When it comes to underwriting diabetics, it’s ALL about CONTROL. There are many contributing factors, but control is the most important, by a long shot.
And that control is measured by the “A1C”. Think of it this way—an average glucose reading is like a snapshot—a GIF, I guess—while the A1C is more of a video. Glucose readings can change drastically in the course of a donut, while an A1C measures diabetic control over a period of time.
So if you’re talking to a diabetic, here’s what we need to know:
- The most recent A1C. We’re looking for something in the 7.0 range. If you’re client can tell you theirs, that’s a good sign. Shows awareness, compliance. If they don’t—and most don’t—that might be a concern.
- Average glucose reading. The 100 range is great, but again, since this measurement can vary, some outlying tests can still be considered. Glucose is something diabetics tend to know, as they often test it themselves.
- Age at onset. Adult onset is much better from an underwriting perspective, but adult onset with lousy control can be worse than childhood onset with great control.
- Method of treatment. This can range from diet and exercise, to oral medication, to insulin. Insulin-dependent diabetics used to be an automatic decline, but today, we can write most of them.
- Other symptoms. Watch out for ways the diabetes is rearing its ugly head—protein in the urine, neuropathy (numbness of the limbs), retinopathy (vision issues resulting from the diabetes). These are tougher to write.
My father died from diabetic complications. By the time he died, he had a glass eye, a prosthesis, and had received a kidney/pancreas transplant. He lived for nearly 50 years as an insulin-dependent diabetic.
So we KNOW THIS IMPAIRMENT, and NOBODY works diabetes cases better than we do.
Some sample results:
- Female, 64. Diabetic since age 13, insulin-dependent. Tough case. But she shows tremendous compliance. Most recent A1C was 6.4, glucose 135. We got her a Table B offer.
- Male, 72. Big guy—6’2”, 225. Insulin dependent for the last 5 years (oral meds prior to that), A1C in the 7.9 range, glucose in the 160 range. And some mild neuropathy. We got this one Standard, believe it or not. Because with diabetics, older is better. The harsh truth is that something else will probably kill him first.
- Male, 42. Insulin-dependent since age 10, good control—Table D range.