Oct 1, 2020

It took a car accident – and workplace benefits – for Nadine to get her diabetes device covered

Nadine Sowik has type 1 diabetes and hypoglycemia unawareness, which she says makes a continuous glucose monitor a necessity. But insurance wouldn’t cover it until a nearly catastrophic car...

Nadine Sowik with car
Nadine Sowik has type 1 diabetes and hypoglycemia unawareness, which she says makes a continuous glucose monitor a necessity. But insurance wouldn’t cover it until a nearly catastrophic car crash.

Nadine Sowik, a Vancouver care home worker who lives in Surrey, sometimes marvels at how far diabetes management has come. She was diagnosed with Type 1 diabetes at the age of 21, in 1983. Since then, her ability to manage her blood sugar levels is “1,000 times better than it was.”

“There were no glucose meters in those days,” she says. “I checked my sugar levels by peeing on strips and I gave myself two needles of insulin a day. I did that for many years, moving to more injections, different types of insulin, and always having a lot of trouble with hypoglycemia (low blood sugar). My sugar levels would drop without me being aware of it.”

Through her journey with diabetes, Nadine has struggled with hypoglycemia, which can have symptoms including trembling, anxiety, nausea, confusion and drowsiness. But Nadine also has a condition known as “hypoglycemia unawareness”, which means she feels few or no symptoms before falling unconscious or experiencing significant confusion. For people like Nadine, it’s not that they don’t notice the signs – it’s that there may not be signs to notice.

“I wanted an insulin pump (a device that lets patients deliver insulin by pressing a button) but my endocrinologist told me I wasn’t a good candidate. Later, I left his practice for other reasons.  For the next five years my GP handled my diabetes concerns. After an acquaintance told me how much she liked her insulin pump, I got a referral to another endocrinologist, who said I was a great candidate for a pump.”

Nadine’s first insulin pump was covered by her work insurance. But what wasn’t covered was a Continuous Glucose Monitor (CGM), a device that measures glucose levels automatically using sensors under the skin. CGM was appealing to Nadine because of her hypoglycemia unawareness. Since she doesn’t experience early signs of hypoglycemia, the CGM could help give her warnings when her body doesn’t.

BC PharmaCare also denied her application for CGM coverage. The reason they gave was that she hadn’t explored all her other options. “I honestly don’t think the health ministry understood what I was asking for,” she says.

Nadine did eventually get coverage for the CGM she needed. But she wouldn’t recommend her path to others. It started in February 2019, when she was involved in a serious car accident.

“I’d had no signals that my sugar was low but I must have passed out,” she explains. “The police thought I was drunk and arrested me. Three other cars were involved, and although everyone was okay, I felt I was the world’s worst person for causing the accident. I was off work for three weeks and went into counselling.”

“My endocrinologist tried twice with my work insurance to get me coverage for sensors before my car accident” she reflects. “Both requests were denied. The second request was in review but was denied the day after my accident because ‘my condition does not meet the medical criteria’.”

That made up her mind. Nadine decided that she had to have an HCL (hybrid closed loop) system to prevent a similar hypoglycemic incident from happening again. A HCL system is an insulin pump that works with a CGM) sensor to adjust insulin levels every five minutes to make sure glucose levels stay in the right range.

As result of the accident and at the urging of Nadine’s endocrinologist, her work insurance has since agreed to provide partial coverage of ongoing CGM expenses. She reapplied to BC PharmaCare for at least some help covering the monitor, but still hasn’t heard back despite her several follow-ups. But, for Nadine, the monitor shouldn’t be considered a “nice-to-have” – she believes it would prevent accidents like hers “If I had coverage for the CGM, regardless from where, this car accident could have been avoided.”

Now that she finally has the CGM, it’s been a life-changer. “The alarms tell me of the risk of hypoglycemia, so I have to eat, and I’m also notified of highs. I’m in range about 70 percent of the time now.” Nadine refers to her target range of blood sugar levels, which can vary from patient to patient.  I wouldn’t trade it for the world, but I live on a single income. If I didn’t have a union job with benefits, I couldn’t afford to have an insulin pump or CGM.”

Not everyone has her kind of coverage. The experience of people like Nadine show the advantages of a HCL system with a CGM that automates the delivery of background insulin to keep her, and people around her safe. But her experience also shows there might be a need for doctors and other healthcare decision-makers to learn more about the range of options out there, and how they’re covered.

Nadine has seen first-hand how much type 1 diabetes management has evolved. She knows she’s one of the fortunate few to have coverage for the system she has today. Although the government is considering covering CGM, it currently remains cost-prohibitive for some who face similar struggles as Nadine. And in her eyes, better coverage might have prevented her four-way car crash.

Diabetes Canada is campaigning to make CGM affordable and accessible. Learn more or send an email to your provincial representative at .

This story was created by Content Works, Postmedia’s commercial content division on behalf of Medtronic