When I was at the doc on Tuesday we decided on what pump I would use and got the paperwork done for the order. The nurse mentioned that I was required to have been on MDI for at least 6 months before I could get a pump. I thought I had been but when I looked at my insulin prescription this morning to order a refill I noticed that I’ve actually only been on MDI for 4 months (it feels like a lifetime though)!!
I’m wondering if anyone knows if the 6 month requirement is imposed by the insurance company (United Healthcare) or Medtronic? Otherwise, it must be a requirement of my doctor’s office.
In any case, I think my pump will be delayed two months. Bummer.
The source of this is Medicare which requires you to have 6 months of MDI under your belt. Unfortunately many insurance companies use Medicare as a foundation for their policies as they position themselves to be no more generous than Medicare. You may have to wait, it kind of depends on whether your doctor is willing/able to write a letter of medical necessity to get the requirement waived. In the scope of things this isn’t a total buzz kill. I’ve been on MDI for six years. You really can do this.
Thanks @Brian_BSC! I don’t mind the MDI so much really. I’m excited about the pump though and my excitement deflated a little when I realized I might have to wait a little longer. 6 months takes me to November which is my birthday month so I can look forward to that since I’m not looking forward to being a year older! Haha!
Come to think of it…my doctor might actually write a letter of necessity. This all started because my Dexcom trial showed that I was going too low at night - shortly after midnight every night. My husband works 6pm - 4am so I’m home alone and that was the catalyst for the pump conversation. I’m not going to ask her to write the letter because the wait isn’t terrible. I’ll just wait and see if she does it on her own.
What basal insulin are you using? You might be able to minimize the lows at night by changing you basal injection time or splitting your basal injection.
I’m currently taking 20 units of Lantus before bed. My doctor reduced it from 22 units after the Dexcom results. The problem now is, I wake up too high. Around 3 a.m. my blood sugar starts to rise. 22 units of Lantus was keeping my waking blood sugar lower (mid to high 90’s). At 20 units I’m waking with numbers in the 130’s (which isn’t terrible but too high for my preference).
This sounds strange. Lantus doesn’t peak for 5 hours, if you take it before bed you shouldn’t be having a low at midnight (unless you go to bed at 7pm). Lantus absolutely must be injected into your bodyfat, make sure you pinch up. If you get just a bit into muscle or into a vein it will act as a rapid insulin. You might find changing your injection timing to taking your Lantus at dinner might work better. Splitting your Lantus (half in the morning/half at night) may also tamper down any peak you experience at midnight. You should check with your doctor about changing your injections.
I would also note that many of us suffer from highs in the morning, that is Darn Phenomenon (DP). I recently changed to Tresiba which helped keep my blood sugars flat through the dark hours of 3-5 am, but I still deal with a rise as soon as my feet hit the floor. Actually I consider waking with a blood sugar of 130 mg/dl a win. I would just take a small correction and considered it a good start to the day.
You could talk to your doctor about splitting the Lantus dose, or try changing the time of the shot. In my case, neither worked, however. The changes “helped” for 2-3 days, after which the insulin level in my body leveled off and I went back to the same pattern of overnight (and late-afternoon) lows. That was the catalyst for my changing to a pump – which definitely did solve the problem.
What pump are you on Thas? I have second thoughts about the Tandem after reading about insulin not working past 3 days. For now I am back on my old minimed and will switch again to my Animas Ping. But I do a whole different regimen and only use it for boluses. I dont sleep with it or use it for basal other than a very small amount to keep occlusions away.
You can check with your insurance to find out if the 6 month requirement is with them or your dr. We’ve never had a plan that required a wait, although it’s common. My daughter’s first endo required 2 yrs on MDI for kids. The 2nd one didn’t prescribe pumps during the honeymoon, but we got her started while in a very strong honeymoon after our first visit.
I’m on the Animas Vibe. Haven’t had any pump- related failures in the year that I’ve had it. Site and tubing issues, she, but the pump has performed well.
Yes, we had the same situation with our son…well, Omnipod told us there is a 6 month window FROM THE DATE OF DIAGNOSIS…not necessarily when you started MDI regimen…at least in our case. But we had met the 6 months, so it wasn’t an issue (they had just received mistaken information). However, Omnipod said that if the Doctor doesn’t feel you should wait the 6 months, they can write an exception for the insurance in your case. We didn’t have to go this route, but they mentioned had we been under 6 months, we could have still gotten the pump for our son via this medical exception the doctor can write up, and the Insurance would still accept it. Maybe you can go this route, if it’s something your insurance will approve.
The letter of necessity is a good idea; lows are just . . . undesirable and well worth avoiding if possible. Also, lows frighten doctors AND insurance companies much more than highs do, so there is some potential leverage there.
Splitting the Lantus dose works well for some people, also. I started splitting my basal insulin a year or two back and get a much flatter line as a result.
And I would rather correct a high upon waking, which is pretty simple to do, than go seriously low overnight while I’m not in full command of myself. Particularly when alone. But that’s just me.
Lots of good suggestions here. Let us know how things go!
We were told that we would be denied for a pump because Caleb had not been on injection therapy for six months. He was pumping with insurance approval less than four months after diagnosis, so in our case it was misinformation.
I know there are doctors that will not allow their patients to pump before six months of injection therapy. If the nurse was not clear that it was a doctor imposed requirement, perhaps she’s just preparing you for the possibility of denial.
Yes, of course, but in my experience you’d be much better off splitting Levemir as an MDI basal if you’re experiencing night-time variations. As others have mentioned, Tresiba is also good in this regard and probably doesn’t need to be split (subject to the usual YDMV rule…).
I don’t want to dissuade you from going on a pump, there are certainly advantages, but having been on the fence for many years now, and still on MDI with great results I’m sure you can manage well until things get ironed out with the various permissions. Who knows, you might find as others here have, that sometimes MDI is actually preferable.
No, I was going down below 70 between midnight and 3 a.m. Then rising slowly to waking around 90. She said going that low in the night is too risky. It might explain why I wake up during those hours thinking I’m going to puke.
And, thank goodness for the CGM trial or else we would have never known this.
If memory serves, I had to push like a MF to get my daughter on a pump by month 4 or so, despite the fact that our insurance approved coverage the day after her diagnosis. Then the “saline start” BS! Don’t even get me started… Needless to say, we have a wonderful new endo. Didn’t blink when I asked her for a rx for Tresiba basal as a back-up shortly after it came on the market (after I demonstrated my general knowledge of how Tresiba functions for the “average” PWD).
My impression is that it is more common for kids. Still completely and ridiculously unnecessary IMO. Exactly how is practicing pushing buttons and administering saline without seeing the results of actual insulin being dosed useful???
What my daughter and I did was play “the nodding dog” game. We both smiled politely and respectfully as we both started saline-filled OmniPods at the “pump training” appointment after we received her pump. (I had already done many, many hours of homework with Gary Scheiner’s Think Like a Pancreas and had reduced my daughter’s long-acting basal dose the night before her appointment. And she was already using the Dexcom CGM.) We said thanks and goodby at the end of the appointment, walked to the car, removed the useless and wasted Pod, filled another with her rapid-acting insulin, and started “cooking with gas” from then on. At the next week’s follow up appointment we pretended like it was the first time using a Pod with the real stuff. If I had had my way, my daughter would have been pumping the day after her diagnosis. Much better control of BGs with a pump compared to MDI, with much more freedom to “graze” which has always been my daughter’s eating style.
And I can’t sing the praises of being able to have different basal rates throughout the day and night as needed loudly enough, not to mention the beauty of temp basals!
