Hi all ,
New to this site but not to pumping and diabetes. I am an insulin dependent diabetic. Diagnosed 95. Been using the pump a few years. It’s out of warranty and flakey. My endo says she will not replace because of my numbers. Even though my meter says otherwise. My H1ac is higher than my last lab even though I have been eating better and have overall better Meter readings. Avg 150. So has anyone had to fight with their endo to replace their pump ?
Hi all ,
You are in charge of your care, your endo shouldn't be telling you that you can't have a pump. I don't see any endo, just a PCP. Nobody but me should make major decisions about how I manage my D!
Thanks for your reply this is her response she cut and pasted from some HMO document
To have a pump
• Have a diagnosis of diabetes which always needs to be treated with insulin.
• Check his or her blood sugar 4-8 times a day.
• Show advanced carbohydrate counting skills.
• Use 3-4 insulin injections a day.
• Have worked with a Kaiser Permanente Diabetes Care Team for at least six months, but did
not get to blood sugar targets or treatment goals.
• Have an order from a Kaiser Permanente Endocrinologist for an insulin pump."
I replied to each one. I see my diabetic educator … Full disclosure even though I got orientated on the pump … Took some pump classes. It really wasn’t until I took an advanced pump class at a TCOYD conference I really understood how to fully take advantage of it …
Now I understand the need for knowledge of carb counting, and the frequent testing - it allows you to micro-dose. But if you have been doing a good job managing D, and part of that is use of your pump, why should you not be able to continue? THAT'S LIKE GETTING A BAD GRADE ON A REPORT CARD, FOR DOING WELL ON ALL OF THE EXAMS AND ASSIGNMENTS IN SCHOOL.
dO YOU HAVE TYPE 1? if YOU HAVE TYPE 2, SOMETIMES IT IS THE POLICY OF THE HEALTHCARE COVERAGE - NOT THE md. I TOO HAVE Kaiser AND WHEN I WAS NEW TO THEM (TYPE 1 FOR 30+ YEARS) I HAD TO PROVE THAT I INDEED HAD TYPE 1, AND THAT I KNEW WHAT I WAS DOING, THAT MY GOOD a1c'S WERE BECAUSE OF MY WORK AND MY TOOLS (oops sorry, hit the caps button). Not because I was too low all the time or that I was type 2.
Did the Endo state exactly why you "weren't worthy" of continuing to do well using your pump>
I know, I'm getting snarky - I'm known for that - but have good intentions.
Oooh another fan of TCOYD!
My experience is that while my control while on MDIs was very good, with a pump it is even better, and it is much easier to keep that good control, especially since it is pretty much impossible for me to have anything resembling a ‘regular’ schedule. And even that totally irregular schedule is always subject to change at the last minute. I would think they would want you to do everything in you power to keep well controlled since you will then have fewer complications down the line. I was fortunate to have an endocrinologist who really encouraged me to use a pump and maintain really tight control. He recently left the area and at my next appointment there is supposed to be a new doctor. Hopefully this one will also be a good fit for me.
Another thing, just what is the current pump doing that is flaky? And one thing that is really great about pumps is the ability to download all the info. And the software can then provide the standard deviation info. Maybe your lower 1C was due to more lows. But now, your numbers are a tad higher, but consistent. One thing you can do is impress them with data. I test (have been for years) 10-15x a day, I also brought in my CGM data. I just wish they would cover CGM's for adults.
my endo was such an idiot I had to ask for it and I was taking over 10 inj of Novolog and 2 of Lantus a day. So Glad to have left him behind. A1c went from 9 to 6 in three months...I so wanted to slap him...They aren't all in touch with their patients...But then not all patients are in touch with their diabetic needs. Switch Doctors, keep improving your life, and Good Luck...!
Les, where are you geographically? If you are in the Portland area, I can give you names of good and cooperative MD's, I also can get a name for you in San Diego. Feel free to send me a personal message or friend me here. I'd be happy to help out. I had a hard time negotiating the find a new Endo bit after moving here to Portland.
I was switched to the pump by another endo when I complained that the HMO dropped pens from the formulary … I didnt go willingly lol …but I really like it now … I think it would be better for me to get a longer inset needle since I have a high BMI … I am also testing and adjusting way more … Also if I get two high numbers in a row I change injection sites. … I need to replace because the case at the battery is cracked and due to the seal at the control buttons is broken it is no longer water resistant … I am going to do everything to get them to cover the pump( yup out of warranty)
Obtw you guys are great … I left another diabetes community today because I got nothing but crap from type 2 non insulin dependent folks …
Thanks for your replies and support …
I am in the SF Bay Area …since I am a Kaiser member I have to stay within the system. Definitely could find another endo.
In Portland (and I believe San Diego - I wasn't with Kaiser) there are more than one endo/CDE. Of course the challenge is finding the one that has your outlook and with whom you can work well. For me, it is important that the Endo/CDE recognize that I am intelligent, my 30+ years experience is worth something, and that my labs (which are good) are due to my work and diligence. It is hard to convince a new MD/CDE that you know what you are doing. Maybe you can somehow find others in your area with Kaiser coverage. Check to see if there is a SF Bay area group here. Post the question of who they might recommend. I have my next telephone apt (have to talk to them every three months no matter what in order for Kaiser to cover my pump - my Endo is willing to do the phone chat). I'll ask if he knows the Endo people in San Francisco.
Well I guess me complaining loudly but politely got results and I will get my pump replaced. The positive aspect of this whole thing is … I researched various papers on the subject of the pump, H1ac, and general pump usage. I also got extra motivated to be a very good pump user … And I for reconnected with a community of people effected with diabetes … Thanks for your input and support …
Glad your getting a new pump. That was weird your endo wasn't willing to get you a new pump at first given your old one was cracked. As soon as my 2020 was out of warranty the CDE I saw once wanted it replaced when I was pregnant with my son, didn't matter that it was still in good working order and not even damaged in anyway other than where the paint wore off from being in a case not specifically for it. Heck, I am now on my third brand of pump even given my second is still in warranty until Jan of next year(MedT wasn't working for me, hate them with a passion).
Update … Just got my new pump and had a training session with a RDE with type 1 and a pumper. I did get a TSlim and I live it already something must have been bad with my old pump because my numbers are down … Which is a good thing … I give two thumbs up on the Tandem TSlim …