In Israel, CGM’s are provided – with 100% reimbursement – to three categories of people with type 1 diabetes: children up to the age of 19, pregnant women, and adults suffering from hypoglycemic unawareness. In order to be diagnosed with hypoglycemic unawareness, you must be hospitalized twice in a 12-month period – either ER or ambulance – with a blood glucose level under 50 mg/dL.
Though JDRF Israel has pushed for CGM’s to be available to all adults with type 1 diabetes, as well as children, this has not yet happened. In fact, the 2013 review committee meeting protocol stated, absurdly, that the CGM “didn’t really help balance sugar levels.”
As someone who has had type 1 diabetes since the age of ten, and as a tax paying citizen, I feel a sense of “CGM entitlement.” So I decided to take matters into my own hands and take advantage of the misguided system. I prepared myself to visit the ER with a blood glucose level under 50 mg/dL. In other words, I planned an insulin overdose.
The morning of my first ER visit, I had a low-carb breakfast, but despite repeated half-unit boluses and a stepped-up basal rate, I just couldn’t get my level under 100. After walking around a bit and planting myself next to the hospital, I started to feel it, that ethereal feeling I get when my sugar level is plunging. My glucometer said 54. It was time to check myself into the ER.
At admittance, I was directed to the “ER light” area, not a full-blown ER but kind of like an outpatient version. I mumbled a white lie about leaving my glucometer in my wife’s car and not knowing what my sugar level was. After a few minutes of cold sweat hypoglycemia, the nurse finally called my name.
She had a glucometer, and unfortunately it seemed that the hospital had yet to hear of the pain-minimizing lancing device. The nurse pulled out some sort of long, sharp medical pin and pricked my finger without warning , plunging the needle deep into the pad of my middle finger. The end result: an intensely painful gusher, and a glucose level of “only” 57! (Note to self: bring lancing device for visit #2 and wait a little longer for boluses to kick in.)
I told the nurse I’d treat the hypoglycemia on my own and she was fine with that. A cappuccino with two sugars and a croissant later, the nurse called me back for the follow-up check. I told her I’d prick myself this time – far less painful – and sugar clocked in at 78. To get the release form and necessary paperwork, I waited another hour to meet with the on-duty doctor, who wasn’t overly verbose and let me go with an encouraging, “Take care!”
With one ER visit down and one to go, I was halfway to getting a CGM. I postponed ER visit #2 until the last possible day before my scheduled endo appointment. I was a little worried since my recorded glucose on visit #1 was not under 50, and was determined that this time I would have a proper insulin overdose and arrive sub-50. I kicked in a few boluses and after an hour of waiting in the car outside the ER, I reached 47.
Unfortunately, I made a critical error at check-in: I said that I was feeling “dizzy,” which indeed I was. But this innocent five-letter word had unwittingly qualified me for the full-blown emergency room; little did I know what I was getting myself into.
The admitting nurse tested my sugar using the lancing device that I whipped out of my bag in a flash: 43. Nailed it this time! She escorted me to the overflowing ER, which and looked like a cross between an out-of-control emergency room and an insane asylum from days long ago.
Despite my vehement objections, the medical staff insisted on finding a bed for me, telling me that I was “gonna be here for a while.” I had already begun popping glucose tablets, but was feeling weak and delirious. They rolled in a bed and improvised a place for me right next to a wheelchair-bound woman in a short dress. No separating curtain! Three staff members were attending to the woman beside me. Across the way a doctor was trying to protect herself as an elderly man lashed out at her with his cane, while down the aisle another patient was bleeding and groaning in misery.
I needed to find a champion for my cause, someone who would hook me up with some sugar and help get me out of that place. My eyes met up with a nurse, who responded to my pleading look and came over to my bed. I asked her for a cup of tea with three sugars, which she brought to me within a couple of minutes. She came back to check up on me 15 minutes later, and I told her that I was back to normal and good to go. She did the follow-up test, which came in at 71.
Now all I had to do was get the ER doctor to sign off on the paperwork, which proved to be easier said than done. Even with my sugar at 71, she nonetheless wanted to give me a glucagon injection. I told her that I was fine, and that I wanted to free up my bed for someone who really needed it, but she wasn’t amused. She said that they “would be seeing me again” since I “didn’t know how to take care of myself.”
With two sets of ER paperwork in hand, the next day I went to my endo. I filled in the forms she gave me, and no issue was made of my “high low” from the first visit. One week later, I had my fully subsidized CGM, with absolutely no out-of-pocket expenses for the rest of my (diabetic) life.
Don Weintraub is a technology marketing consultant and freelance writer living in Tel Aviv. Born and raised in the Motor City. He has an MBA in Marketing and an MA in Middle Eastern Studies from the University of Michigan. Ironically diagnosed as a T1 on Valentine’s Day in 1975, over the years Don has transitioned from Lente and Ketostix to the Medtronic Paradigm Veo pump and Freestyle Navigator 2.0 CGM.