I am seeing my endo on Tuesday and we will be talking about starting on an insulin pump. I wanted to figure out what was even available to me as I’m in an odd situation.
I’m a T2 with a TDD of 90-120 (depends on whether or not I’m doing IF, and yes I am already low-carb). The Tandem seems like a good fit, with its high capacity. Unfortunately I have United Health Care and it sounds like they only cover Medtronic and maybe Omnipod. Unless I could buy the pump myself, and then have UHC pay for the supplies?
Since I’m a T2, UHC will not pay for a CGM, so I’m paying for my Dexcom myself. All the currently available Medtronic pumps appear to require that you buy their CGM, so I’m not even sure if UHC would pay for one…
With the Omnipod’s 200u capacity, I would need to change pods really often. Unless there’s a way to inject more, so that I can keep it on for a full 3 days?
Any thoughts or options I may have missed would be appreciated!
The fill port on the Omnipod is on the bottom so you can’t re-fill it once it is put on. I don’t know if you could use the U-500 insulin with the medtronic? The newer medtronic looks like they are finally catching up with the competition…
I can’t really give you specific information on UHC, there was significant pushback when they announced that they would only cover Medtronic. Since then I think they have softened their position, but I am not clear by how much. A good overview comparing insulin pumps was written by Gary Scheiner for DiabetesForecast in March. It contains a comparison chart as well. You may well find that you have some latitude if your endo is willing to provide you a letter of medical necessity arguing that you need up to 150 units of more per day (depending upon circumstances) which might make something like the Tandem a better fit since refilling every other day is excessive.
I believe that you can still get Medtronics Revel Pumps without buying the CGM option. I am currently using the Revel 723 with no CGM. I chose this pump because it holds 300 units. I don’t believe that Medtronic sells their newer pumps without the CGM.
The Revel is still an excellent pump that is minus some of the bells and whistles of their newer models. If you intend to continue with your Dexcom the Revel will most likely meet your needs
If you can swing a Tandem pump from UHC you might want to look at their T-Flex model. It was designed with type 2 diabetics in mind. It holds a whooping 480 units and will deliver a maximum bolus of 60 units. It is basically a T-Slim pump that has been super-sized to meet the higher insulin needs of a Type 2. An integrated CGM is not an option with the T-Flex
Since, I can’t refill an Omnipod, that’s right out. For now the T:Flex sounds like the right pump for me. I contacted UHC to figure out what they will cover and otherwise, I’ll have my doctor file for an exemption as you suggested.
I’ll ask my endo for a sample of Tresiba while I’m there, and give it a trial before committing to a pump. If it manages my early morning blood sugar reasonably well, which is where I really struggle, then I could save myself lots of trouble.
Don’t know where you are reading that. After July 1st they’re basically ONLY paying for new pumps from Medtronic (if you have an in-warranty pump from another maker you can still get supplies). I haven’t heard of one successful story of someone getting something else covered - even getting pods has been difficult for Omnipod users.
Unless you’re some sort of magical unicorn as a T2 and they’ll somehow cover it for you when they won’t for a T1… but good luck with that.
I’m curious what UHC says about covering T2’s for Medtronic pumps since every single product on Medtronic’s website has an integrated CGM, which UHC does not cover for T2’s. Should get an answer this week.
Saw my endo today and no convincing was required. She said that she would like to see me on a pump and was willing to write letters to insurance so that I can get the right one for me!
Next up is to call the Tandem representative she gave me and figure things out.
Convincing your endo is often the easiest part. Now the real work begins. But if you run into any snags, I’m sure plenty of folks on the Forum can give you pointers on how to navigate this rocky road.
I am really disappointed in Tandem… When I spoke with the CDE, she was telling me really cool stuff about the Tandem pumps and I naively thought that they applied to the t:flex. When I spoke with Tandem though I have learned that the t:flex will not:
Have update-able software
Participate in the pump upgrade program when new models come out
Eventually integrate with a CGM
Eventually be used in a hybrid closed loop
Essentially, if I get a t:flex there’s no upgrading and it’s what I’ll have for the next 4 years or longer.
Since I’ve never pumped before I am not sure how to prioritize changing sites every 3 days vs. doing it every 2 and having an upgrade path and possibly getting a hybrid one day? I was told by my CDE that I shouldn’t just add more insulin to an existing set though maybe that’s a rule that some people break?
I will try to chime in here because I was just in an almost identical boat…
While I do not have UHC, so I can not help there, I was a T2 who got a CGM approved. It was MUCH easier to do through Medtronic than Tandem. That is a shame because I REALLY wanted to go with the X2 system. Both systems CAN run with our without a CGM so there is no problem there. I REALLY like the look and the feel of the Tandem better.
As a person who is HIGHLY insulin resistant (about 550 TDD) I am running U500 through the pump. This has its advantages but is also why I made sure my Endo wrote me for a CGM. There is no way in hell I was going to run U500 in a pump without something to warm me if I was fixing to bottom out. So the good news is if you run U500 it opens up greater pump option for us T2s… The Bad news is U500 is not a rapid acting insulin so learning how to dose and “riding the curve” is a bit of a trick to learn.
In the end, I got the 630G with an upgrade to the 670G when it comes out. Why, if I liked the Tandem so much, you might ask… Well Tandem was great to deal with BUT they farm out their fulfillment to a company called Edge Park Medical Supply for my insurance (and many others). Edge Park was HORRIBLE to deal with. They did not follow up with the doctor for over a month, until I started calling 3x a day to ask them what was going on. Then they told the doctor the wrong diagnosis code to use so my claim got denied for the CGM at first. So that was going to trigger a review and appeals process. Dexcom was involved too but Edge Park told them to stop working on my behalf. It was just a huge mess. I had Medtronic working on it at the same time for their pumps and they were ready to ship in a week compared to 2 months for Tandem. (Tandem did get everything approved about 2 days after my 630G got here) As a bonus, Medtronic had a financial assistance if you made less that like $45K with no dependents and like $60K for me with 2. So, once I qualified there they payed for 90% of my pump out of pocket costs and gave me co-insurance for next year worth about $3k towards my supplies and gave me a free upgrade to the 670G. Winner-Winner… So, yes, the Tandem looked nicer but Medtronic came through when Edge Park couldn’t. But I still like the look of the Tandem… Lol
So my advice is to:
A) Think about U500 with your insulin needs (as an added bonus you will need less TDD with a pump and on U500) and choose any pump BUT know that it is trickier to run and not FDA approved so your Endo has to know that you CAN do it, or,
B) Look into the T;Flex but your will never get integrated CGM and integration IS nice. Plus you will be limited in the future. T:Flex wasn’t even a consideration for me.
C) Go with any pump (X2 or 630G) but know that you might be limited if your U100 insulin needs increase unless your switch to U500 down the road.
But regardless, try to have Tandem and/or Medtronic approve you and fight for you. They usually are experts at getting the things through the hurdles. Oh, and Omnipod isn’t even an option with your needs or wish list.
For many people on a pump, my son included, day 1 and 2 have much better absorption than day 3. For my son there is such a significant drop in effectiveness on the 3rd day that I choose to change his infusion set every other day. He is T1D, but I would think this would be the same for many T2 pumpers.
I decided to go with the Tandem T:Slim X2. Partly because I love my Dexcom and didn’t want to downgrade to the Enlite that comes with the Minimed. But also because I think changing every two days may be better anyway (so wouldn’t need the larger capacity T:Flex). The upgradeable firmware is doesn’t hurt either.
UHC will pay 100% for of the supplies, so I paid for the pump ($4,300) and it should ship on Monday. I am quite grateful that I am in a position to pay out-of-pocket to go with my preference.
They are sending me the t:90 9mm infusion set, though I plan on asking for samples of the others when I go in for training.
Thank you for the support and advice. Fingers crossed this works out!
For now the T:Flex sounds like the right pump for me. I contacted UHC to figure out what they will cover and otherwise, I’ll have my doctor file for an exemption as you suggested.