As of the 2004 tax year, CRA will look at applications for the DTC using criteria proposed in legislation pending from the February 2005 budget.

What does this mean to you?

The most important thing that it means is that insulin delivery is no longer a deciding factor in defining Life Sustaining Therapy.  For those who have previously been approved because of insulin pump use, it means you will have to reapply under the new legislative guidelines. This does NOT mean that you no longer qualify, it simply means beginning the application process again.

If you are the parent of a child 14 years or younger, you must have a doctor sign the form T2201.  They are certifying that your child has Type 1 Diabetes.  Canada Revenue Agency (CRA) assumes that a child of this age, who has Type 1 Diabetes DOES require 14 hours of Life Sustaining Therapy when the amount of time spent by the parent is also factored in. 

If your child is over 14 or you are an adult, you will now have to prove that it takes you over 14 hours per week to perform Life Sustaining Therapy as required by your diabetes.  In your initial application, the more information you and your physician can provide, the easier the process will be.  There is still a good chance that your doctor will be sent a supplementary questionnaire to fill out and certify that you do require at least 14 hours per week to perform Life Sustaining Therapy. Once your doctor signs this second form noting tasks performed totalling 14 hours or more, you will be eligible for the DTC.

What tasks are included/defined as therapy in Type 1 diabetes?

• time spent to establish the insulin ratio but not the time spent totalling the number of carbohydrates eaten

• calibrating glucometer

• monitoring blood glucose

• maintaining log book and analyzing trends

• preparing insulin

• administering insulin (this is something that takes time out of your daily living. The time the pump spends delivering your insulin no longer counts)

• calibrating insulin pumps

• changing tubing

• rotating insertion sites

• programming the insulin pump

• treating and recuperating from hypoglycaemia when caused by a life event rather than human error.

Points to Remember for years prior to 2004

Please note that the following are simply guides--things that have worked for other parents. This is not meant to replace legal advise or counsel. If you have specific legal questions or concerns, please consult a professional.
 

• When your doctor fills out this form, please remind him that "feeding" is NOT bringing food to your mouth. In the case of this legislation feeding is defined as involving something more than eating a meal prepared by another person. One cannot feed oneself unless one is capable of taking basic foodstuffs in the form commonly available in a grocery store and cooking or otherwise preparing and setting out a meal. The test is feeding oneself, not simply eating a meal. The language of the legislation is clear in that respect. The requisite ability to feed oneself involves the ability to prepare a reasonable range of food and not just to prepare and set out snacks, junk foods or frozen dinners. One should also be able to match their dietary requirements to their medical needs. In the case of young children, they clearly cannot feed themselves.

• A person with Type 1 Diabetes does require Life Sustaining Therapy. Insulin is not therapy alone. It cannot be given like an aspirin but must be monitored in conjunction with diet, exercise, illness and more.

• Currently the CRA is recognizing only injection time as "therapy" For those on a pump, remember that injections are going on every time you bolus or a basal is delivered. Your other hurdle in this case is to prove that the pump is a medical necessity and not a lifestyle choice.

• If your child does NOT receive insulin therapy your child would die in approximately 72 hours. INSULIN (the therapy) is essential to sustain a vital function of your child, that is, all their body. INSULIN is require to be administered at least once, twice, or more times DAILY to survive. The total therapy required to maintain and manage your child with Type I is in EXCESS of 14 hours. We would suggest that if your child is awake they are being managed or supervised to maintain their life. Further, the last qualifier is obviously true for a Type 1 diabetes as insulin would never be administered to someone who has a healthy and functioning pancreas. If you inject insulin into a healthy person you will kill them.
   

Points to note in application/appeal/court request:

• ______was diagnosed with Type 1 (sometimes called Juvenile) diabetes in ____ and she/he has been insulin-dependent since that time

• Type 1 Diabetes is a disease and there is currently to no cure other than transplantation, a choice not offered to children or most adults. Insulin injection is the only therapy that reduces the effects and mortality rate associated with the disease.

• As will all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins, and fats is altered

• In Type 1 Diabetes, the beta cells no longer produce insulin. Insulin is required to allow glucose to enter the blood cells to be used as fuel

• Without insulin and monitoring of _____ blood sugars and the assessment of trends and adjustments in her/his insulin dosages, ____ will suffer hypoglycemia caused by too much insulin in her/his system and hyperglycemia caused by too little insulin in his/her system

• Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells causing hyperglycemia

• When suffering from hyperglycemia, the high levels of glucose in the diabetic’s blood causes the diabetic to urinate more which, in turn, causes excessive thirst

• When ____ has hyperglycemia, it means she/he does not have enough insulin in his/her body and this can result in her/him being very thirsty, tired, have blurred vision, frequent urination and nausea

• Hyperglycemia increases the risk for all types of strokes

• Without intervention and treatment for hyperglycemia caused by too little, or no insulin ____can develop Diabetic Ketoacidosis, a life-threatening complication of hyperglycemia.

• Diabetic Ketoacidosis, if untreated, is fatal

• With too much insulin in his/her body ____ blood glucose gets too low causing her/him to suffer from hypoglycemia

• When suffering from hypoglycemia, low levels of glucose in the body caused by too much insulin, the body does not have the energy required to function properly

• When ____suffers from mild-moderate hypoglycemia, or low blood sugar values, she/he feels weak, confused, irritable, hungry and tired.

• Without intervention and/or treatment for hypoglycemia ______ can develop severe hypoglycemia

• Severe hypoglycemia can cause unconsciousness, coma or even convulsions

• The Appellant submits that the claim for the Disability Tax Credit with respect to his/her dependant’s impairment is correct

• The Appellant claims under provision of the Act in the force for the year ____ and subsequent on the basis that, in the absence of insulin therapy his/her daughter/son’s basic activities of daily living would be markedly restricted; In fact, his/her daughter/son would die
   

Cases worth looking at and citing

• 1989] 1 S.C.R. R. v Tutton 1392
  Withholding insulin will kill your children resulting in criminal negligence.

• Court File No. 2002-1979(IT)I Dan Tammi v Her Majesty the Queen (This is an oral decision). Citation: 2004TCC93
  This is the best case found so far. It speaks directly to the difficulty of the daily management of someone who has Type I Diabetes ( this case deals with a six year old).

• [2004] TCC 420 Docket: 2004 – 763 (IT) I Sullivan v. The Queen
  In this case, the judge has broadened the definition of "therapy" to include time spent monitoring meals.

• [2004] TCC 393 Docket: 2003 – 2518 (IT) I Schlegel v. The Queen
  Here a judge ruled that the CCRA did not provide medical testimony to refute the claimant's doctor's testimony that he received Life Sustaining Therapy and therefore he was granted the tax credit for the medication he was now using.

What is therapy?
This is a hotly debated issue with CCRA. They are currently defining therapy as injection time only. Those who live with Type 1 diabetes know that there is much more to it than that. In making your case, you may wish to also quote or include reference to the Canadian Diabetes Clinical Practice Guidelines as well as the definition of therapy mentioned on the Canadian Medical Association website.
Reference to the DCCT trials and the importance of tight control may also be of assistance in helping them to understand what therapy truly is.

Some of the Canadian Diabetes Association Clinical Practice Guidelines of relevance include...

• Section S32 of the Canadian Diabetes Association 2003 Clinical Practice Guidelines states " The most successful protocols for Type 1 diabetes rely on basal-bolus regimens with intermediate- or long-acting insulin, or extended long-acting insulin analogue once or twice daily as the basal insulin, and fast-acting insulin or rapid-acting insulin analogue as the bolus insulin for food intake at each meal (intensive therapy)"

• The types of insulin therapy and insulin action times are found at
  http://www.diabetes.ca/cpg2003/downloads/insulin.pdf

• In section S84 of the Canadian Diabetes Association's 2003 Clinical Practice Guidelines which focuses on Type 1 Diabetes in Children and Adolescents, they emphasize the difficult task diabetes management can be. "Children and adolescents with new-onset type 1 diabetes and their families require intensive diabetes education by an interdisciplinary pediatric diabetes healthcare (DHC) team to provide them with the necessary skills and knowledge to manage this disease. The complex physical, developmental and emotional needs of children and their families require specialized care to ensure the best long-term outcomes. Education topics must include insulin action and administration, dosage adjustment, blood glucose (BG) testing, sick-day management and prevention of DKA, nutrition therapy, exercise, and prevention and treatment of hypoglycemia."