Posts filed under 'diabetes'
Just when you think you can count on the life insurance underwriting guidelines, Glaxo SmithKline’s Avandia, becomes a curve ball that no one is sure how to handle.
Two US Senators released a confidential study that insinuates a strong link between Avandia and the occurrence of heart attacks.
While I’m not going to weigh in on the facts as the feds and the drug companies flail away on this one, I do want to bring up the kind of quandary this throws into life insurance underwriting and type 2 diabetes. Let’s say, for instance, that a person is shopping for life insurance. They have everything going for them. Late onset diabetes at age 55. A1c’s that are always 6.5 or under. No other risk factors like obesity or heart disease.
This person is going to get standard, possibly standard plus rates. But, from an underwriting standpoint, what if they way they’ve achieved the great control they have is with Avandia. What if they’ve controlled their diabetes but are at a greater risk of a heart attack due to the drug they are taking.
Well, the good news for the person wanting insurance, at least for now is that life insurance underwriters try to base most of their decisions on mortality studies. While I have heard some pretty big numbers being thrown around as far as the heart attack related deaths being attributed to Avandia, no measurable mortality risk has been attributed to the use of the drug.
Having said that, you can bet if there is a ban on Avandia, all bets will be off from an underwriting point of view.
Bottom line. Fortunately, life insurance underwriting is not real prone to knee jerk reactions to studies. For now at least, Avanida use, given good control, would get the same treatment as any other drug used for type 2 diabetes.
February 22nd, 2010
So, you have this life insurance policy and you don’t know if it’s a good deal or not, but it’s in force. That’s a good thing and actually far better than most folks have done. But what if there is a better deal out there?
I am amazed at the loyalty that people have to life insurance policies. The thing that amazes me is that there is generally not an agent that is actively staying in touch and servicing your business and in so many cases the loyalty isn’t to the company for their stellar financial ratings. Clients have often expressed to me that they kind of don’t feel right about switching because, I guess, they feel like that makes them a bad customer.
Let me try to put some perspective on this. The agent who sold you the policy was paid a commission. While most agents don’t agree, in this office that means you get our service for the life of that policy. Some customers feel a certain loyalty to me because I do stay in touch and help them with their questions. Some don’t.
But the norm is that you will buy a policy, be thanked for your business and you will never hear from the agent again. They made their money and they are done with that sale. Nothing personal. They just really don’t see the value in being their for their customers.
You should have no second thoughts at all about replacing a policy through me, good service and all, if you find a better deal, and you should certainly have no loyalty to someone who doesn’t remember your name after the commission check is cashed.
As for the company, let’s really get a grip. It’s going to happen one of two ways. Let’s say you have a policy for $500,000 for which you are paying the company $1000 a year. Let’s say 8 years into the policy you find a better deal. The company has been paid $8000, more than enough to pay for underwriting and any cost associated with putting the policy in force, and then some. So they make, say, $6000 and you cancel your policy and go elsewhere.
Now true, they would have loved to continue to get $1000 a year, but what they won’t miss is the chance to pay your family a $500,000 death benefit. Don’t take that wrong. Insurance companies stand ready to pay and pay without a fuss, but from a profit and loss standpoint, keeping the half million on their side of the ledger is a good thing. The longer you are a customer the higher the risk that they will pay out the big one.
So, are you hurting their feelings or messing them up when you replace their policy? The answer would be nope.
Bottom line. Whether your cholesterol has gotten better or you’ve lost weight and your diabetes is better controlled, or if you just got your last policy through one of those over priced no exam companies, shop it and don’t be bashful about replacing it if you find a better deal.
One other thing to keep in mind. A better deal isn’t always just price. How long the price is guaranteed is a huge factor also.
October 29th, 2009
I am currently working with a client who, when we got his labs back, was staring at an A1c of 10.9 and a microalbumin of 6.0. This, by the way is an instant decline since he was obviously has undiagnosed type 2 diabetes.
So what exactly does an A1c mean? Just how out of whack does your glucose need to be to equate to a 10.9?
Turns out that his average glucose, and this is including those readings that are good and low, is about 300. That isn’t good any way you look at it and obviously his kidneys are working overtime with his microalbumin at over twice normal.
When we started working on this case he and I both thought the only issue we were dealing with was his weight. He is obese and as I’ve written on frequently in the past, this is another example of just how obesity impacts other health issues.
Bottom line. Until he sees a doctor and gets the diabetes under good control we won’t be able to help him. Once controlled we should be able to get back on track.
Oh, by the way, great news. A type 1 diabetic that I had written about a month or so ago was approved today a rates that were better than we had quoted. Chalk one up for a great underwriter.
September 14th, 2009
Relieve that stress and get away from it all for a little camping. Pictured above is what a few thousand people call getting away from it all every year during the Ride the Rockies bicycle tour. A little bike ride through the mountains with 2000 people. What, are they nuts?
I have long contested that anxiety disorder is an affliction primarily contained to big cities which by my definition is any city that you can’t be out of by car in five minutes or less, preferably less. Between narrow, winding mountain roads, people on vacation in rented motor homes (they’ve never driven one before), 2000 bicycles and sleeping in tents just inches from each other, I can see how anxiety disorder, at least for me, could be cleverly cloaked as an “enjoyable getaway”.
I suppose if stress relief comes in the form of getting away from work and your normal routine, even something as crazy as Ride the Rockies might be just the right medicine.
Now, of course, to why I write this blog. How do life insurance underwriters look at anxiety disorders and what makes them comfortable about approving policies that really don’t penalize the poor people who live in, for instance, Denver?
I have often thrown out a list of underwriting thresholds that are used to evaluate bipolar disorder and make the comment that the list is also pertinent to anxiety disorder and depression. For the sake of this post I’ll tweek that list to specifically address anxiety.
1. Someone who has not been hospitalized for anxiety related issues other than for diagnosis?
2. Someone who is compliant with their treatment, both medications and regular followups?
3. Someone who, in spite of anxiety is leading a stable family life or social life?
4. Someone whose anxiety doesn’t impact a stable work life?
5. Someone who is not on disability for anxiety disorder.
6. Doesn’t need multiple medications to control the anxiety.
From an underwriting standpoint anxiety is much less complicated than bipolar disorder or depression and given the list above, which probably would include the majority of those with anxiety issues, good rates are certainly within reach.
Bottom line. I live in a small town called Salida, Colorado and without literally going hours out of my way, if I go to visit family in Wyoming I have to go through Denver. I have determined that I have transient anxiety disorder. It disrupts my mood to drive through Denver. But that’s all personal and not relevant to the poor, medicated people that live there.
June 17th, 2009
For years there has been plenty of debate in the medical community over the best measure for diagnosis of diabetes, or more specifically, which test gives the most accurate assessment for that diagnosis.
For years life insurance companies have used the A1c as a measure of whether a person is pre-diabetic, diabetic, and if they are diabetic, how well controlled the situation is. The reason they have used and I think the most valid argument for the medical community to use it as a baseline is that, simply put, it is less volatile than glucose testing.
A fasting glucose test, a snapshot at best, only tells the doctor what is going on at that very second in time. It is not unusual for someone who is undeniably diabetic to be able to produce stellar fasting glucose tests. On the other hand with the A1c, it is virtually impossible to miss the fact that, on average, a person’s glucose is running well above guideline normal.
Now with the major world diabetes organizations leaning toward using the hbA1c as the default test for the medical community, patients will have quicker, more accurate diagnosis which will lead to earlier treatment intervention.
As an aside, it will also lead to a little less fuss between insurance underwriters and medical practitioners. If adopted, the guideline discussed of making an A1c of 6.5 the guideline for diagnosis of diabetes will also match up with most insurance companies that work well with diabetes as their cutoff for their best rate class offered with the disease.
Bottom line. I think anyone that has been around diabetes for long knows just how whacky single glucose readings can be. Everyone will find adoption of the A1c to be a prudent move.
June 5th, 2009
No, no. I don’t really think I’m special. Family nickname and joke. “Ed’s done so well they named an entire school curriculum after him.” Ha Ha! Today I want to reflect on this, my 1000th post, and the journey and events of the last 2 1/2 years getting here.
I write about life insurance because I am really passionate about what I do. I believe in the product. I’ve seen the results of having it and I’ve seen the calamity of a family death in the absence of it. I’ve talked with widows in both situations and there is a common thread, they both believe in the importance of life insurance.
I’ve found that the more I write, the more opinionated I get. I used to think that you just can’t fix stupid and now I’m on a mission to do just exactly that. I truly believe that if I stand on my cyber soap box and yell long and loud enough, that even the hardest of heads out there will suffer a crack and some common sense will leak in.
I believe with all my heart that the under served life insurance clients of the world deserve the best possible service that I and my staff and the great insurance companies we work with can provide. I believe with all my heart that idiot life insurance companies that decline perfectly well controlled cases of bipolar disorder just because it’s bipolar disorder should have to disclose on their websites those impairments that they don’t want to participate in. I believe with all my heart that agents that take applications for clients with issues such as cancer history, diabetes, heart disease or depression without knowing the company underwriting stance on those issues, should have to leave the business and not come back.
We have made huge gains through this forum for the under served and no group more so than the issues of bipolar disorder and depression. Nearly every client who found us through this blog and was ultimately helped had been declined at least once. It was not uncommon for them to have been declined 2, 3 or 4 times. It is my passion to save or salvage as many people as possible from that degrading useless treatment.
I have used this forum to pound on products that are a rip off to clients sold by agents who profit greatly from those sales. I get my head ripped off occasionally, but if I give people some reason to pause and rethink what is being proposed before they buy whole life insurance or sell their term insurance policy in a life settlement or purchase any kind of policy that isn’t absolutely fully guaranteed then I’ve helped. If I can bail someone out of a crashing universal life or variable universal life before it collapses and they lose everything they were coerced into “investing” I’ve helped. If I can get someone a better rate because they and their agent didn’t know all of the options available, I’ve helped.
If I occasionally rip some heads off, it’s only because I think the life insurance buying public deserves to know. It’s true that I think Suze Orman is a life insurance idiot and it’s true that I believe Selectquote uses advertising that borders on bait and switch. It’s true that I don’t think Zander Insurance does as good a job as Dave Ramsey believes and it’s absolutely true that i don’t believe that the biggest of the online agencies give good customer service. I believe all of us old folks need to know that AARP is not where you should buy your insurance and that New York Life should be ashamed of the products they offer us through AARP. There is no reason for me to hold back on these opinions and plenty of room on the soapbox for those who have joined in the rant.
I have been zealous about educating as well as encouraging self education when it comes to personal health issues. I have shared the last years of my father’s life taken by cancer and my mother’s battle won over breast cancer in the hope that the information would be of value. If a client truly understands their health issue they will deal with it more effectively, live longer and be in a more powerful position to apply for and receive better life insurance rates.
So, for 2 1/2 years I have done my best to make sure that life insurance and the life insurance business is better understood than it was before. I have done my best to make sure the rules are posted where everyone can read them so people can make an intelligent choice as to what team they want to play on. I have done my best, as my Lord would want it, to be a servant to all I can.
Bottom line. It’s a rapidly changing landscape in the life insurance business and because of that I suspect the next 1000 posts will come quicker and provide even more crucial guidance. There is work to be done with financial times tougher and the needs for some bastion of financial stability falling not on investments or houses, but on the rock solid guarantees of life insurance.
My heartfelt gratitude to my office manager/internet translator/great friend Kyra Clark for teaching me what a blog is and encouraging me to try it. I will withhold my opinion on her advise to join the Twitter voice for a while.
June 2nd, 2009
I’m going to make up some statistics for the sake of this discussion. They may not be completely accurate, but I suspect they are close enough for government work. Do I get TARP money for saying that?
It is my belief that 75% of men don’t know what their lipid panel values are. A lipid panel would be total cholesterol, hdl, ldl, and triglycerides. I arrived at 75% because a recent study indicated that slightly less than 50% of men get annual physicals and I’m figuring the guys who do get physicals are still guys, so half of them don’t even look at the results. Quick, what is your total cholesterol, hdl and ldl?
The other reason I suspect the number of cholesterol ignorant men is high is because a surprisingly large number of them seem surprised when they take a life insurance exam and find out that they are going to have to pay a higher rate because it their cholesterol is higher or their hdl lower than the rate class they applied for will support and honestly, more than likely, higher than their doctor would condone if they would ever go see him.
So, having told it like it is I thought I would share with all of my fellow men some info from dlife.com, a diabetes support website, on how to lower your cholesterol before you go to the doctor or take an insurance exam.
Bottom line. Healthy is a good thing whether it’s for insurance or just because you might live longer. But you can’t tell how healthy you are by how you feel or look. Even if it’s just the health fair let’s work on it guys and see if we can get those percentages to where we don’t act like an endangered species.
June 2nd, 2009
I’ve written before about the dramatic and often amazing results that extremely overweight people have see in regards to their diabetes when they undergo gastric bypass surgery.
Gastric bypass is a procedure that essentially creates a dramatically smaller stomach by stapling off the majority of the stomach and leaving just a “pouch” for the food to pass through. With this much smaller stomach a person gets full quicker, and that combined with eating the right things, a healthy diet, creates rapid weight loss and in many cases an almost instant reversal or cure of type 2 diabetes.
Such is the case in an interview posted by TuDiabetes today. The story tells about a woman whose diabetes was really poorly controlled even on medication and within a week of the bypass she was able to come off of medications completely and her glucose levels were lower than they had been in years.
The decision to have gastric bypass surgery is not to be taken lightly and has risks that need to be considered, but for many those risks pale in comparison to the risks face by continued obesity and out of control diabetes. There really is no soft way to explain how damaging the combination is and how it can lead quickly to a loss of the quality of life, if not the loss of life itself.
Life insurance underwriters view gastric bypass carefully knowing that there are risks from the surgery and the dramatic weight loss for the first year or so, but within a few years the weight loss and improved overall health often lead to much better rates than a person would have received prior to the surgery, if they were insurable at all at that point.
Bottom line. Gastric bypass has always had a stigma attached, just as obesity has. To put it bluntly, there are a lot of people who probably say under their breath that it’s just a case of a fat person taking the easy way out. But let’s be real. There isn’t anything easy about the situation they are in and when they choose the surgery there’s nothing easy about the way out…..and it saved and changed their lives.
May 29th, 2009
American Heart Association twitter this morning, “80% of sudden cardiac arrest victims collapse at home. Are you ready to save someone you love?” It provided a link to a CPR website.
This Twitter @HeartofDiabetes is all about education on the link between diabetes and heart disease. This is a subject that we have continually talked about, the fact that when a life insurance underwriter looks at obesity and/or type 2 diabetes, they know that without effective management and excellent control other health issues are likely to follow. It’s not like the only thing they have to weigh is the chance of a person with diabetes going into a diabetic coma.
It’s the combination of risk factors and collateral health issues that an underwriter has to weigh when they consider an application. Especially in the overweight population having type 2 diabetes puts them at risk of high blood pressure, stroke, coronary artery disease and kidney damage along with a host of issues that have a lower mortality risk. The key to avoiding the downhill slide into health issues that will change your life and can end your life is taking the situation seriously.
Education, compliance and control should be the mantra. Know about your diabetes. Know what it is, what makes it worse and what makes it better. Know how worse and better are measured. Educate yourself on diet and exercise programs. Learn about the direct correlation between obesity and diabetes. Learn what the hbA1c is and why it’s important to keep it in a controlled range.
Compliance is all about listening to your doctor and following recommendations and prescribed treatment. When you don’t feel like you’re getting the information you need from your doctor, finding a diabetes education forum or a professional diabetes educator to help you take control of your condition and your life.
The good news with life insurance is that a diagnosis of diabetes doesn’t knock you out of the running for competitive, affordable life insurance rates. Given good control and no other risk factors, standard or better rates are not uncommon. If you are over age 60 and diagnosed in the last 5 years you actually have a good shot at preferred plus rates with one of our companies.
Bottom line. Diabetes is a destructive disease if not taken seriously. The diagnosis is a wake up call that you should definitely not be hitting the snooze button on.
May 29th, 2009
Guilty as charged. I am one of those recovering saltaholics that grabs the salt shaker and tops off a meal before I’ve even taken a bite to see if it needs it. I love salt and although I am getting better about at least giving something a taste first, the truth is, well, I’m still recovering and fall off the wagon occasionally.
A high salt/low potassium diet is a pretty reliable ticket to the land of high blood pressure, stroke and some types of asthma. A topic of considerable attention lately has been the unbelievable amounts of sodium found in some of the most popular dishes in some of the most popular restaurants most of go to at least occasionally. Sometimes it seems to me that restaurants offerings are kind of self defeating. They make meals taste good by adding large amounts of salt and it often tastes so good that people are driven to eat every last bite, which unchecked leads to obesity.
Now perspective is a good thing. No reason to freak out if there really isn’t a reason, right? They (whoever they are) say that the maximum sodium intake for an adult should be about one teaspoon daily. I am an admitted saltaholic and if I were presented with a salt free day’s worth of meals, I doubt that I would add an entire teaspoon over the course of a day. That’s a lot of salt!
My downfall comes when I eat dinner out at a restaurant that knows two things for sure. 1. We, as a nation, love salt and want it on most everything we eat and 2. The more salt we eat the more beverages we tend to drink. Chili’s restaurants are one of the most consistent abusers of sodium out there. That one teaspoon is roughly equal to 2300 mg. Just a few of Chili’s sodium busting treats are their boneless buffalo chicken salad which sounds healthy but has 4400 mg of sodium, about twice what you should take in on a daily basis. Then there is their Southern Smokehouse Bacon Big Mouth Burger which tops the sodium scale at 4150 mg.
PF Changs has proven to be the king of salt. Their Hot and Sour Soup Bowl tips the scales at an amazing 6878 mg. 3 times the daily recommended maximum in one bowl of soup. I’m wondering if that soup really, really tastes bad and they hope that enough salt will cover it up.
Given the kind of abuse your body goes through at these restaurants, it’s a wonder that life insurance applications don’t ask where and how often you eat meals out. While hypertension and even a stroke can be underwritten at good rates, if a person is hanging out at the who’s who of salty foods, they have to present a higher mortality risk than those who actually monitor their salt intake at almost any level.
Bottom line. Eating right is simply not part of the American way of life and our habit of ignoring how food is prepared, especially the salt and fat that is used, is a recipe for obesity, type 2 diabetes, high blood pressure and stroke. It may be time to ask for sodium confessions before we order a meal.
May 18th, 2009
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