Questions and Answers
Q: I am 28 years old and have had diabetes for 21 years. I want to try to have children, but I am concerned about how my blood sugars will react to pregnancy. How low can blood sugars go before it starts to harm the fetus?
A: Maternal hypoglycemia does not harm the fetus as much as maternal hyperglycemia, which leads to a congenital malformation and/or stillbirth.
High blood sugar, especially at night, is a common concern during early pregnancy. This reaction is caused by metabolic changes during pregnancy.
Low reactions may result from tight control needed to sustain near-normal blood sugar values. The issue that arises is a mother's awareness of the symptoms, due to lowered thresholds. Since the average blood sugar levels are lower than usual, the symptoms of weakness, palpitations, tremors, etc., may not appear at 50 to 60 mg/dl, but rather at lower values, like 30 to 40 mg/dl. Levels this low lead to a severe hypoglycemic response, leaving the pregnant woman to experience confusion, seizure or even coma. If severe hypoglycemia is left untreated and the safety of the mother is jeopardized, the fetus may be in danger.
Pregnant women with type 1 diabetes should frequently check their blood sugar levels in order to avoid asymptomatic hypoglycemia. An ideal testing frequency is eight times per day, including
- once before each meal, for the assessment of asymptomatic hypoglycemia
- one hour after each meal, for the evaluation of the effect of a particular meal and insulin doses
- bedtime, to determine reactions and their appropriate treatment
- during the middle of the night, to detect hypoglycemia
Target ranges for each test are patterned after a mother's plasma blood sugar levels in a normal pregnancy
- fasting glucose: 60 to 90 mg/dl
- premeal glucose: 60 to 105 mg/dl
- one hour post-meal: 140 mg/dl or lower
- 2 a.m. to 6 a.m.: 60 to 120 mg/dl
The prevention of asymptomatic hypoglycemia depends on maintaining blood glucose values in the near-normal ranges through frequent self-monitoring and insulin adjustment. Appropriate dietary management is also vital to provide adequate nutrition for both the mother and fetus. This plan will help promote a healthy and successful outcome for the pregnancy.
Loretta Hothersall, MSN, RNS, CS, RNPC
Maine Center for Endocrinology and Diabetes
Is An Insulin Pump Durable Equipment?
Q: I am in the process of trying to purchase an insulin pump and want to hear if anyone else has experienced the same issues I have with my employee health insurance. My insurance provider considers the insulin pump "durable medical equipment."
We have a lifetime $2,500 cap on durable medical equipment, like prosthetics, oxygen, wheelchairs, etc. However, they also consider the delivery system of disposable catheters, tubing and needles as part of durable medical equipment. Disposable is not durable. In other words, I have $2,500 toward a $5,000 insulin pump, with no coverage for supplies. As I understand, supplies can run up to $400 a month.
We have a separate prescription network plan that covers medications, insulin, syringes, lancets, insulin pens and glucose test strips-all insulin delivery systems, except those used with the insulin pump.
I would like to get this discrepancy rectified. I've discovered that many insurance companies separate items: the pump is durable equipment and the supplies fall under prescription coverage. There is no specific mention of the insulin pump in our current policy. Could anyone offer advice as to how I might go about a chance in policy? Any input would be greatly appreciated. Please feel free to call me.
Fort Myers, Florida
A: Some insurance companies will cover the insulin infusion pump and related supplies under the major medical benefit of the plan, but for the most part these products are considered durable medical equipment by the majority of insurance policies. It is also true that some insurance plans cover the insulin pump supplies under the prescription benefit of the plan but this is very rare.
The best way to go about getting a change on your plan benefits is to go back to the employer and make suggestions for changes. Many employers offer different options to choose from as well. Some states have mandates for diabetes management. You can check with your state insurance commissioner for this information.
I nsurance Department Supervisor