Requirements for getting a Pump?

Type 2
1

I spent a considerable amount of time reading through posts here, but many are quite dated. I have a few questions regarding the use of a Pump for an insulin dependent Type 2. My insurance plan (THANKFULLY!!!) covers all diabetic supplies including DME at 100% with no copay.

Can I as a Type 2 (Am I still a Type 2?) even get a pump without taking injections for at least 6 months?

As far as "proof" that I could live healthier, what do I need to provide or does the Pump Rep deal with the insurance carrier? I travel roughly 50% for work and on my own time I am rarely indoors. During the spring and summer I am not near land as we spend weekends out on the boat on the hook.

I am going to a new Endo on the 7th (that in itself is a long story)so I have no idea what she will be like as far as keeping up with new technologies and procedures so what are my options if she does not agree that I need it? That brings me to my last questions - Do I need it? Would I benefit from it enough to really pursue it? Like I said - I am very active outdoors and need to have a flexible solution that will allow for hot / cold, far from home, difficult meal schedule, MUST be able to use near and in the water and in a tree stand lol!

Looking forward to hear some new opinions and personal recommendations. I am currently on Humalog and Lantis which are adding up to 5 - 7 injections a day and putting a serious hit on my personal life.

Thanks!
Gary

2

Gary, I did an advanced search here and we have 145 members who are type 2 on pumps. and meet another Gary, one of them:
http://www.tudiabetes.org/profile/Stmwndr

I can't answer all your questions, but I can definitely say that even though you are on insulin, you're still a type 2 (this is a very common misconception, I never could get my type2 dad to get it). Also I've found the pump reps are more than willing to help you with the insurance. I use the Accu-chek Combo (love it), but it is not waterproof, although it's easy to disconnect for short periods of time. You might want to look at the Omnipod (and others). I think you will like the flexibility the pump gives you to vary eating times, lower basals for exercise, etc

3

Hi Gary, I am also Type 2 and I just started using a pump last week. I decided to pump for the same reason as you, I'm not in an office or a factory all day. I work as technician for a gas company and might be all over town during the day or in my workshop weekends. The flexibility is what I was looking for.

I had no trouble getting approved for my pump because I also have good insurance. My Medtronic Rep took care of the insurance all I had to do was get my doctor to approve. I did that by proving to him that I understood how to use insulin. I counted carbs religiously, I kept detailed logs and managed my best A1c ever. Once he was convinced that I understood basal rates, I to C ratios and correction factors he was very agreeable.

Your question about whether you need it comes down to a simple factor, are you insulin dependant and use both basal (long acting) and bolus (meal time) insulin. A pump is just a delivery method just like injections are. The decision to pump is based on personal preference. I will add that some forks are able to achieve better control when pumping.

For your active lifestyle and love of water sports I would suggest you look at the Animas Ping brand pump because it is water proof. My Medtronic's pump is not but that wasn't an issue for me since I'm not into water sports.

Like I said earlier, I'm only a week into using a pump. So far I'm loving it. I'm still getting used to the being connected factor but that's not a deal breaker. It's just a matter of getting used to the mechanics of things.

Gary

4

Plenty of T2s on here have pumps. I think a lot has changed from years ago (when only T1s could get a pump, and even then it was hard!).

Here is what you should do:

1. Find an endo who is pump friendly. Tell them you want a pump. Some justifications people have used for needing a pump include variable/hectic work schedule, dawn phenomenon, and being very active.

2. Your endo will write you a "certificate of medical necessity," which is basically a physician saying that you need this device.

3. Insurance companies all have different requirements. Some require that you be on injections for a certain period of time, some do not.

4. Pick a pump that you feel best meets your needs. Minimed does a great job of working with insurance companies to get approval. Usually, a certificate of medical necessity is all the insurance company needs, but if they deny your request, the pump manufacturer will work to appeal.

5. Make sure you have at least 3 months' worth of blood sugar and insulin logs. You should also have proof that you've taken a course in advanced carb counting and/or met with a dietician. Sometimes insurance companies ask for this, sometimes they do not. But endos usually require these things anyway.

5

If you are Type 2, you are a Type 2 on insulin. Have you ever been tested to see if you have antibodies and are possibly LADA instead of Type 2.

Either way, if you are Type 2, I assume your total daily dose of insulin is high. If that is the case, be sure to pick a pump that works well with high insulin use. Although the Ping is great for being waterproof as one poster mentioned, it only has a 200 unit reservoir. By the time you prime, you usually only have 170-180 units. So if your TDD is greater than 55-60, you’re going to be forced to change your reservoir more often than every 3 days which is technically how long you should plan to wear each infusion set. It is kind of a pain to change out reservoirs, so you really want a pump that will let you go 3 or more days.

Pumps that hold 300 units of insulin are the 700 series Medtronic pumps, the Tandem, and the Accu-Chek.

Basically do your homework when you choose a pump. Each pump has its strengths and weaknesses and you need to decide which features are most important to you.

Good luck. I think that a pump will improve your quality of life. Also good luck with your new endo.

6

That's a good point about reservoir size. I choose the Medtronic 723 for just that reason. My TDD was 65-70 and I didn't want to be changing sets every 2 days. Funny thing is that since I started pumping my TDD has decreased to where I could go three days on 200 units. Go Figure.

7

A lot of people see a reduction in insulin use when they start pumping. But not everyone does, so IMO if you’re close to maxing out a 180-200 unit reservoir, I really recommend a 300 unit reservoir.

I’m a Type 1 who is very sensitive to insulin. My TDD averages about 20 units per day, so I actually use my Ping reservoir for a week before changing out. I still change my infusion set every 2-3 days.

Most new pumpers don’t realize that you don’t have to change your infusion set and reservoir at the same time. But until one really understands priming, filling cannula, etc., I think that the safest thing is to change both at the same time.

8

I have struggled with this same issue. As a T2, have been using insulin for two years and I still struggle with certain things like Darn Phenomenon. I inject 4-6 times/day and test 6-8 times a day and am very diligent about my diet, all of which my endo is aware of.

But getting a pump from my insurance is no cake walk. The immediate answer will be no and it will require my doctor establishing the medical necessity of the pump. My insurance (Aetna) policy follows Medicare and allows you to either be grandfathered in by having a pump before joining Aetna or to satisfy a set of conditions:

1.The member has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin dose for at least 6 months prior to initiation of the insulin pump*; and
2.The member has completed a comprehensive diabetes education program; and
3.The member has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump; and
4.The member meets at least one of the following criteria while on multiple daily injections (more than 3 injections per day) of insulin:

a.Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dL; or
b.Elevated glycosylated hemoglobin level (HbA1c greater than 7.0%, where upper range of normal is less than 6.0%; for other HbA1c assays, 1% over upper range of normal); or
c.History of recurring hypoglycemia (less than 60 mg/dL); or
d.History of severe glycemic excursions; or
e.Wide fluctuations in blood glucose before mealtime (e.g., pre-prandial blood glucose levels commonly exceed 140 mg/dL)

I can easily satisfy the first three conditions, but the fourth condition requires me to display what I consider to be poor control. I consider myself very good at using insulin to control my blood sugar. I know that if I had too, I could use syringes and vials of R/NPH and attain reasonable control. I am just a bit angry as a T2, that the patients that display poor control are granted a pump rather than patients who could benefit the most.

And this last statement, in my view is most important. A pump is no better then injections if you don't use it effectively. The data I have seen suggest that T1 patients moving to the pump reduce their A1c by 0.5% on average (whoop dee doo). There are many patients that get greatly improved control. Those are the patients that "really" use the pump. To really use the pump, you need to make dozens of more decisions each day (over injections). I'm not always clear that a patient who doesn't properly count carb, test and inject their insulin will do any better using a pump.

In the end, I suspect that my endo could make the case that a pump is warranted for me through the necessary proof of medical necessity, but for right now, I consider insulin pens easier for my active life. I travel a good deal and am outside, a pump requires more supplies and backups. I just grab a few pens, a bunch of pen needles and my frio and I am fine.

9

You left this requirement off your list:..."Diabetes needs to be documented by a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method."

Many type 2's have a hard time meeting this requirement when they first start insulin...but eventually many stop producing insulin at some point.

10

You are correct, this is an additional requirement that is part of Medicare (See Section 60-14 of the CMS guidance). In the case of Aetna, they have dropped that requirement, but they follow almost exactly the rest of the Medicare guidance.

Each insurance company (and sometimes even different plans from the same company) have different policies. Many insurance companies make these policies readily available on-line, even for non-members.

11

I was required to supply a C-peptide test to United Health Care for my first pump, but later UHC approved my CGMS with just a Rx to MiniMed and at that time my doctor said UHC had disapproved all of his prior requests for CGMS coverage. I have BCBS (Anthem) now and they have never asked for any documentation from my Doctor.

12

I have BCBS also and had no problem getting my pump the only glitch was a mistake on my birthdate and BCBS said they I was not insured. After that was corrected things sailed thru. I did not try for a CGM because my Medtronics rep said it's hard for T2's to get approved for a CGM with BCBS. I really didn't want one anyway so I let it go at that.

13

Thanks Everyone! Some great information here. My visit is on the 7th, so we will see what she says and what the Insurance Company says and then I will let you all know.

14

Well, good news for a change! I just met with my new Endo and she was literally amazed at what I knew! She said most patients don't even know what a I:C or ISF is! I met with the CDE 1st for an hour and a half, and she said there was nothing more to teach me that I didn't already know and that she would recommend that the Dr. skip her office requirement of 1 year with no missed visits and go ahead and order a pump for me. I have to go back March 4th to meet with the trainer and get my new pump. I wanted to go with the Omnipod as my 1st choice, but she said she has had very bad luck with them, whether it be bad pods, or non-adhesion. She said she had a few patients try them, and the longest they lasted on them was 4 months, so she does not recommend it. Her 1st choice is the MiniMed, but I told her I needed something to use in and around the water, and asked if she would recommend the Anamas. She said she like the pump, but warned that several patients have had water related failures and that although they claim it is waterproof, she thinks it is more water resistant. She is really pushing the minimed because her office is on that system for patients to upload data. In the end, she said that she would order the Anamas for me though, and gave me a few days to think it over and call with a decision. I have seen waterproof cases for the minimed, but I don't have any 1st hand real world knowledge on how effective they are. Are they really good enough to count on doing 75 on a jet ski, or standing in waist high water all day?

I know I have asked a lot of you folks in a short period of time, but I would appreciate any thought, tips, or hints to help me decide. Thanks!

Gary

15

We have enjoyed every minute of our chats with you. Sorry we can't make that decision for you. You have done your homework I'm sure you will make the best decision for you.

As for doing 75 on a jet ski I don't know about that one, I guess it would work if well secured, I would be hesistant to submerge any pump for a long period even if it is waterproof. There are ways around these things. I wear my pump in my shirt pocket everyday. No one says you have to wear it on your belt.

Gary

16

I have type 1 and I am wearing pump. As I am, as you, very active outdoor and moving around a lot during the day the pump is a big help. Because I can change the insulin rate after my spontaneous actions. Just changing and I can be more active or less active than I planned. This make life much more flexible as Diabetic. I love my pump.Easy to wear it when I have underwear with integrated pocket.

17

Gary, I wear Animas and in the past I wore Medtronic. My two cents if you are frequently in the water I would not want a pump that wasn’t water proof. Yes, if there’s a crack your pump will fry but you have more options if you start out with a water proof pump. Just inspect your pump for obvious cracks first and have a back up plan for insulin if your pump malfunctions.



On the negative side I also would be concerned about how you plan to secure the pump to your body during high speed events like water skiing, jet skiing etc. The last thing you want is a $6,000 pump at the bottom of the lake if you go one way and your pump goes another. It could easily shear off at the tubing if you weren’t careful about how you secured it to you. Also some people go low during water activities and need to suspend or disconnect anyway so if you like Medtronic features better then it may not be a barrier anyway.



Regarding downloading Animas has Diasend which you can use at home and bring in print outs that your endo wants. Or your endo can set that up their office too. My endo has all the software for most meters and pumps at the office not just Medtronic.

18

I decided to give the Omnipod a demo. I have been wearing it now for 3 days and so far no issues at all. The Saline Trial is being delivered on Friday and I will be wearing that for a few weeks to test it in the real world. They are sending a rep to my house to train me on it and make sure I understand it. Luckily, I will be getting to trial the newer smaller version too!

I reached out to Animas and as of now, I have not heard back from them on getting a demo or trial unit.

As far as the jet ski goes - I have a Mustang Survival vest that has pockets that are secure both inside and out, so if I do decide on the Ping, I will have a good place to put it. I do worry a bit about all of the bouncing and rough riding, but we will have to see about that once I talk to the rep. With the Omnipod that will not be as large a concern, but will still have room for the PDM in a waterproof case. The ski has watertight storage on it for my other "stuff" that I always carry. I will more than likely put together a second kit for dedicated use on the boat / ski. Never hurts to be too prepared.