Dear Fellow Type I Diabetics and Pumpers
Part II - (I am trying to be more precise with my exact question)
I will simplify this forum and discussion: I am looking for a comprehensive and detailed of your own individual (not personal) process to get from MDI Therapy to Pump Therapy. (exclude insurance, unless it was a relative as part of your compliance to start on Pump Therapy) For Example, What did your Doctor (Endo-Intern), Diabetic Specialist, Diabetic Nurse Practitioner discussed with your particular need to go on Pump Therapy and then what did they require you to show that you could maintain or be on Pump Therapy. This includes: How to carb count, use a sliding scale on bolus (both correction/meals +combined and your Basil rate also), taking your blood sugars daily and consistently from 4 times to 16 + times a day and then maintain a worksheet, logbook or type of entry your were required to do. Included, how to respond appropriately to any hypo or hyperglycemic events on a daily or weekly bases.
I got a new endocrinologist at the end of 2009.
I walked into his office for the first time and met with him. After 5 minutes of preliminary questions, going over the BG logs I store in my Wavesense iPhone app, and talking about my history, he asked me if I wanted to go on the pump. I’m not sure what his particular criteria are, but, apparently, I met them within 10 minutes of our meeting. He simply told me that he thought I would like pump therapy better than MDI. I told him I wanted to stay on MDI, so, he just gave me some literature to look over, told me to think about it, and the issue never came up again until this past July when I told him I wanted to try pump therapy. He smiled, suggested the Animas Ping, then I told him I wanted to try the Omnipod because I didn’t feel comfortable about the tubing. He smiled again, said fine, you’ll like the Omnipod, told me he’d set everything up and to expect a call from the area rep. The only "requirements’ were to fill out the Omnipod application and include my BG logs for the last 60 days (I do believe it was 60 days anyway).
Honestly dino, I have never heard of a situation like yours and it sounds absolutely ridiculous to have to jump through so many hoops for such a long period of time.
Best of luck.
I know… I B as in B and S as in S!!! Now this is actually KINDA Govt Health Care (Veterans Affairs Medical) Can you imagine what is to come of this so call new heath care program… I say GOOD LUCK and if anything like VA SYSTEMS …Can you imagine the CANINE MUTINY this will cause!!! I just sat down with MEDTRONIC REP This afternoon We met at VA… This is not normal!!! but I took the “bull by the horns” and contacted them… instead of the cumbersome and mundane crap at VA… Medtronic Rep call my Nurse Praction aka Diabetes Control Specialist… I will be I will hear about this…after Medtronic Reps ask my DCS she told the Medtronic Rep we are getting closer, not quite but there but getting closer to MAYBE issuing a pump!!! NO LIE!!!
I see that you have gotten the pump company involved. That is a big advantage. They will keep after the VA.
I got the book Pumping Insulin and looked at the forms in the book. I recreated the forms on my computer. I did this on my computer so that I could print it out for the doctor to send insurance company. No matter what the decision is keep logging. I logged everything and anything. I included each and every time I did a glucose test. I exercised. How I felt before and after my highs and lows. How I felt about having to stop everything give myself shots (10-12 a day). How having to take shots affected life style. How hard it was to find a place to give myself shots. You can’t just whip out your diabetic supplies and give yourself a shot in the middle of a meeting. How it made people around me uncomfortable when they knew I was about to give myself a shot. The more detail you give them the better.
Please do not accept a no from the insurance company. Keep fighting. Have your endo reapply each and every time you get told no. If your endo. is not willing to do the work then try to find a new endo if that is possible. It is worth the fight.
I had to show highly fluctuating BG numbers. Including uncontrolled lows. It was farily simple.
It depends on several administrative issues. The insurance company doesn’t even look at your records. It trusts the decision of the doctor and hence it sup to the doctor to make the call. This is how it worked in my case.
The one that i had before going on pump was some one whom the company liked because he keeps the cost of treatment extremely low. I got this information from the insurance company website!!! He kept pushing me to continue on injections even though things weren’t really under good control!! I mean i was experiencing wild fluctuations …but he was only concerned about A1c which always stayed around 6.5
Then i moved to different one and i explained him my problems with the swings. I never kept a detailed record of my BS history. But still he immediately recommended me for insulin pump.
To me it appeared that his primary concern if i still had a reasonable amount of insulin sensitivity (i am a T1 D for the last 18 years)
I was seeing a GP rather than an endo, using logs from the One Touch Ultra Smart as I never bothered taking notes. He’d suggested pumps/ 'log/ lantus pretty regularly but I was always “nah” about it. I decided I wanted one and told him and he was like “so long, it’s been good to know ya” and referred me to an endo.
I could pick two and figured I could get into see the young, Indian doctor more quickly than the old, white head of the department guy and got in to see her within a few days, she checked w/ MM and insurance. Insurance wanted 30 day log and I sort of took pleasure in producing a truly bestial account of my activities. I was not ever shy about “180? 2U in arm, did 50 pushups” sort of antics, all of which were scribbled in miniscule scrawling all over a tiny notebook. I think it was sort of a formality and within 5 or 6 weeks I was pumping. On my own I made appointments w/ CDE and dietician but that was pointless because I was drastically changing my regimen.
I agree with Unicornzz getting the pump company involved. I suspect that they provide a lot of the nagging because, of course, they are going to make tons of $$ on the deal, once they get the documentation from the doctor, they are just waiting to get paid.
I see a PCP who basically lets me manage my own D because he knows I know what I’m doing. I never mentioned the pump to him because I decided fairly suddently after thinking I didn’t “need” it. My A1C is 6.4, I just realized pumps are state of the art and I wanted one! I contacted Animas and they asked for a 30 day log of numbers as part of their application. They did the legwork to get the doctor to fill out the forms and bugged him (nicely) when he was taking too long. The pump trainer did ask me some of the questions you listed after I had my pump, but just to know what I needed help with. I gave them my I:C ratios, correction factor and basal rates (which they recommended reducing by 20%. They put those numbers on the form for the doc. Bottom line? No requirements. I agree with everyone you are getting a runaround and I recommend doing what I did and starting with the pump company who will then navigate the system for you. With a huge heavyhanded system like the VA they will do it much more efficiently than you can. (Nothing personal, just reality).
First, immediately after diagnosis my sister wanted her on the pump (she is an R.N.) but they would not allow it. Pedi endo at hospital where she was diagnosed has a policy of keeping his pts on NPH until he puts them on the pump and waits until he has a group of three families, hospitalizes them for three days and conducts a pump school. Very thorough, but this could take anywhere from six months until a year and a half as he does this in groups of three. Sis immediately looked around and choose Naomi Berrie Diabetes Center in NY. They will put you on a pump anywhere within three to six months, after training. You have to keep accurate and detailed written logs (we still do), see a social worker, see the CDE twice and nutritionist once or twice. Trained in bolus/basal routine (“poor man’s pump”). When we left the hospital, we already had been trained in carb counting and used a sliding scale of sorts (not accurate enough). NB told us her ICR, her correction factor, put her on Lantus and Novolog, and had us check blood sugars every three or four hours. We did basal rate testing immediately on the Lantus, though it is only overnight basal, not four or five basal periods like the pump. We learned how to respond to hypoglycemic episodes before we left the hospital after dx. New pedi endo did not like us to overdo the corrections for lows, depending on the low would use anywhere from five to 20 grams of carbs. Because she has Type 1 and endos in our area have a pumping practice, not difficult to get the pump, though you must be trained first. I have read a lot of endos prescribe the pump “conditionally.” As in, you can have a pump IF… your blood sugars are good; or IF your blood sugars are bad (some won’t prescribe it if you have good control on MDI). You can have a pump IF your child is older, etc., etc. These endos need to be avoided, IMO, as a pump is nothing more than an insulin delivery device and it should be up to the person which insulin delivery device he/she chooses. If you have Type 2 and want a pump, there may be other obstacles but I am sure by hunting around for the right endo, you can get the pump prescribed and paid for by insurance.
If I deduce correctly, one of the really key pump qualifiers is hypo unawareness, another is dawn phenomenon, and a third is poor results with MDI, especially getting your basal insulin to work consistently. Tied into the decision is the carb counting, lots of testing, understanding I:C ratios, demonstrating that you can reason out the steps to correcting a high or low. IOW, are you mentally engaged in managing this disease, or just doing the minimal work to get by (so to speak)? Sounds like you are definitely engaged!
In my case, my endo already knew that I fit all the “criteria”, plus she is a pumping advocate, so when I walked into her office and demanded a pump it was easy.
Keep the faith,