November 23, 2020
Medical Underwriting Corner: Diabetes Mellitus
This series better equips you for field underwriting.
In this series of the Medical Underwriting Corner, we’ll take a look at Diabetes Mellitus (DM). DM is a disorder of glucose metabolism, in which there is insufficient insulin produced by the pancreas resulting in elevated blood glucose levels.
There are two types of DM, Type 1 and Type 2:
- Type 1 is insulin dependent diabetes, which occurs when the pancreas is unable to produce any insulin. It is often diagnosed in childhood.
- Type 2 is a relative insulin resistance, in which insulin produced by the pancreas is less than required and / or not utilized by the cells of the body efficiently. This often occurs in overweight individuals and can be treated by oral medications, at least initially, but insulin may be used for better control.
Pre-diabetes (also known as Impaired Fasting Glucose and Impaired Glucose Tolerance) is a condition in which a person is identified as having a higher risk of developing DM over time. To lower the chances of progression to DM, an individual is advised to eat healthy, diet to lose weight and exercise.
In DM and pre-diabetes, the blood glucose and hemoglobin A1C (HbA1C) are both monitored. If medications are given, the goal is to bring those values back into a normal range.
A major risk of having DM is the future development of vascular disease. DM is a cardiac risk factor – a medical condition which if not well-controlled can lead to an increased risk of rapid build-up of atherosclerotic plaque in the arteries. This may result in coronary artery disease (CAD), heart attack, stroke, kidney disease (nephropathy), blindness (retinopathy), and numbness and tingling of the feet (neuropathy) due to insufficient blood flow to the legs and feet.
In underwriting life insurance, many risk factors are taken into consideration:
- Control of diabetes; HbA1C levels and blood glucose
- Compliance with treatment
- Age of onset
- Length of time since diagnoses
- Tobacco use
- Associated complications; including but not limited to, neuropathy nephropathy, and retinopathy.
- Other cardiac risk factors
Many of these factors can be assessed by questions on the application, the results of the paramedical exam and the laboratory tests done on blood and urine. The best offer is made whenever possible according to underwriting guidelines.
