Suspending Basal Insulin To Treat a Low BG


#21

I have already had two Medicare/supplemental insurance-funded Animas Ping pumps. They also pay for insulin and supplies under Plan B for durable medical equipment. All I am trying to do is replace what I had.

Service has been curtailed by Medtronics as of Nov. 12. Now they will replace any malfunctioning Animas pump with a Medtronics 630g or 670g instead of another Animas (a complete change from their original agreement with Animas). Anyway, I don’t want a Medtronics pump. I want a t-slim x2 with a G6 DEXCOM and should be able to obtain one since Animas, my Ping manufacturer, has gone out of business in the U.S. If Medicare now backs Medtronic’s hyjacking of Animas customers, I will not go down quietly!

I know nothing about Advantage plans and don’t have one.


#22

@Willow4

So assuming you are not talking about the Tandem $1000 offer then I don’t think it would have anything to do with Tandem.

The Tandem X2 sounds like a total Medicare issue - no?

The Dexcom G6 (based on other postings) might be getting covered by Medicare in the April 2019 timeframe? It sounds like that is no question that the G6 WILL be covered but the unknown part is the precise timeframe.


#23

I have been dealing exclusively with the Tandem Regional Manager on this. I was told that my warranty expiration date was an issue. She had also supplied me with the DEXCOM application, which I filled out and emailed back to her. We decided to wait until the holidays were over to pursue the matter. The $1,000 offer is not available for Medicare funding. If there are various approval dates to be awaited, I have until September 2019 when supplies for Animas will no longer be officially available through Medtronics.

I hate the way this has been panning out… the lack of available choices as well as the Medtronics coersive herding methods (by email as well as by snail mail) to get Animas users to accept their pump(s).

But this is totally off the original thread subject. Maybe it should be separated?


#24

lol - I didn’t notice. I am the worst with hijacking.
:stuck_out_tongue:

I would think that Sept 2019 would make sense for you to be eligible for a new pump. Do you know how similar situations were handled when other pump companies went out of business or stopped distribution in the USA market?


#25

I know some people on Medicare that have switched to Medtronic for the rest of their Animas warranty. They are planning to choose a t:slim when that warranty is up. If you get a Medtronic pump to replace your Animas, you do not get a 5-year warranty with that pump. You only get the warranty time left on your Animas pump. Obviously you would need to confirm that but that is my understanding.

You’re not the only person frustrated that you can’t switch to Tandem due to Medicare regulations.


#26

Well, I am the only person I know who is in this situation and 78 years old (in 2 days). If I wait for my Animas pump warranty to expire while using a Medtronics pump, I will be 81 years old by the time I can get a t-slim and a DEXCOM of my choice. Although I have no immediate exit plans, I do wonder whether this is their way to cut down the numbers by attrition :hushed:

Medicare regulations. What regulations cover this? I have spoken with Medicare and they can’t show me a single regulation that covers this.


#27

IF that’s the case, it’s no different than when using the Pathways method of upgrading from one MM pump to the next model.


#28

But that makes one endure an unfamiliar and unwanted pump for several years, depending upon how much time until the warranty expires. Definitely not a good thing!


#29

Sadly Medicare customer service doesn’t often know about Medicare regulations, especially for not common items like insulin pumps and CGM.

My wife runs into it daily in the CGM manufacturer she works for.

My understanding is Medicare pushes insulin pump mfgrs to cover 5 years under warranty. Since Animas is no longer around, Medicare looks to Medtronic to honor the warranty however they want. So this is where your “Catch 22” is in play.


#30

I see this as breach of contract by Animas (Johnson & Johnson).

I just spent over an hour on the phone with Medicare’s Durable Equipment Department. They offered to give me a list of places where I can have my Ping repaired! They also referred to Medtronics’ offer to replace the Animas Ping with their own unit as a “courtesy move” by Medtronics. How can they be so ignorant? “Courtesy” my foot! This was a grab for the 90,000 Animas customers and some kind of deal they made with Johnson & Johnson in exchange for Animas leaving the U.S., Canada and Mexico markets entirely. The not-so-subtle coercion exerted recently by reducing the time Medtronics would service Animas products under warranty is a blatant move to accelerate the herding of Animas customers to Medtronics products. Shameful! Exasperating! Frustrating! And so unfair. But certainly reflective of the wanton and unregulated actions of corporations.

BTW, the Medicare rep I spoke with also mentioned that their lease arrangements last 13 months even though the warranties are for 5 years. After the 13 months, the user becomes the owner of the pump. I don’t know whether that affects the situation.


#31

Thanks to all for this discussion. I’ve been suffering lows nightly and have been treating them with glucose tabs. They don’t work quickly enough to keep my G6 from telling me that the low is continuing or getting worse! I will start getting up and treating with a peanut butter and jelly sandwich, which I’ve tried and know that it works.


#32

If, by “getting up”, you mean getting out of bed, or getting out of your chair, my suggestion is to keep Skittles or other quick carbs here and there. I’ve got them on the nightstand, in my fanny pack, and next to my easy chair. I never leave home without Skittles, which are 1 carb each and are fast, without the expense of glucotabs which I despise for the cost, taste, and choke-provoking aspects.


#33

I have been turning off my insulin pump for lows ever since I got one. If you can’t fix it with that you are either overdosing or else doing something you have to do like snow shoveling. In those cases you likely do need some carbs too.

I always carry glucose tablets but I generally need them only once in 3 months. If I go low on my dexcom I generally can just suspend. If there are double down arrows then I need to use the tablets and also fix what I did wrong.

Eating extra carbs is fine for people that are thin but not ok for people trying to lose weight.

One other possibility is you need to suspend sooner. The pump does this very conservatively so I often have to disable the IQ part so my glucose will come down after a meal. At other times it does great keeping me from lows.


#34

The reality is that everybody is not the same.

What works for one person does not work the same for another.

If it was that easy we would not even need forums such as this.

We find that a basal suspend is quite effective at moderating the lows and is able to control many lows. This is not 100% effective and we still need to decide where and when additional carbs are required. I am thankful the Basal-IQ suspend works as great as it does. I do not expect it to be perfect.


#35

Hi Tim35,

I don’t disagree with you about everyone being different. And I said I too use carbs as needed but each time I consider it a mistake being fixed. I would say glucose above or below desired level is by definition a wrong insulin level for the conditions. Not implying it is easy.

I would say a closed loop pump does a better job than most people including me can do manually overall, so I disagree with the gist of most posts here on this.

And I expect things to get better. There is no reason a closed loop pump can’t be as good as a normal pancreas. We might have to go back to embedded pumps again but it should all work. Most of the remaining problems seem to be the errors still in the sensors.


#36

treating lows is always more effective with carbs.

BUT preventing lows by reducing or stopping your basal insulin is still effective if the predictor - yourself or the algorithm- is working properly.

the main issue you left out is the idea that insulin is insulin basal and bolus combine for an overall effect. the major time that my basal is suspended is when i am still having stable bg after a meal and then my basal resumes as the meal time insulin wears off. a similar effect could occur Without suspending your basal you would simply adjust the amount of your bolus since you know you will have basal running the whole time.
it could be considered a sales pitch but i would need to see research comparing patients all with similar A1Cs for 1 year and then have one suspend for a year and another never suspend then see if there is any change in the A1C and their feelings of control or safety with their diabetes i.e. thing like how often do they go low specifically would answer your question.

i know the rest of this thread was highjacked but i wonder do you ever do a temporary basal increase like 120% when you are sick? certainly the same principle would apply in reverse.


#37

Jonathan nice to hear from you. I do increase a basal to 120% at times but I still realize that the basal I increase for an hour or so will be absorbed over time (for me four hours or so). I increase it mostly when I find that I am sick and I increase the basal across the board as in all day. For me I never, ever suspend my basal as I do not believe it increase BS like eating a quick acting carb does. And if people agree that insulin is absorbed over hours I can’t justify it in theory either. But many people have said that suspending the basal works for them so I so go for it. On the other hand I would reduce my basal by using a 90% temp basal if I found that my basals are too high and I wanted to see if a lower basal makes more sense.


#38

I use temporary basal quite a bit. Different parts of my stomach and sides have different absorbing qualities. Do not know if it’s the amount of skin there or something else.


#39

When you determine you need a higher or lower basal because of absorption in the site do you change the basal for 24 hours at a time?


#40

If it’s because of the site location I’ll do the change for 24 Hours.