Insulin pumps

Some may recall my journey into deciding between a pod or a pump. After a LOT of research I decided on the Tandem X2 with I/Q control. My goal was to get better over the day with out going thru the highs and lows of just bolus dosing. I contacted my Endo Doc to she what she thought. She thought it was a good choice but wanted me to see the Diabetic Nurse educator . Had the visit , learned I would need to learn how to count carbs. But the Big hang up would be the results of a CPEPTIDE BLOOD Test .
This test measures the amount of insulin your body produce on its on own. At a certain range, Medicare will not pay for the pump. Well appears I don’t qualify for a pump. Maybe when I go down hill father.

You have to learn to count carbs no matter what… pump or no pump. The c-peptide is another story. Most older T1s and LADA still make some insulin. If you are already taking insulin, then your body will make less insulin because you are supplementing. Maybe you can do another c-peptide test in a few months time and be within the Medicare limit then. Time will tell. But your choice of the Tandem x2 with CIQ is an excellent one.

How is it that you’re using insulin without counting carbs? Are you only on long-acting insulin and not meal-time boluses with fast-acting insulin?

While I love my T:slim w/ Control-IQ, unfortunately Medicare only covers this type of expense for Type 1s or similar, hence the c-peptide test. Tandem is working on getting Control-IQ “indicated” for Type 2, but they expect that to take at least a year. It will be easier to get Medicare on board after that little piece of paperwork is in order, though. Unfortunately, Type 2s tend to have very different insulin needs than Types 1/1.5, so it’s not a one-size fits all scenario

While they lack the cool automation, you do have “patch pump” options available to you, though. I know the V-go is covered by Medicare part D, and I assume the similar CeQur Simplicity is also. They’re both push-the-button to bolus discreetly without injecting “pumps”. The major difference between the two being that the V-go also delivers a non-adjustable/pre-set basal (there are different dosage options for your doctor to pick from), while the CeQur does not do basal at all and you still have to take long-acting insulin if you use it.


CeQur Simplicity:

What is your c-peptide result? Are you close to the allowed Medicare number? If you’re borderline, some people have strategies for trying to game the test. I had my first c-peptide test ever when I went on Medicare and as a longtime Type 1, had no issues. But it can be tough for people producing insulin.

Also I know that you were previously considering Omnipod. Under Medicare Omnipod is covered as a pharmacy benefit and as far as I know, it is not subject to Medicare requirements for a pump. Medicare does not consider the Omnipod to be a pump. Because it is covered as a pharmacy benefit, you don’t get Part B insulin coverage and the Omnipod option can end up being quite a bit more expensive than a tubed pump. Not all Medicare Part D plans cover Omnipod, but I had coverage at Tier 3 through Cigna. With both Tidepool’s and Insulet’s hybrid artificial pancreas systems on the horizon, an Omnipod might be an option for you to get some automated help from your insulin system.

I used Omnipod for a while on Medicare to try Looping and was able to get coverage for changing my pods every other day (low insulin user but big adhesive issues.) So you might have to change your pods every two days because of your high insulin usage, but this might be a good option if you can’t get a t:slim. And because Omnipod is covered as pharmacy, you’re not subject to the same Medicare DME warranty. I was actually able to get pods at the same time that I was getting DME Tandem pump supplies.

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If you fast 18 hours you will get a true c peptide baseline.
Otherwise it’s kind of hard to figure out where you are moving etc