I once again got denied for the pump by my Endo due to not having my BGL’s in range. It has been like this for over 4 years and I have tried everything. Lantus, Levimer and even Metformin (we wont start on that train wreck) and its not helped. I already know I:C , corrections and basal and everything. He thinks I need to be in more control before going on the pump which I don’t understand at all !!
Do you all think I should just give up and change Endo’s? He has denied me for over 4 years.
Tough question. At the very least, it wouldn’t hurt for you to get a second opinion from another endocrinologist that is convenient with you. Is your family on the same page as you? Perhaps you could ask around in the Australia group and/or try to locate others on this site living near you and ask them who they use as their endo. Personally , I have “fired” a specialist based on the analysis of information I provided to a support group dealing with another problem I had in the past and been satisfied with the results. That doesn’t necessarily mean you’ll have similar results.
I have been considering a second opinion but just dont know how about to do it. My mum is pretty much on the same page as me. We are close to one of the best diabetes clinics for my state. I think I will go with the second opinion.
Thanks for responding 
Are the ratios are from this endork? If the carb counting, corrections, basals, etc. are all done correctly, the numbers should be decent and, if they aren’t, I would think that the doctor should be fixing them, not getting in your way about a treatment paradigm. Kick him to the curb. “Best” doesn’t always mean “best”, sometimes it means complacent and conservative, neither of which are much use for us.
first of all. Love the endork thing.Yes these ratios are from him. I have the carb counting and corrections down pat. Its just basal. I can be high before bed then fine at 2am and super high by 8am. I risk lows at 2am if I change my overnight Levimer. thats one of the reasons why I need the pump. I need them multiple basal rates.This “endork” (love that word) has rarely helped me change my basal in fact they have got angry at me for ringing to confirm a change.I think its time to get a second opinion or just skip to the kicking him to the curb.
Silly question: exactly what numbers is he using to say that he won’t put you on a pump?
I have known endos over the years who use a pump as a threat: Get your numbers better or I’ll be forced to put you on a pump. And others use it the other way around, as a “Carrot” to dangle in front: If you don’t get your numbers better then I won’t put you on a pump.
Maybe he thinks your numbers are OK as they are, but you might have higher standards (especially with respect to dawn phenomena).
I sit on low 200’s all day and when I wake up its always in the 300’s (major DP)
I sure he is using the Carrot method even though I have “stabilized” my levels.
Oh trust me he is hell bent on getting them between 80 - 150 (sorry bare with me while I convert from mmol/L to mg/dL) all the time. its just impossible on MDI
Another thing that I would suggest would be to take a look at “Using Insulin” or “Think Like a Pancreas”? Both of those books have detailed instructions on calculating your basal rates. Once you have those calculated, you should be able to get things much closer? I think that is probably very challenging because I’ve noticed w/ the pump, even small adjustments can make a big difference in the end result from which I figure if you are a little bit off w/ shots, it would be very hard to figure out adjustments, particularly without a great deal of support? Good luck w/ that!
I don’t think the carrot method is working. If you’re in the 200’s all day (not just hitting them after meals) then you need a sizeable (not just a tweak) revision in insulin doses to get your before meal numbers reasonable. And if your current endo just tells you that “you’re doing it wrong” and nothing else then he’s not helping and yes it is time to dump him.
Do you adjust your doses yourself? Or are you dependent on your endo to tweak your doses? Self-management of insulin doses has been the “standard of care” since at least the 80’s. I was diagnosed at age 14 in 1982, and literally the second day in the hospital recovering from DKA they started teaching me how to adjust doses (in response to urine tests, believe it or not, home bg testing was still not popular.) If you and your endo can’t resolve these control-freak type issues (and these are not truly “medical issues” but “who’s actually in charge issues”) with MDI then there’s really no purpose trying to work with him using a pump instead because he won’t help you there either.
Others here will focus extensively on the after meal numbers but realistically it’s pointless to look at those until you feel that you have your before meal numbers reasonable controlled.
I would not give up. I would fight, fight, fight. I have fired at least 5 doctors because they would not fight for the pump for me. I now have a doctor that asked me where do I wanted to go with my treatment. I told her that I wanted to be on a pump and she made it happen. I was on a pump in less that 6 months or 3 doctor appointments.
I do believe it is time to try out a new doctor. When making the appointment for a new doctor I would suggest you ask how the doctor feels about the pump and how many patients they have on a pump. Each of the pump companies handed me stacks of papers with he benefits of being on a pump to hand to the doctors.
I would say that not only would you benefit from a pump but I would suggest trying to get a CGM also.
My first question is 'why is it so important for you to be on the pump?"
Although I am a pumper, the pump is not a magic bullet. It still requires attention to carbs, ratios, boluses, BG Levels.
My second question is 'why does the doctor say you need more control BEFORE getting the pump? How does he respond to the suggestion that the pump might mean better control?"
Is it possible that this is just a bureaucratic issue? Does the healthcare system have thresholds that must be met before authorizing a pump?
"endo-shopping’ will possibly help you find an endo who will prescribe a pump. But consider the other benefits and services you get from your current endo which you’ll be giving up. Suppose you find an endo who will prescribe a pump, but he/she turns out to be a total jerk?
Terry
I would definitely get a second opinion if I were you…a pump might help you with better control, as long as you check frequently.
I had a Dr. that said that I wasn’t bad enough to need a pump. I think he was asked to leave the clinic for various reasons. The first words out of the new Dr was " WHY are you not on the pump? A pump is a tool for control. Get rid of your Endo and find someone who is up to date dealing with diabetes. Contact the pump manufacture for referral in your area. I am very touchy and hard to control. The pump is the way to go. Go for it.
Terry, as I said before I have major dawn phenomena. I have tried everything to help and fix it but I just simply can’t without a low or highs in the morning. I do not belive the pump is a one stop fix. Its another tool we have to help this terrible disease.
He says after time yes you will have better control (I am not expecting it to happen immediately in fact I was thinking its going to take months even years to settle everything.)
As we live in Australia, nope. No threshold for them. I contacted the clinic and the health ombudsman about it.
I am pretty sure my next endo wont be a jerk because I know two people that go to 2 of the best hospitals in the state and they all say the endos there are fantastic.
I do adjust my insulin doses myself except for lately basal because my endo likes to do that now. I can’t touch my insulin to carb and corrections because this endo has me on more NovoRapid then Levimer which means I am prone to ketones and fast.
wow thats fantastic
I have already contacted my potential endo offices and they are very very pump pro. So I don’t think I will have any problems with that
Unfortunately, I can’t afford a CGM. They aren’t covered by insurance here 
Its not your endo’s decision, its yours. Move to another who will assist your diabetes regiment, not dictate it.
This sounds like a very old fashioned Dr to me. It’s very old to go and blame the patient for unstable numbers and withold newer treatments and options from the patient that may help them since they are “non-compliant”. I’d get a new Dr, this guy sounds like a control freak, a lot like quite a few I’ve dealt with in MY D career. I’ve learned to recognize them and now get rid of them as soon as I recognize the pattern. Four years is more than long enough, I think you gave him too many opportunities to make it right. . . .
I understand how you feel. My levels are all over the place. If this dr wont put you on a pump, a second opinion may be the key. I fought to get myself on a pump and finally getting it (awaiting for approval). I do suggest reading thinking like a pancreas and pumping insulin! Those two books has brought everything into prospective for me as I am on the mix insulin. I learned more from those two books than what I’ve learned on my own and at appts. i have gotten familiar with I:C and ratios. i even started exercise in books so i get a sense of it.
I had a doctor who said the same thing to me. He had me on an outdated sliding scale, outdated insulins, etc. I followed blindly, believing he knew what he was doing. Boy was I wrong. In DKA 3 times in 1.5 years. He wouldn’t sign for me to get a pump. Finally got a new endo. First appointment with him he put me on newer insulins, carb-counting…a few appointments later he got me a pump.