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- If you’ve been diagnosed with diabetes, you’ll start a treatment regimen and work with your doctor to determine what’s best for the type of diabetes you have. There are different treatment requirements for Type 1 and Type 2 diabetes, and you will need specific diabetes supplies to treat your illness.
What is the Goal in Treating Diabetes?Because people with diabetes have glucose (blood sugar) levels that are too high, the main goal of treatment is to bring those levels down. But it’s also important for the levels to not drop too low—you would end up with abnormally low levels of glucose, which is called hypoglycemia.
- Type 1: Type 1 diabetes is treated with a healthy diet, specifically designed for diabetics, exercise, and insulin injections or an insulin pump.
- Type 2: Type 2 diabetes treatment starts with changes in diet, weight loss, if necessary, and exercise. If the disease can’t be controlled with these, medications are used.
The American Diabetes Association (ADA) has established guidelines for a diabetic diet. It’s balanced and low in fat, cholesterol, and simple sugars. Your total calories for the day are divided into three meals. Within the last two years, the ADA has revised its opinion on simple sugars. You can now have small amounts of simple sugars when combined with a complex (balanced) meal.
Losing Weight and Exercise
Besides simply being healthier, weight loss and exercise increase your body’s sensitivity to insulin, which prevents high glucose levels.
Testing Your Glucose Levels
With both treatment programs, you will need to keep a careful eye on your glucose levels. Your doctor or health care provider will tell you how to do this and what supplies you’ll need.
- Self-Monitoring of Blood Glucose or SMBG: One way you can monitor your glucose level is with this piece of equipment. It has a meter that indicates your glucose level, which reflects the effectiveness of your diet, exercise, and/or medication.
- Doing your SMBG: Using a lancet (a needle used to get a drop of blood), a small drop of blood is used to measure your glucose level. This is usually done before meals, after meals, and at bedtime.
- If you’re on insulin: Patients who are on insulin need to test their glucose levels more often than those who don’t take insulin.
Goals for Self-testing: Your doctor and health care providers will help you set your individual goals for your glucose levels.
Review your results with your doctor: You will need to go over your SMGB results with your doctor at your visits.
If you have Type 1 diabetes, you will be taking insulin to treat it. There are several different kinds that act on your glucose levels at different rates. Your doctor will prescribe the kind of insulin that is best for you.
Most insulin must be injected. Patients used to carry syringes and needles, but there are now pre-filled insulin pens which hold an insulin cartridge. An even more recent “insulin delivery system” is an insulin pump. The pump is used when a continuous delivery of insulin is needed.
Under certain situations, you may need to check for ketones in your urine. Ketones in the urine mean that your body is using fat for energy instead of glucose. This happens when there is not enough insulin available to use glucose for energy. This happens most often with Type 1 diabetes. Your doctor or health care provider will tell you when to check your urine for ketones.
Below are conditions that may be signs of high ketone levels:
- You feel nauseated or are vomiting
- You feel tired constantly
- You are thirsty or have a very dry mouth
- You feel confused or “foggy”
- Your skin is flushed
There are urine test kits that check for ketones—you use strips and to test your urine. The strip will change color, which you then compare to a chart for a reading.
Does Medicare Pay for Diabetes Supplies?
Medicare will cover the cost of some diabetes supplies. In order for them to be covered, your doctor must prescribe the supplies.
Some of the covered supplies include:
- Glucose testing monitors
- Glucose test strips
- Lancet devices
- Glucose control solutions used to check the accuracy of test strips and monitors
- Insulin is covered ONLY if used with an external insulin pump
You pay 20% of the Medicare-approved amount and your Original Medicare Part B deductible applies.
NOTE: Insulin and certain medical supplies used to inject insulin, such as syringes and some oral diabetes drugs, may be covered under Medicare prescription drug coverage (Part D).
Getting Your Diabetes Supplies
It’s best to order your supplies from a Medicare-approved supplier. Although you can buy supplies in a store, be sure the store is Medicare-approved.
Medicare Advantage Plans
If you have a Medicare Advantage Plan, it’s important that you check with your individual plan coverage to see how to get your diabetes supplies. You may not have to pay anything out-of-pocket, but there may be rules that you must follow.
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- People who have Type 1 diabetes must use insulin to control their disease. Unlike Type 2 diabetes, which requires daily checks with glucose meters, type 1 patients can’t simply rely on a diabetic diet, exercise, or even diabetes medications in pill form. In those with Type 1, the pancreas no longer makes insulin. Therefore, Type 1 diabetics require insulin that can be given with injections throughout the day or with an insulin pump.Insulin pumps are a fairly new way to treat diabetes. Because glucose levels in Type 1 diabetes are so hard to regulate, an insulin pump delivers a much more controlled, continuous insulin treatment. There are many advantages to using an insulin pump, but it does take the patient some time to adjustWhat are Insulin Pumps?An insulin pump has a pump reservoir (like the insulin cartridge that insulin pens use), a battery-operated pump, and a computer chip that allows the patient to control the exact amount of insulin being delivered to the body. Currently, pumps on the market are about the size of a pager. The pump is attached to a thin, plastic tube (the infusion set) that has a cannula (like a soft needle) at the end. The insulin passes through it. The cannula is inserted under the skin, usually around the abdomen and is changed every two days. The tubes can be disconnected from the pump when you shower. The pump delivers insulin continuously 24 hours a day. The amount of insulin that you require is programmed like a computer and given at a constant rate. The amount you need can depend on things like your activity level or sleep. For example, the patient can program the pump to deliver more insulin during meals to cover the need for more insulin when you digest carbohydrates.
What’s New in Insulin Pumps?
Exciting technology is constantly being developed to make the insulin pump even more effective. One innovation involves being able to use the pump together with newer glucose-sensing implantable sensors. The sensor communicates with a small device—the screen displays information about your glucose reading.
Getting Comfortable Using an Insulin Pump
Using a medical device that inserts under your skin may sound unpleasant. But after an adjustment period, which may take a couple of months, patients live very normal lives with their insulin pumps. Your diabetes doctor and treatment team will answer any questions about how to use your pump correctly.
Some tips to remember about your insulin pump:
- If you travel, remember to bring extra supplies or at least an insulin pen if you are not able to use your pump
- When you take your insulin pump off or turn it off, work out a way to remind yourself to turn it back on
- Make a habit of recording all your glucose level checks and other information about carbohydrates, etc.
Remember there a lot of advantages to using an insulin pump over pen or other injections.
- The pump delivers insulin more accurately than injections
- The pump makes managing your diabetes much easier
- The pump allows you to be more flexible about what and when you eat
Does Medicare Cover Insulin Pumps?
Medicare may cover insulin and insulin pumps for people with Medicare Part B who have diabetes and meet certain conditions.
- You have Type 1 insulin-dependent diabetes
- Have Type 2 insulin-dependent diabetes with glucose that is difficult to control
- Have gestational diabetes with glucose that is difficult to control
- Your doctor must prescribe it for you
- It is considered “Durable Medical Equipment,” which is medical equipment ordered by your doctor for use in your home
As of January, 2011, there are new guidelines for Durable Medical Goods. Medicare is using a new program called “competitive bidding to help save you and Medicare money and ensure that you get quality equipment, supplies and services. In some areas of the country, you must use specific suppliers or Medicare will not pay for the item. It’s important to see if you are affected by this new program. It is effective in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, TX (mail-order diabetes supplies come under this new rule).
You are responsible for paying 20% of the Medicare-approved amount and the Original Medicare Part B deductible applies.
Work with your doctor and healthcare providers to determine if an insulin pump is right for your diabetes treatment.
- Diabetes can have serious complications affecting many parts of the body. High glucose levels from diabetes can result in poor circulation to your lower legs and feet. Often, this causes nerve damage called neuropathy, which can lead to lack of sensation in your feet, foot ulcers, and in severe cases results in amputation. Fortunately, with conscientious treatment of diabetes and good foot care, many of these problems can be avoided or at least treated.The Importance of Good Foot CareThere are many things you can do to prevent problems with your feet. Most of them involve good foot care. But start by taking care of your diabetes overall. If you keep your glucose level under control, you are less likely to have foot problems.
The following are good foot care tips:
- Check your feet every day for cuts, red spots, sores or infected toenails.
- Wash your feet every day in warm, NOT hot water. Dry your feet well and especially between the toes.
- Put on a thin coat of lotion or petroleum jelly on the tops and bottoms of your feet. Do not put the lotion between your toes because it can cause an infection.
- Treat corns and calluses gently. Check with your doctor or podiatrist about how to care for them.
- Trim your toenails weekly or have a foot doctor do it if you can’t see well or reach your feet.
- Wear shoes and socks constantly. Never go barefoot because you could step on something and hurt your feet.
- Always check the insides of your shoes to make sure there are no stones or other objects in them.
- Wear socks at night if your feet get cold. Check your feet often in cold weather in case of frostbite.
- Put your feet up when sitting. Wiggle your toes for 5 minutes, two or three times a day.
- Do not cross your legs for long periods of time.
When you have “peripheral” neuropathy in your feet, it’s very difficult to feel pain, cold, or heat. Because you have loss of feeling, you may not feel a foot injury. If you develop a blister, you may not know it. Often, you won’t notice a foot injury until the skin breaks down and becomes infected. Because of this lack of sensation in your feet, wearing shoes that don’t fit well can potentially cause this kind of damage to your feet. That’s why it’s so important to wear properly fitted shoes.
Diabetic shoes are specially fitted for people who have even mild forms of neuropathy. There are companies that specialize in pedorthics, which is the design of footwear and special insoles that can prevent or lessen foot injury and pain. Diabetic shoes are often made wider and deeper that regular shoes, with a larger “toe box.” This is partly to have room if insoles are needed. The pedorthic insoles are usually custom made for each individual diabetes patient. This ensures the fit and helps with uneven weight distribution or rubbing. The shoes should also allow good air circulation.
Diabetics need to have their shoes fitted by a trained professional, like a podiatrist. What you need in a diabetic shoe are:
- Breathable construction—sandals and fabric shoes are best
- Deep and wide design—to allow for insoles
- Designs with no interior seams that could rub
- Easily adjustable fit—elastic can help
Are Diabetic Shoes Covered by Medicare?
Medicare Part B will cover most of the cost of diabetic shoes, but the doctor treating you must certify that you meet all the following conditions:
- You have diabetes
- You have at least one of the following conditions:
- Foot amputation—partial or complete
- Past foot ulcers
- Calluses that can become foot ulcers and/or lead to nerve damage
- Poor circulation
- Deformed foot
- You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.
Medicare also requires the following:
- A podiatrist of other qualified doctor prescribes the shoes.
- A doctor or other qualified individual provides the shoes.
- If you meet the conditions above, you are covered for one of the following per year:
- One pair of depth-inlay shoes and three sets of inserts
- One pair of customized shoes that have been molded to your foot (including inserts). These are made if you have a foot deformity and cannot wear deep-inlay shoes.
For Original Medicare Part B to cover your diabetic shoes, you must get them from a Medicare-approved supplier.
NOTE: If you have a Medicare Advantage Plan, check with your individual plan to see cover limits.
Take Care of Your Feet
Wearing diabetic shoes and taking good care of your feet will help prevent damage and injury to your feet. Discuss any questions you might have with your primary doctor or podiatrist.