March 12, 2014

Meth. or Insulin

“This is rather startling.” 

That was the opening paragraph of an email I received yesterday from Jeff Hitchcock. He’s not easily startled. What had caught his attention was a JAMA paper titled, “National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations.”

Just like the title says, the paper estimates Emergency Room visits for what is called IHEs or insulin-related hypoglycemia and errors. The authors’ figure is 97,648 IFEs annually, of which 29% result in hospitalization. 

Jeff had started totaling up the costs of all those visits. Emails like this make me think he likes to spin me up. Like I need help?

I found an article that puts the prices on these in another journal. The American Journal of Managed Care. There is a group that is going to be super geeky about costs, right? In, "The Incidence and Costs of Hypoglycemia in Type 2 Diabetes" they say, “costs for hypoglycemia visits were $17,564 for an inpatient admission, $1387 for an ED visit.” (remember ED here being Emergency Department, not the blue pill problem.) 

Easy enough to take the number of visits and multiply it out by the costs and - Son-Of-A...hypos are estimated to cost about $640 million a year

The JAMA piece goes on to say these IHEs are far more likely to be the elderly. “Insulin-treated patients 80 years or older were more than twice as likely to visit the ED and nearly 5 times as likely to be subsequently hospitalized for IHEs than those 45 to 64 years.” These are they very people who can’t get continuous glucose monitors (CGM) to help warn of hypos, because Medicare says CGMs are not medically necessary. 

I can think of over half a billion reasons why maybe they are needed.

Beyond the money, the JAMA piece says, “Severe neurologic sequelae* were documented in an estimated 60.6% of ED visits for IHEs, and blood glucose levels of 50 mg/dL or less were recorded in more than half of cases (53.4%).” (*I had to look sequelae up too. Thanks wikipedia, “Typically, a sequela is a chronic condition that is a complication of an acute condition that begins during that acute condition.”) So translating that here: Chronic neurologic conditions as a result of the acute event, aka hypos are, disproportionally hitting American seniors. 

That just ain’t right.  

Look at it this way, (I swear this is the citation I’ll drag out) says, “stimulants, including amphetamines and methamphetamine, were involved in 93,562 ED visits.”

Diabetes beats Breaking Bad.
97.8K ED visits for Team Insulin over 93.5k for Meth. et al.  

This is "rather startling." 

YDMV - so your term for what "This is ____" may be more colorful. I trust they will show up in the comments. 



  1. And this doesn't account for hyperglycemia, either. I bet that would add some significant numbers.

  2. GAH!!!

    Preaching to the choir but how in the WORLD can anyone look at those numbers and decide that those costs are better than CGMs for the people who want them (who are BEGGING for them)?

    I have never needed an ambulance or ER for a low (knock on wood) and I attribute that mostly to the fact that I was diagnosed in the era of CGM technology.

  3. Not sure yet it it is preaching or introducing the next few chords to the choir but yeah the choir matters.

  4. Wow. I had suspected all along (like many of us) that the results of denying CGMs to Medicare and other elderly patients were costing more than the savings from possibly saying yes to them.

    These numbers take a sledgehammer to the argument that CGMs are too expensive for seniors.

  5. More ammo for Sue from to get her husband's CGM covered by Medicare!!!

  6. There is a circular logic to denials for CGM systems, but CMS is very slow and under political influence in Congress, so we can't expect overnight changes. What we CAN do is make PWDs persistent pests to Medicare on this subject so we are constantly advocating for coverage. Maybe by the time I'm ready to retire, we can get these things covered!

  7. Wow! I really hope that all of us with Diabetes can get this changed. This is just insane.

  8. 40 yrs T1D, no complications, no ER visits since teen yrs due to evolving technology & excellent DSME. Anyone injecting / infusing insulin which can kill you with the slightest miscalculation (or simple periodic wonkiness of D ) should have covered access to CGM ! It can save a life. It can save healthcare $ on ER visits & complications. I've used it for ~10 yts now, you'd have to pry it out of my cold dead hands. (Which is what I might be should you take it.) Elderly, coverage yes ! Better get it Medicare covered period before we retire. (Now that we make it to retirement thanks to technology.)

    $ spent on diabetes care, education & technology SAVES money ! (I'm not an actuarial, but I'm sure someone could model this out.) Thanks for getting me fired up.

  9. Deb

    Thanks for the comment. Particularly the words about education. Good diabetes education is key. Getting educators paid is sadly tricky.

    See this piece by my friend Hope at StripSafely:

    There is a link from that to this , easy Tweeting of elected officials:

  10. Bennet, as a CDE myself . . . .I HEAR YOU !

    Great stuff from Hope. RE: Strips, I can't believe we are at risk of having LESS accurate BGM . . . .and to imagine being forced to use less accurate strips to calibrate CGM, essentially adding error. Not the direction we want to head !