. For instance, if you know it’s very hard to get the quantity of test strips you need and you are running low – you are already going to run into trouble. Put an electronic reminder on your phone or handwrite a note on your calendar for ONE MONTH before you need to re-order. For some of us this denial is only once a year, for those on Medicaid or Medicare, this denial can be per order. If you must pay out of pocket at the pharmacy between orders, save the receipt to submit to insurance for some reimbursement – sometimes this works.
4. Warranties for medical devices. Put reminders on your calendar when you receive a device for 2 months before the warranty expires. For example, I know that my DexCom transmitter is going to expire in 8 weeks, so I’ve entered a reminder to call and start the re-order process. Find a timing that works for your insurance company. If you are working with a mail order company or directly with a device company, you can ask them for assistance in remembering when to make the next new order.

Routine wellness / prevention visits: Diabetes is a chronic disease that doesn’t have a cure (yet), and if we can keep up with it and manage fairly well, we can avoid a lot of the pain and suffering that comes with complications. I always like to say, the ONLY thing you have to be diagnosed with because of diabetes, IS diabetes. You can live a very healthy life without complications with the right “up keep” on management and preventative services. This is not a guarantee that doing all of this prevents everything, after all, life is much less predictable than that, but it’s a good start.

1. Every three months – see your Endo or clinician that helps you mange your diabetes? Don’t have one? How about a diabetes educator? They can help you navigate the ins and outs of diabetes management that changes with time, life and situation. If you have a diabetes educator, great – make sure you see them at least once a year (even if you think you know everything). It’s a great way to check up on what you are doing and find out if there is anything new or better you can try or do. Products and guidelines change each year – so don’t miss out!
2. Twice a year, see your dentist for regular cleanings. Dental health and gum health can be compromised when diabetes isn’t managed well. Keeping up with this small task does a lot for you in the long run in preventing complications.
3. Become aware of your feet. Notice any change in sensation in your feet? Go see a doc when you have numbness or tingling. If you have lost sensation in your feet or toes, test bath water with your hand before putting your foot in. Wear shoes – inside and out (slippers are amazing) that protect you from stepping on something that can cut your feet. Examine your feet at least once a week – make sure there are not cuts that are having trouble healing, no wounds that need tending to and not objects stuck there. Sounds crazy, right? Well, I had a patient one time that did not notice he had a small tack in his foot. We don’t know how long it had been there, but it did have to be surgically removed and he was given a tetanus shot and antibiotics. This is an extreme example, but if you have any loss of sensation on your feet you may not notice something like a splinter or a tack that is causing problems.

Self-care: This sounds like a silly one for becoming a more informed patient, but it’s quite possibly the most important step. When you live with a chronic disease it’s important to realize it may be affecting other parts of your life and that taking time to care for yourself is important. Self-care for everyone is different, for me it’s a massage and visit to my chiropractor. For others it’s therapy or a walk in the woods. Just like you can’t expect a car to run forever without changing the oil, you cannot expect yourself to be able to take the best care of yourself without a little TLC. Diabetes may be forever, but misery is optional.