Diabetes on Birth Control

One of the biggest fears of any single young woman is getting pregnant. I feel this is tenfold now that I have Type 1 diabetes. The stress of affording my own health care is enough – I don’t want the added physical and emotional burden of surviving pregnancy with diabetes much less affording my child’s coverage (given the possibility that the child will also have diabetes). No one can yet prove that my diagnosis was a result of genetics, but they cannot disprove it, either. I’d rather not take the chance.

In the past five years, I have attempted different types of birth control. The pill was always the easiest and most reliable option, but low and behold, no matter how many different types I tried, it always had a negative impact on my blood sugar readings and insulin resistance. What does this mean?

Well, while on the pill, my blood sugar skyrocketed, and I needed to take more insulin to keep it stable, but then, during the week of my period when I wasn’t on the pill, my blood sugar plummeted so that I would experience severe lows and have to readjust my insulin to carb ratio. You would think I could account for this every month, and believe me, I tried, but there was no telling when that initial plummet would happen. Sometimes, it was a few days before my period; sometimes, a few days after. The following week when I started taking the pill again, my blood sugar would rise so that I would constantly be adjusting my insulin to carbohydrate ratio until I got it right. It seemed to vary month to month.

Because I was tired of the constant ups and downs and the effect the pill had on my hormones and my emotional sanity, a few months ago, I stopped taking it. Cold turkey. I knew my body before I started the pill and relied on its natural cycle, but that was before I committed myself to long-term relationships. Now it was time to trust it again. It certainly improved my blood sugar readings.

While on the pill, I was taking up to one unit of insulin per 14 grams of carbohydrates in addition to a base insulin of .600 units my insulin pump administered every hour. After a few months free of its chained existence, I was taking one unit of insulin per 17 grams of carbs between the hours of 6 a.m. and 9:30 p.m., and one unit per 20 grams of carbs between 9:30 p.m. and 6 a.m. My base insulin dropped from .600 units every hour to .300 from midnight to 5 a.m., .375 from 5 a.m. to noon, .400 from noon to 7 p.m., and then .375 from 7 p.m. to midnight. My blood sugar readings have never been better.

Before             After

Base:    .600 units        .363 units (average)

Bolus:   1:14 grams       1:19 grams (average)

Needless to say, I’m done with the pill, but that age-old fear of pregnancy crept up on me again. I was finally at a point where I could stabilize my blood sugar levels and afford health coverage. If I became pregnant, all of that stability would come crashing down. Not to mention the toll it would take on my already suppressed body and the development of the child. I couldn’t do that to a child. I’m not ready to take that risk – that if I’m unable to control my blood sugar readings while pregnant, I could affect the child’s physical and mental development. That is one responsibility I’d rather avoid for now.

I wasn’t alone. A few friends and colleagues suggested I look into an IUD (intrauterine device). It’s a small, “T-shaped” device inserted into the uterus to prevent pregnancy. It is one of the most effective forms of birth control, can be removed at any time, and last anywhere from three to 12 years (depending on which one you choose). After looking at associated risks and benefits and consulting with multiple providers and those who had used it, I decided I would give it a try.

But this was before the Affordable Care Act was fully implemented on January 1, 2014. I was told my health insurance at the time would only cover 80 percent of the device after I reached my deductible. I was on a short-term, high-risk pool plan. I hadn’t met my deductible of $500, and I didn’t plan to since the plan ended in a few short months. What was the point in working towards a deductible for a plan I didn’t intend to keep? I figured if the device cost $200, I would go ahead and pay for it, but any more than that, and I’d have to consult my budget.

Of course, when I called the doctor’s office, they refused to tell me how much the device would cost. They said I needed to check with my insurance company. When I called my insurance company, they said they needed the billing code the doctor’s office would use so they could see how much it would cost. When I called my doctor’s office again, they gave me the billing code, and when I relayed it to my insurance company, they said they also needed the device’s medical code. Back and forth. Back and forth.

The doctor’s office refused to tell me the cost until it was processed through my insurance company. My insurance company could only say they would pay for 80 percent after I reached my deductible. I couldn’t believe that as the consumer, I was the one who would end up paying for the device, but no one would tell me the cost. Finally, I spoke to someone at the billing office at the doctor’s office, explaining that my deductible was $500 so if the device was going to cost me that much, I needed to be able to budget it, instead of receiving a surprise bill a few months later. She told me the cost: $494.

I didn’t end up getting the device. I figured I’d look into it again when I started a new long-term insurance plan. Of course, I ended up keeping the high-risk pool an extra month and paid $500 for a three-month supply of needed insulin pump equipment. All in hindsight, as they say.

But it still brings up an interesting point. If everyone is pushing for high deductible plans to lower health care costs, then as the consumer, don’t we have a right to know how much things cost? I’m tired of being the middle person, going back and forth between the insurance company and the doctor’s office. I am the one that’s being affected. I should be the one that has the ultimate say. But alas, I must learn to breathe beneath this avalanche, scooping snow to figure out which way is up.

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