it's my experience most endos won't even consider putting someone on a pump unless and until they have qualified and quantified knowledge and assurance the pump user knows what they're doing and is of sound mind to do it, i.e., verification of testing enough, carb counting, emergency resources - if needed, etc...not everyone gets a pump...some, i believe, think it's some panacea into wonderland when it comes to D management, it's not, just another resource which requires a lot of testing and dedication, especially when first starting out. yeah, i've had all the training, the 'training' isn't the issue, I can navigate my way around POD and Medtronic, it's getting it set for my body, basal rates, etc..and D management specific for me; one size never fits all with this stuff.
What is qualified and quantified knowledge? I think I have that..I call it ready to roll with whatever changes come along with this stuff. All those things you listed need to be done with or without a pump. Are you able to set your basal, insulin duration and insulin to carb ratios, the timing ratios, testing requirements and analysis on MDI? Is that the qualified and quantified knowledge?? I don't think you should slap on a POD if those are not known and if you don't know how to set them or test the accuracy of them. I know folks start pumping without training and get along just fine, and without a buddy to see after them. I would not do it if I didn't know or trust all of my own rates and stuff.
providing them with a log book for a week, supplying them with CGM and meter data, etc...endo asks CDE/pump nurse, 'does she know how to count carbs (yes!), does she know how to navigate thru pump, has she been trained (yes!), does she test her blood sugars (yes!), blah, blah, blah...that's my perception of quantified/qualified info and knowledge required by my Endo. Nah, I'll wait...my problems have been with MDI - basal, levemir and my experience with pump has been all my rates/ratios, ICR, ISF have dramatically changed such that I was dropping (double arrows down at 70) with a low .30 basal rate, of course, at night. So, I want someone to partner through this with me - who has knowledge, someone whom I can say, "I'm here now, advise - guide me on what to do." That's just me. I never said a cgm was required, i said it's what's required for me, I (ME) wouldn't feel comfortable starting a pump without it. It's also not whether this endo respects my ability to manage my D, this is their office requirements for all pump starters. I do worry that insulin can kill me, cause it can..it can kill anyone who takes too much, that's a given, but diabetes can kill me too. so what the heck. Who said anything about 'blaming providers for mis-use of D products'. Nothing was mentioned about a mis-use of anything. Many do misuse pumps or don't use them correctly, who's to say who's to blame, if that's the term you'd like to use; is it ignorance, not well trained, pumper too aggressive, diabetes not well controlled, etc..who knows.
My Doctor sent me to a one on one pump class after collecting 3 months worth of MDI log's. The instructor was a very experienced RN/CDE/CPE. The class was setup to last as long as it takes to go over everything needed to operate the pump and pass a written test that included carb counting and pump programing. After I passed the test they gave me a bottle of insulin and asked me to program my pump, load the insulin, and insert my first infusion set. My doctor supplied the set up sheet for all of my settings. He has never touched my pump and instructed me to never let anyone fiddle with it...all he has asked is that if I make permanent changes, please send a email and if he thinks I'm making a big mistake, his PA will call me or send me a email. I used insulin for 20 years before seeing a Endocrinologist, PCP just gave me a new Rx every year and asked if I was happy and how work was going...just guy talk...
A pump Buddy...seems like your Doctor may not trust you...or he does not know you well enough to just turn his back and let you run with it.....you know at some point that's what he will have to do, it is our responsibility.
A pump Buddy...seems like your Doctor may not trust you...or he does not know you well enough to just turn his back and let you run with it.....you know at some point that's what he will have to do, it is our responsibility.
As i've said, this is a requirement (a 'pump buddy') for all his new pump patients and it's typed out on their standard/generic pump requirement intake - out - take sheet, certainly wasn't specific to or for me. That's standard, that's similar, I would imagine, for all who start the pump, we all have to have training and verification of knowledge that we know what we're doing. It's our responsibility, yes...if an Endo puts someone on a pump, they're responsible too, they do indeed take on that 'liability'. If an endo puts someone on a pump who doesn't even know how to carb count correctly or has no clue how to change basal rates, do a temp basal setting, insert/change infusion set(s) - cannulas, fill reservoirs, pumps, etc..who's 'fault' is it. Maybe that 'said pumper' can and will get into big trouble, maybe he or she dosen't know what he/she dosen't know.
Wow! As you all know I basically don't use my doctors very much but reading these posts of what was required I have a new appreciation for my old doctor's hands off attitude. Basically an Animas rep brought an approval form for my doctor to sign on which they'd put a starting basal rate. He signed it, my insurance approved me and then I was working strictly with Animas. They sent their rep to my house and we spent a couple hours mainly going over the logistics of infusion sets. From talking to me and watching my terrible hand eye coordination she probably figured that's what I needed/wanted help with.( had read every page of the online workbook before my pump came than every page of the manual after it came) I was then called by another branch of Animas and offered a daily follow up call. When I realized it was basically just for me to "report it" I asked if I could have a person to call if I needed anything instead. We did that and I did call that person once with an issue. Done. Nobody asked for any logs, nobody tested me on my skills. I guess my doctor figured I knew what I was doing.
Maybe the difference is that was a PCP not an endo. It might not have been adequate for some people but for me it was exactly what I wanted and needed.
i think every endo does things differently..as I mentioned, this endo was telling me horror stories of some ppl he put on pumps, which for all I know, could have resulted in legal actions??? We here on tudiabetes, aren't the norm, i think. we seem to be very dedicated, test, etc...but really what's a layperson who knows nothing about diabetes going to do. a pump buddy who has no training or knowledge..pls. like i'm supposed to appoint some co worker or friend to come test my blood sugars, what the heck are they gonna do with that info? i understand this office's 'safety first' issues but at some point, it's not worth the effort. Who cares what a manual says, that's about the mechanics of the pump and not specific to the individual pumper. We employ pump nurses to help with the actual changes and variations, not the mechanics, that's the easy stuff.
I worked w/ the Medtronic rep too. I know she consulted with the doctor a bit and made a few suggestions about things during the short "we're helping you period" but once it seemed to work, I was on my own.
For liability, the doctor would have to do something negligent or wrong. If they follow the pump training "manual", they will, to some degree, build a defense that it wasn't their fault, it was the pump companies or, I'm sure, user error!
if they put someone on a pump who doesn't know what they're doing or hasn't had training, isn't that doing something wrong. going from MDI to a pump, for many, is drastically different, if the pumper hasn't been trained properly by that doctor or whomever, isn't that their responsibility? I actually wouldn't feel comfortable going to a PCP provider who knew nothing about a pump or type 1 diabetes for that matter and just signs over an insulin pump to me. but, that's just me.
I think they have a process in place designed to get patients to go through the training and "sign off" that they understand what they are doing. We have all sorts of folks who are just like "I'm savvvy, I did it myself..." however they would likely be precluded from a claim.
I can sympathize with the doctor's concerns relating to pump training. There's a wide variance in diabetes knowledge and training within the diabetic population. Better to over-train than under-train. Sarah, I think it's smart to go along with your doctor's pump buddy requirement. It won't hurt and may help.
That being said, I'm always open to the pump trainer's session to introduce me to a new pump. If I've been using that particular model then I prefer not to waste their or my time.
I switched to an Omnipod for five months last year. I agreed to meet with the pump rep to go through a pump session start. I had already read through the entire manual and other instructional literature. I could have done it on my own but I didn't want to make waves and I know I can always learn something new.
What would chafe would be a doctor wanting to change my basal rates, I:C, ISF, insulin duration, BG target, auto-off time, or any other pump settings. I have those dialed-in even though they are all subject to change if needed. I think any doctor that has worked with me for any amount of time can see that I don't need that kind of help. If they want to get that deep in the trenches with me then they better be ready to answer random 3:00 a.m. telephone calls!
This is a hard disease to manage and I think the medicos get that to the extant that any person can understand what it feels like to endure the slack-jawed vacant-eyed confusion of a sub-40 low and the greasy sultry syrupy dim-witted 250+ high.
I can see why they want a pump buddy in the house, they likely don't want the responsibility of any poor choice or action made by an inexperienced pumper who is ready to just slap the thing on and then when it does not work out (as in the past) they don't want to be blamed. When does the patient own the responsibility??
I have an IM doc who is awesome. There are plenty of docs who can support us bonehead pumpers, just so ya know.
May I ask who prescribed the pumps you do have?
As you said, Sarah, we're all different. I found the manual extremely helpful and still do consult it on occasion for certain settings I've forgotten or not used before. For me the mechanics were not the easy stuff, the changes and variations on the other hand, I'm used to working with, and when I get stuck I come on here for all the experience.I've never worked with an enco. I guess it all comes down to the open-ended question mental health professionals are taught to ask, that medical doctors seem oblivious to: "How can I help?" Since everyone has different needs, different skills, etc. there is no "one sized fits all". As for this "pump buddy stuff" I agree with you, Sarah, it sounds ridiculous. Even though I would have rebelled against a nurse I needed to report to when I made a change, logs, tests...any of it..I can understand the point of it all. Having a friend who knows nothing about D come to test my blood sugar...that seems pointless.
I misunderstood. I thought the pump buddy was someone who had some knowledge of insulin pump therapy. I agree, a random stranger to hold your hand seems a bit too much like kindergarten to me!
I think the pump buddy is there to call 911 if you blow yourself up with the pump. No knowledge needed!
I wonder if they send a "pumper truck" then!
Wow! This is absolutely amazing. Don't this doc would like my attitude at all. I view the docs I deal with as members of my team. This one would have been fired and I would have had a little bit of fun because of his / her stupidity.
I just started pumping in early July. I have never seen an endo...in fact my first appointment with an endo is on Tuesday. The first time I ever saw a CDE was in mid-August (yep, mid-August). I read Pumping Insulin and the Roche Rep / Nurse showed up at the house and we did about 2.5 hours training. My PCM doesn't do pumps so the it was the nurse and me (and Pumping Insulin) determining the initial settings. The only real question left now is which endo is going to join the team...the VA endo or the civilian endo (I have two appt's this week with the VA being first).
Mike
Mike brings up the critical point in all this: THEY work for us! It isn't what they require us to do, it's what we need for ourselves. We consult them for their expertise, but in the end it is our decision what to utilize or reject.
I wonder what I would do if I didn't need a doctor's script to get my kit.
WOW! I guess I'm like the rest of you regarding this...BLOWN AWAY with a "Pump Buddy"!! I currently use a Paradigm REAL-Time Revel Insulin Pump from Medtronic Minimed with CGM. When I started pumping many years ago using earlier versions of the pump, the Endo and nurse explained how to do everything. However, they filled my reservoir with sterile saline solution and told me that I'd keep taking my injections for the first week while learning the "bells and whistles" of the pump's operation to get used to it. This gave me a chance to figure it out comfortably, knowing that I wasn't going to inadvertently bolus myself with a ton of insulin and end up in serious trouble. I think that approach was totally fine (at least for me). I think it's kind of goofy to go as far as having a "Pump Buddy", when a person can just use saline and pretend it's insulin for a week or so.