Posts filed under 'Type 2 diabetes'
It’s been a while since I’ve brought this up, but let’s be very real about this. There is a type 2 diabetes epidemic going on in this country and it seems to be riding into town sitting squarely on the tail gate of the obesity epidemic.
So Ed, how many people does it take to screw in a light bulb? Wait. Wrong question. How many people does it take before someone believes a problem has reached epidemic proportions? Is 20 million enough? That’s how many people are estimated to have type 2 diabetes in America. Is 80-100 million enough. That is the number of BMI 30+ obese people are estimated to be tromping around the US. Since obesity is the leading culprit in adult onset type 2 diabetes, is anyone willing to say we have an epidemic sized problem on our hands?
That is the bad news. The good news is that for those who realize they have a problem and get the right treatment and control their health issues, life insurance can still be affordable. Very often people are led to believe that being overweight or having diabetes or heart disease is the end of their chance to have life insurance. It’s true that if a person is diagnosed with a serious health issue and can’t or doesn’t get it under control, it can make getting affordable life insurance hard to impossible. For those who accept the challenge and take control of their health, you can be right back in the middle of the life insurance pack at standard or better rates.
Bottom line. As a nation we need to come to grips with the epidemics. As individuals we need to come to grips with our personal lifestyles and future health. We can choose not to participate in the epidemic.
May 9th, 2008
My wife was telling me the other day about a man in our church who had been diagnosed with type 1 diabetes last week. He’s 40 something years old. I know that most type a diabetes onset is in early years, generally under 25, with the majority of it under age 15.
I also know that adult onset type 1 isn’t an unheard of thing. In fact I posted a blog not too long ago on type 1.5 LADA, essentially adult onset type 1 juvenile diabetes. It isn’t a take off on type 2. It is truly an insulin dependent late onset mutation. Anyway, we talked about the fact that we were able to find several reasonable life insurance offers on the case that brought 1.5 to my attention.
But where I was going with this has to do with the size of town I live in, about 6,000 people. Apparently last week our church friend was one of 10 people in our town that were diagnosed with adult onset type 1. I think, statistically speaking, that number is off the charts.
Bottom line. I hope to be able to interview the doctor (they were all seen by the same doctor) and get his take on how that could happen. Stay tuned.
May 8th, 2008
Just as we’ve discussed so often, with any number of health issues from heart disease to cancer to diabetes, the earlier it is detected the better the chances of controlling or stopping it before it causes irreparable harm.
With diabetes there have always been the old standby warning signs like family history and obesity, but now a study has shown promise of a blood test that will possibly reveal markers for early detection of type 2 diabetes.
Since type 2 diabetes can lead to a whole host of other health issues (as if it weren’t enough on its’ own), catching it before it’s even had time to fully manifest itself could possibly give a person a chance to make changes that could head it off before it even becomes an issue. Finding these markers may even lead to breakthroughs in actual prevention.
From a life insurance view, type 2 diabetes, if well controlled and in the absence of other risk factors can still garner standard or better rates. The criteria in general for getting the best rates with type 2 diabetes are:
1. Age of onset after 50
2. hbA1c under 6.5
3. History of compliance with treatment
4. No other risk factors or side effects such as obesity, CAD, gluacoma, neuropathy, etc.
Bottom line. Don’t give up looking for life insurance if you have diabetes. Most companies don’t want your business, but a good independent agent will be able to steer you in the right direction.
April 29th, 2008
I get so tired of doctors (what’s new?) who make a diagnosis and just give people prescriptions and basically just tell them to go away and take their medicine.
My office manager’s mother was recently diagnosed as being type 2 diabetic. She was put on Metformin and told to come back in three months for a checkup. Being a good working knowledge of diabetes from having work on literally hundreds of cases in her career in life insurance, she began to ask her mother questions. What was her A1c? Mom didn’t know. What did the doctor suggest to do other than take the medication? Nothing. What was the diagnosis based on? A one time glucose reading of 113!!! Were there any other labs out of normal? Didn’t know. Did the doctor discuss what’s normal and what it would take to get back to normal on a long term basis? No!!!
This guy is a quack of the worst kind. No retest. No A1c. No recommendation to try diet and exercise first. No education as to why he recommended what he did and what type 2 diabetes means in the whole scheme of things.
Bottom line. I think every exam room should have a computer link to Google so that when a doctor makes a diagnosis, they can immediately pull up information for a client and discuss and print it out so that the client understands their diagnosis or misdiagnoses, what their options are and what their prognosis should be given the different options. Doctors that just write prescriptions and turn and walk out should be given a CDL and told to go drive trucks for a living.
April 21st, 2008
I watched a program on 60 minutes last night that reviewed the impact of gastric bypass surgery not just on obesity, but on all of the other risk factors that a person takes on when they are overweight. The results weren’t surprising, but rather affirming based on my experience of working with people who have battle obesity and won.
The stories of the eight people they interviewed were all dramatic in their own right. One lost 160 pounds, another 96 pounds, another 130 pounds and one lost 260 pounds. Incredible weight loss. All 8 of them had type 2 diabetes prior to the gastric bypass. All 8 of them are now off of medication and no longer have diabetes. Some of them had sleep apnea and now none of them do.
One of the 8 was a doctor who had always recommended gastric bypass as a measure of last resort. He now says that he believes the benefits far outweigh the risks in the morbidly obese and believes that more people should consider the surgery rather than face a life of increased risk of diabetes, heart disease and cancer.
Life insurance companies are often characterized as beating up on the overweight by offering them higher rates than those who, according to their build charts, are less of a risk. I know the feeling of being offered a higher rate than I think I deserve, but the reality is that when it comes to obesity there are so many potential collateral health issues, that companies aren’t over reacting. The best that someone who is overweight can hope for is to lock in as good a rate as they can before they have any other health issues. After getting coverage they should go about reducing the risk through weight loss whether by diet, exercise, gastric bypass or stomach banding and then reapply for a better rate. The truth is that the life insurance rate shouldn’t be the impetus to take the necessary steps. Prolonging your life should be reason enough.
Another statistic that came from the show, a rather amazing thing when you look at the long term success of diet and exercise, is that between 80 and 90% of those who have gastric bypass don’t regain the weight. And, with the procedure now done almost always laproscopically, it is much safer than in the past.
Bottom line. It should be for your own life and health, but if the reason is for better life insurance, the end result is the same. Lose the weight and your chances of serious disease go down, way down. Lose the weight and you live longer and have more fun, way more fun. Do it because it’s the right thing to do.
April 21st, 2008
There’s really never been bad news when it comes to life insurance underwriting of type 2 diabetes. Would people with diabetes like to pay less for life insurance? Of course they would, which puts them in the same boat with all of us who don’t have diabetes.
Are they paying too much? You know, I would have to answer that question with a resounding no. Life insurance these days, especially term insurance, is such a bargain that really the limiting factor is usually what rate class a person is approved at, but rather are they willing to budget the money for life insurance.
I have frequently compared the underwriting of diabetes to underwriting bipolar disorder or any of the maladies that really do take an aggressive commitment to treatment and control. With diabetes, lack of control can lead to other health issues, and the further down that road a person slips, the less likely they are to find affordable life insurance.
We’ve covered these criteria before, but it never hurts to revisit exactly what life insurance underwriters are looking for. Age of diagnosis is important. That is one of the tough things with type 1 diabetes. Age of onset is generally fairly early in life and the truth is that the longer your body has to cope with diabetes and the potential risk factors, the more likely a person is to fall into collateral health issues. With type 2 diabetes there is an underwriting difference between onset before 40, 40-50, and after 50. The older the onset the more favorable the underwriting. It remains to be seen how underwriting will handle the coming wave of early (teens-30’s) onset.
Control is another big factor. Generally this is measured by the hbA1c, a long term measure of glucose levels. While life insurance underwriters are generally a little more stringent than the ADA recommendations, the ADA isn’t in the insurance business. The truth is that the ADA fails to address life insurance at all for all their claims to be diabetes advocates, but that’s for another post on another day.
Lastly, the underwriters want to see compliance. Nothing bugs an underwriter toward higher rates than reading medical records of someone who isn’t consistent with their prescribed treatment. Only taking medication when you feel like you need it is almost always taking it too late.
Bottom line. There are very competitive rates available to people with diabetes. At least for those who have accepted the challenge and are meeting it.
March 2nd, 2008
Well, just when life insurance underwriters and doctors think they’re on the same page, and they believe it’s the right page, someone kicks the door down and throws a wrench in their thinking.
In search of a way to control diabetes, and specifically type 2 diabetes, the goal has alway been lower glucose levels. The American Diabetes Association has indicated for years that those with diabetes should strive to get their blood sugar as close to normal as possible. They advocate an hbA1c of under 7. Insurance companies have suggested by way of their rate class underwriting that real control is demonstrated with A1c’s under 6.5 and preferably under 6.
The belief has always been that lower glucose levels lessen the risk of heart disease. Now a major federal study has been partially halted because just the opposite result is occurring. The incidence of onset of heart disease was significantly higher in those who were physically and medically pushed to keep the blood sugar at near non-diabetic levels than in those who were steered toward a more moderate control.
This news has doctors and scientists scrambling to try to determine how they could have had it so wrong.
Bottom line. It’s not likely you will see a shift in life insurance underwriting unless further studies come to the same conclusion. Better than standard rates will still take an hbA1c below 6.5, onset after age 50 and all other risk factors in control.
February 7th, 2008
With all the political spin put on health care and how to handle all of those who are uninsured or under insured, maybe, just maybe, the emphasis ought to be on education and prevention as much as or even more than treatment.
A study just released shows that type 2 diabetes is exacting a heavy toll, not only in health care costs, but in lost time and lost lives. The incidence of newly diagnosed diabetes is growing at an alarming rate, and it isn’t “adult onset”, the traditional type 2. More and more there are children being diagnosed. The study showed that there were 63% more people with diabetes in 2004 than there were in 1994. The scary part is that this study was only done on insured people.
If diabetes is rampant in those with insurance, what is going on with the tens of millions of uninsured people. And if the numbers are increasing so rapidly among those with insurance, what does that say about the quality of medical care that is being offered. There is obviously very little emphasis put on prevention. It is a rare case of type 2 diabetes that just pops up out of nowhere. Generally a person diagnosed with diabetes should have seen that one coming.
The study also showed that there is a much higher incidence of kidney failure associated with type 2 diabetes during the study period. Again, since all of these folks were insured, the quality of the medical care has to be questioned. Diabetes has to be in a fairly uncontrolled state in order to cause kidney damage. That means that education is lacking and people, even if it’s covered by insurance, are not being compliant with their treatment.
Bottom line. Underwriting for life insurance looks for compliance and control in diabetes. Life insurance underwriters are very aware that poorly controlled or uncontrolled diabetes is a problem that carries a viciously high mortality rate. They don’t want anything to do with that type of risk, at least not at reasonable rates. Juvenile onset of type 2 diabetes is a real problem. Underwriters are fussy about people diagnosed in their 30’s and 40’s. What are they going to do when the teenagers of today reach adulthood with 20 years of diabetes under their belt and want life insurance? Will they be insurable at all? The only chance I can see of that happening is if they have really taken charge and are controlling it religiously.
February 2nd, 2008
With my 2007 reward for Redundiferous Excellence safely tucked away on my office shelf, I am, like Tiger Woods and the Fedex Cup, shooting for two in a row. I hope that I have left no chance unturned to drive home the point that life insurance underwriters want to see compliance with treatment and control of the health issue, almost no matter what health impairment we’re talking about.
For years we have tried to be very clear about what it takes to get fair and affordable life insurance rates with diabetes, whether type 1 or type 2. Underwriters want to know that you are compliant with treatment and monitoring. They really like that a person is concerned enough to make sure they do all the right things. Doing this, in most cases, will lead to control of the disease, which will lend itself to better overall health and a better mortality assumption.
Bipolar disorder is no different. There are extreme cases where treatment helps, but just never seems to put the disorder back on the shelf from which it came, but in most cases bipolar can be controlled. Like diabetes, reasonable life insurance rates are available if the bipolar is not severe or debilitating. This is generally measured by whether or not a person has been hospitalized for it and how stable their life is. If a person is able to carry on a relatively normal family and work life, and they are compliant with recommended treatment, decent rates should be available.
Bottom line. Don’t buy into the normal life insurance agent knee jerk reaction that bipolar = decline. A good independent agent will know what questions to ask and what insurance companies to shop to find what you need.
January 28th, 2008
I was asked a few days ago to be interviewed, as a high school assignment, on the subject of obesity and insurance rates. The core question was concerning the fairness of charging higher rates for someone who is overweight. Rebecca Kuo, a student from Houston, TX was the interviewer. Her questions and my thoughts follow.
Alright, Mr. Hinerman! So I guess here are my first questions:
1. What kind of research have you been conducting on this issue? Has it influenced the way you feel about the issue? Over the past several years I have read literally hundreds of articles and studies concerning obesity and it’s impact on health and mortality. I have interviewed underwriters from several major insurance companies and have debated the merits of the build chart system used by most insurance companies.
What has influenced me most about the way I feel about obesity is the knowledge I’ve gained about all of the collateral health issues that can stem from obesity. It’s not just about being overweight. It’s about opening yourself up to a higher risk of heart disease, diabetes, cancer, high blood pressure, and on and on.
2. What do you personally feel about this issue? Have any personal experiences influenced your opinons? My personal feelings are mixed. On the one hand, I believe in most cases that obesity is the result of poor lifestyle choices and at some level I have a hard time mustering a lot empathy for self inflicted problems. On the other hand, as a life insurance professional, I work and work hard as an advocate for the best rates possible for everyone I work with, no matter how the health issue started.
I guess the one thing that stands out that bothers me about the overweight people I attempt to help is that there seems to be a higher than average willingness to just blow it off. We’re talking about life insurance, protection for their family, and to me, blowing it off is not a responsible option.
3. What do you propose to solve this issue and all of the controversy surrounding it? Solving the issue has to start early. Take Mississippi, the most obese state in the country. Those people don’t suddenly become overweight in adulthood. It starts with a childhood life style that comes straight from their parents. More education in school that leads children to healthier choices. Right now there isn’t anyone in school that is telling children about all of the problems that can come from obesity.
4. Obesity increases the risk of cancer, type 2 diabetes, heart disease, etc. Because of this, do you feel that obesity should factor into insurance rates? It has to be a factor. Insurance by its’ very nature spreads risk so that not all of the burden falls on those with the greatest chance of claims. Relieving them of all of the burden would be grossly unfair to people who take care of themselves and avoid health problems.
5. Would losing weight or having weight-loss surgery lower insurance rates? Why or why not? The answer to both is yes. Weight loss is conservatively viewed in the beginning because historically most weight loss is temporary. For that reason, underwriters want to see a track record of successful weight reduction. Weight loss surgery can also reduce rates, but again goals have to be reached before underwriters will jump on board. Weight loss after surgery is dramatic. Before lower rates can be considered, weight has to have been stable at the lower end for 1-2 years before full credit is given.
6. Do you feel that all insurance rates (health insurance, life insurance, etc.) should be equal for those who are obese or just one type? Obesity as a health issue doesn’t bring an underwriter to a one rate conclusion. Someone 5′10 and 250#’s would present a different risk than if they weighed 375#’s. Risk factors have to be viewed as well. Does the person have high blood pressure, diabetes, etc? One size doesn’t fit all.
7. The high cost of treating weight-related illnesses adds significant strain to the US’s health care system. Why do you feel that this is or isn’t fair in deciding overweight people’s insurance rates? Again, and this is my personal view, you have to go back to the root cause of the problem. I understand that insurance and health care systems are set up to spread risk, and to a point I am OK with that. But, if my health care costs become inordinately high because I am carrying too much of the burden of poor lifestyle choices by others, I’ve got a problem with that.
8. If a person admits that it’s their own fault for their obesity (sedentary lifestyle, etc), do you still feel that they deserve fair and equal insurance rates? If so, why? I believe they deserve fair insurance rates. They would probably define fair differently than me. We work hard to get the best possible rates for everyone, but the nature of life insurance is that those that present the most risk pay the most premium. That’s fair.
9. Where were you born, what kind of education have you received, how old are you? (just basic background questions) I was born in Wyoming and have lived my 54 years almost exclusively in the Rocky mountain states. I currently live in Colorado. I am marginally high school educated and just for the record, I have some regrets about not pursuing my education a bit more vigorously. Having said that, I am a successful businessman and don’t regret the outcome.
Bottom line. Obesity is so often the tip of the iceberg, the hole in the dike. Left unchecked, it can start a downward health spiral that no one in their right mind wants to venture in to.
January 24th, 2008
Next Posts
Previous Posts
