Newly diagnosed; Pump question

Type 1 and LADA
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I was diagnosed type 1 1/14/2017 when i was admitted in the hospital for DKA. I am a very active and healthy 25 year old male 175, 15% BF, 5’ 10’’… Already was proficient at counting carbs and exercise for 6-8 hours a week. My father was diagnosed at 40 with type 1 and has been on a pump for 15 of his 17 years. Naturally he was pushing for a pump and so was I. After my first visit with my endo she seemed very supportive of my urgency to begin pump therapy. However, she messaged me a couple days ago and said that ‘insulin pump companies generally want to wait 6 months’.

I have already started the process with Medtronic after my Doc suggested i reach out after my first appointment and heard no mention of this wait period. Is this a pump company policy or my endo’s policy? I find no documentation of my insurance policy requiring this wait period.

This concept is moronic to me. I am a proficient carb counter and a pragmatic manager of my personal health. Due to my high level of activity and high insulin sensitivity i need to be able to bolus partial units and, most importantly, have more control over my basal rates. MDI is not cutting it for me for the simple fact that i cannot ‘turn off’ the lantus.

Sorry for the rant. As many of you know this is a big pill to swallow as a 25 year old who has never had any sort of health problem. Any insight is helpful.

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sorry to welcome you to the club, but I’m very glad you found us! someone else had the same experience and here’s how our members helped

welcome to our community. let us know how things go!

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What’s up Noah. I was dx’d at 19 in the best shape of my life, so I get how you are feeling. Nobody in my family had T1 or T2 though so at least you are familiar with diabetes because of your dad.

I’d contact the insurance company and if there is no restriction then go back to your endo. She’s probably trying to cover herself a bit.

Good luck and question away.

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I know when I got my first pump back in 2015, I’ve been a juvenile onset/type 1, for 50 years at that point. That my endos office had to give a certain number or weeks or months record of my blood sugar readings to show/prove a pump would benefit me. So maybe that’s why you’re having to wait, you haven’t been a diabetic that long, so they want to see how you’re blood sugars are doing.

And you can always call Medtronic and ask them why the wait. Whenever I’ve had to call either Animas, for inset problems or Tandem for pump problems, they are extremely helpful.

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It is the health insurers, not the pump companies, or your endo necessarily, who want you to wait 6 months. (Heck, they’d be happy if they could make you wait forever.) Choosing which pump is an important decision; please be sure to carefully and thoroughly compare the specs of the different pumps.

You won’t find mention of “the wait” in your health insurer’s literature. Because health insurers don’t understand what “transparency” means.

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I think you fit the exact profile of someone who will do well on the pump long term. If you are conversant with your insulin to carb ratios (I:C), insulin sensitivity factor (ISF), and duration of insulin action (DIA), then I think you are a great pump candidate without the wait.

For many people, the amount of information that needs to be absorbed upon diagnosis is like trying the drink water from a fire hose. It’ll often take six months to be comfortable with effectively and safely making changes to your pump settings.

Knowledge is the key ingredient for success with diabetes. Diabetes tech does not equal diabetes expertise and diabetes success. Many people do very well using multiple daily injections (MDI) to manage their blood glucose. If you have not already, I highly recommend that you read a few books about dosing insulin. I’d recommend Using Insulin by Walsh and Roberts, Think Like a Pancreas by Scheiner, and Sugar Surfing by Ponder.

I wouldn’t be too put off if the powers that be decide not to pay for a pump right away. What I would lobby hard for, right now, is a continuous glucose monitor (CGM). A CGM is a tool that will illuminate your blood glucose metabolism and teach you about how your body responds to food, exercise, and insulin dosing. It will also immediately boost your personal safety. Insulin is great medicine but it can be dangerous!

If you haven’t already read a few books about dosing insulin, you have your work cut out for you. Expend your time and attention on getting a great diabetes education. It will serve you well for the rest of your life – unless we’re all pleasantly surprised with a cure. I’m not holding my breath. This is more important than starting on a pump. Get the CGM if you can. It is invaluable.

Good luck! I was diagnosed with T1D on January 14, 1984 at the age of 30.

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Terry, i absolutely agree. Since my diagnoses i have been in total data collection mode. I am doing well with my MDI regimen but frustrated with how lantus drags my sugars down when i exercise. I’ve been communicated with my doc and we’ve been making constant adjustments which is why i desire the more refined control that a pump allows.

I absolutely agree with your stance on CGM. Hypo’s are what i’m having trouble curbing right now and the ability to treat those before i bottom out would be so beneficial. Right now i have BG numbers but no direction.

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Unfortunately I have United so they took the decision making part out of my hands…

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It IS possible to beat UHC and get a different pump, but it’s not easy. I did it. PM me and let’s talk.

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So sorry to hear this, because IMO this so very, very wrong.:slightly_frowning_face: I hope you have the opportunity to choose which pump you want in the future.

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I was diagnosed last year and went directly to a pump. My endo was supportive and suggested it based on my knowledge and comfort. He prepared a letter and sent to insurance company. It was approved no questions asked. If it is really what you want be firm and your endo should be able to make the case to the insurance company.

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That’s encouraging. I understand that it’s atypical for someone to want to jump in but the pump does not intimidate me. I barely remember my father being on injections and he’s always raved about how valuable the pump is. It’s not if but when for me.

It’s very frustrating feeling like my care team and I don’t share the same sense of urgency in equipping me with the best tools to manage this disease. They will either get up to speed or be replaced as far as i’m concerned.

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Hang in there. I have not regretted going directly to the pump. I went from 11.8 A1c at diagnosis to a 5.9 this week - all in one year. I have a Medtronic pump. It works well for me.

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I hear you loud and clear, Noah3. One of the several reasons why I switched endos for my daughter was this very issue. Had to literally beg for about 4 months for a rx for a pump even though our health insurer provided coverage the day after my daughter’s diagnosis. Daughter’s first endo kept repeating to me “Your insurance won’t cover it for 6 months” ever after I gave her the paperwork proving otherwise. If you can believe this, she required me to write a paper demonstrating my knowledge about D if I didn’t want to wait the full six months. (I’m a physician and had already treated D for years, and she knew this. And this was not a CYA requirement at her clinic. But I wrote the damned paper. My daughter wanted a pump so badly and her Lantus injections stung. I was willing to sacrifice a few limbs if that was what it took to get her on a pump ASAP.)

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Noah, sorry to hear about your diagnosis. I am going to offer a little of a contrary opinion, but not for the “usual” reasons.

For the record, I am the father of a somewhat recently diagnosed 14 year old - Dx Christmas 2015. Because of that I have gone kicking and screaming into the world of pharmacies, insurance, prescriptions, sensors, pumps, and physicians with both barrels of my parent tingly sense consistently telling me, that if I don’t get this done right now, my way, my son is going to die or at least be harmed.

Does the 6 months wait seem correct, or in your best interest. No.
Is the ability to micromanage your dosing with a pump amazing - Hell Yes
Is the ability to sleep in, skip meals, and better deal with your exercise regimen all great with a pump - Yep
Most impressive to me, is your fighting attitude and desire to stay healthy which will be to your greatest benefit.

I would caution you to make sure this is the hill you want to empty your “enthusiasm” on. I speak having fought the system on a number of issues; i.e. old insurance covered Dexcom, new one didn’t, new insurance won’t cover our preferred brand of strips, etc. etc. I have filled out mountains of paperwork, multiple appeals with well thought out medical reasons including physician opinions, documented medical difficulties, etc, to be told that my appeal has been reviewed and they are sticking with their original opinion, for no good reason. In one they at least made me feel better by restating my argument before denying it, again…

I say all this, because you may find that even if you appeal, it will take 3-4 months to get your way, at which point you would have qualified anyway. Now if you were denied a CGM, I would fight till hell froze over, or at least until I made enough money that the appeal process was more expensive than just buying the technology myself…

Good luck!

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Au contraire! Health insurers understand “transparency” completely. It means they get to see and interpret your policy, while you (mostly) agree with them. :unamused::rolling_eyes:

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I wanted to mention this on the topic of a newly diagnosed D waiting 6 months before getting a pump. While this may seem troubling, this is actually something that can be quite useful for the appeal.

Appeals have several legs:

  1. "A type X pump won’t work for me because…"
    2) "Using MDI did not work for me because…"
    3-8) Legalese, wording of the insurance SPD, state you live in, self-insured vs fully insured policy, federal standard of care, employment considerations, etc, etc… (let’s worry about those later).

Strictly speaking on point 2 here - If you try to appeal without ever using injections, you can’t really make the claim that MDI didn’t work.

The fight is long. It is a lifetime. There is no hurry. Don’t worry about beating them today. Today what you need to do is work on setting yourself up for beating them 6-12 months from now.

Every low BG you have, every high BG you have - record those, make notes. Why is a pump necessary. Why won’t MDI work, and why won’t a different type of pump work…

Noah, you are my BWD. As long as I can draw a breath I will fight with you.

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Thanks for your insight. I completely understand what you mean when it comes to picking my battles. Since my surprise week in the hospital it seems there is a new one around every corner.

In regards to the CGM - Do you mean denied a CGM in the meantime waiting on the pump in presumably six months or denied one altogether?

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Noah, If there is one piece of kit I wouldn’t want my son to do without it would definitely be the CGM. We could switch from the pump to MDI, from MDI to one shot of who knows what. With the CGM data available, you can much more easily manage your diabetes, exercise, illnesses, everything.

Unfortunately, this is not always covered by insurance without a fight. My advice to you, if you can get a CGM from your insurance, I would encourage you to do this. If you need help with an appeal, citations, cost effectiveness studies, etc. I will help you. This is what I would use most of my “fight” energy for.

Everything else will take care of itself pretty shortly. You only have so much energy, better to focus on the positive things in your life. Every day of waiting for an appeal to come back from an insurer is painful, even more so when it gets denied. Even, even, more so when it gets denied for a technicality and they admit the medical necessity…I hope you get my point, I really suck as a writer trying to help convey my emotional state.

With your positive attitude, and the support of this wonderful site, you are already miles ahead of many less fortunate diabetics.

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One thing I would point out is that if your pump fails, you have to go on shots. So, yes, you may know how to count carbs, but you barely have a handle on taking insulin. You also may be in the honeymoon stage and your insulin needs are going to be all over the place.

I understand your frustration–especially about the diagnosis. I was diagnosed at 43, which is such a WONDERFUL present to get for entering middle age. I would have preferred the hot girlfriend with the red sports car!

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