Bigger is sometimes better: medical aid schemes

Craig McLuckie, a father, tells us why he opted for more comprehensive medical aid scheme once his son was diagnosed with diabetes.

Parenting a sickly son

As parents, we all want the very best for our children. When my second son Ethan was born, in 2007, he had a cleft of the soft palate (the soft tissue at the back of your mouth). This was corrected surgically when he was three months old. After the operation, he really started thriving. So, my wife, Rita, and I put it behind us, looking forward to our child leading a normal, healthy life. Unfortunately, a curve ball was thrown our way.

When Ethan was 16 months old, we were visiting family, in Pietermaritzburg, and the little guy took a bit of a turn. We could not keep up with the nappy changes as he was wetting them at a rapid rate. This of course went hand-in-hand with his insatiable thirst.

Life-long chronic condition

For anybody living with diabetes these are classic symptoms of high blood sugars but at the time I didn’t put two and two together. The surprising thing is how quickly his condition deteriorated and by the following day he was lethargic. Unbeknownst to us he was in a ketogenic state due to his body utilising fatty acids as a fuel source and producing acidic ketones as a by-product. We quickly ended up at the paediatrician, who upon diagnosing Ethan as a Type 1 diabetic, referred us to an endocrinologist.

This is really where our journey begins. I remember sitting with the endocrinologist in his office and looking out the window thinking what a lovely day it was, whilst being told Ethan had this life-long chronic condition. It was quite surreal and bewildering – with the introduction to the different types of insulins (long-, medium- and short-acting); the injecting; what to watch out for, such as the highs and lows; and the dietary requirements. We went home with this package of medication, paraphernalia and our little boy. Our lives as parents of a ‘Kid Powered by Insulin’ had begun.

Medical aid troubles

I had to now begin the process of getting the medical aid approval for Ethan’s chronic medications. At the time, I was with a smaller scheme and I quickly realised that their understanding of diabetes mellitus Type 1 was quite skewed. Their diabetic nurse educator told me if Ethan ate correctly he would be cured and would not need insulin!

In addition, they would only cover 30 needles for injecting, the insulins and 100 glucose test strips per month. Anybody living with diabetes will tell you this is nowhere near enough, especially for a young child whose sugar levels can be quite erratic.

Furthermore, all doctors’ consultation fees came out of our savings and thus we incurred numerous of out-of-the pocket expenses. Diabetes is not a cheap condition to live with.

Great discovery

Based on the advice of Ethan’s health carers and friends we ‘discovered’ a medical aid that was much more in tune with a diabetic’s needs – particularly children.

We also registered with the Centre for Diabetes and Endocrinology (CDE) and their management programme. This helps a great deal as we get access to diabetes educators, endocrinologists and dietitians throughout the year without impacting on our medical savings.

Game changers

The primary aim in treating diabetes is to manage it well to prevent complications, both short- and long-term. Every day one is faced with new challenges: What is your child eating? How active are they? Are they ill? These factors will affect blood sugar levels. Being able to accurately dose with insulin is very important.

Here is where the first of our game changers comes in: the insulin pump. Not having to inject your child multiple times during the day and being able to administer very small, accurate insulin dosages is a godsend. It is also imperative that you (or the older child) can monitor blood sugars.

This is where continuous blood glucose monitoring (CBGM) comes in. For us the CBGM has been our second game changer. The system usually consists of a transmitter that attaches to the body and a receiver that gives the readings. Our system gives a reading every five minutes or so and it alarms if the sugars are rapidly rising or dropping. It also allows monitoring of trends. The biggest advantage is the safety factor in being able to avoid low sugar events (and being able to sleep through at night!). The latest technology available can combine the pump and CBGM system.

The right medical aid

For every diabetes patient, it is critical to have the right medical aid and be on the right option. A good medical aid will generally cover the cost of an insulin pump (approximately R30 000; one every three years). Although the consumables do come out of savings. Likewise, with the CBGM system.

The other cost to consider is the test strips as one will still need them as a backup and to calibrate the CBGM system. The insulin is actually the cheapest item.

Holistically speaking there is also the doctor and diabetes educator visits, and dietitians and other specialties if required. I estimate our monthly requirements comes to between R6 000 – R9 000. There is the temptation to buy down and choose a lower option but this means losing out on certain benefits. Affordability is the key issue. As a family, we have sacrificed on other luxuries to ensure we remain on the best option we can afford.


Craig McLuckie lives in Benoni, Gauteng. His youngest son, Ethan, has Type 1 diabetes.