Switching from the pump to the pen

Hi! I'm Hannah. I've been a diabetic for 9 years now. I was dx when I was 11 and started the pump at age 12. I hardly remember anything about the shots and I wasn't offered pens back then.

Anyways, after 8 years of being spoiled with an insulin pump my insurance decides that it is a "luxury" and will no longer cover my supplies. I am appealing this, but in the mean time I have been switched from the minimed pump to lantus and humalog.

I was just wondering if anyone has been through this and has any tips? I seem to need way more humalog with meals than I did on the pump. Also, when is the best time to take the lantus? My doc was kinda just like "well here ya go! Have at it!".

This morning my fasting was 114 and my two hour post prandial was 313! I never get number that high and I count my carbs very well!

I'm just so lost because my blood sugars are usually PERFECT! My last a1c was 5.1 and I've never had anything over 6.0.

I guess this is more of a ramble than anything, but if anyone has any tips please let me know! : )



I switched back to injections earlier this spring (March). It took a while to get things "right" (few months). I noticed, too, that I need more Humalog at meals now. My I:C ratio on the pump was 1:10. Now it's more like 1:7, 1:8. I ended up splitting my Lantus dose (after much trial and error), 50/50 - half at 10am, the other at 10pm. So far, this is working for me. Hope you can get yours figured out soon. And I hope you can get your insurance company to change their minds.

Thanks! I feel like a new diabetic again. I guess maybe the absorption is better with the pump than with the pen. hmm. Trial and error, I suppose.

I am so sorry. It is so unfair the way insurance treats us. A "luxury" my a**.

The 50/50 idea is fantastic. When I was doing basal with Lantus, I was advised that 1) Lantus' duration is NOT 24 hours and 2) Splitting the dose is the way to get more consistent results.

I also believe that using a syringe, some of the insulin does not get delivered as effectively as with the primed tubing of a pump. The pu,p is much more accurate.

I am really sorry this is happeneing. Do we need healthcare reform?

Thanks for the advice! :)

That is just horrible!! What kind of luxury is it to be attached to a pump 24/7? (other than the luxury of staying healthy). Sheesh. Appeal, definitely. And enlist the help of your local media if possible. There was a great story in the NYT recently about a guy who had cancer and, through tweeting, was able to get the insurance company to pay his previously denied medical bills.

I think you need a caring CDE not the doctor who says "here you go have at it." The CDE/nurse at the clinic where I am seen is the first person I ask about my control and how to optimize and what I should do. I have been on MDI for 37 years and have never used a pump. But I do split my lantus dose 50/50 but I do mine at 7 am and 9 pm just because it's when I wake, and when I remember to do it at night. My ratios are different throughout the day but they are 1:5 at breakfast because that is when I am more insulin resistant then 1:9 at lunch and 1:12 now at dinner because I was having some after dinner lows. But it has been a work in progress for 3 months so nothing changes overnight. It is possible, although more difficult to achieve good control on MDI, but it totally sucks that your insurance company is forcing you into this predicament. Good Luck, like I said it is possible to be in control just a lot more work.

Wow! With an A1c of 5.1, we need to be coming to you for advice. Sorry you are having to go through this, but no doubt you will work it out. You sound very committed and knowledgeable. I started on pens and they are, as I am sure you are finding out, easy and relatively painless. As a snacker, and experimenting with extended type bolusing, I used to say that I was on MMMDI.....multiple, multiple, etc, daily injections. A challenge, but worth the effort. Don't feel that you are limited to one injection per meal. Spread the dose out. Splitting your Lantus dose is absolutely worth considering. Due to insurance SNAFUs I had to go back to the pen briefly and I did appreciate how I could inject just about anywhere on my body. It was a good break from my overused sites. Good luck to you.

Just curious, have you heard back from the insurance company? Is there anything we here can do to help?

One thing that comes to mind - http://boingboing.net/2012/07/28/poop-strong-young-cancer-pati.html. This guy had colon cancer and was dropped by his insurance company after he reached his lifetime cap.

I just don't understand how you can be pumping for that long and your insurance company just suddenly denies you coverage. Clearly, your control immediately began to suffer. Doesn't the insurance company realize that your amazing (and an A1C of 5.1 for a T1 is nothing short of AMAZING!) control was BECAUSE YOU WERE PUMPING?!?! It just scares me that insurance companies can so arbitrarily decide one day that they are not going to continue to cover you for something you need to stay healthy and alive. Ugh.

THIS situation is abosolutely abominable. I guess your insurance comoany feels that since you got to 5.1 WITH THE PUMP, YOU ARE SUDDENLY CURED of needing the best, most appropriate therapy. Thus you do not nee NEED THE "luxury" of pump treatment? THAT IS JUST SO. PLEASE PARDON me, tufriends, SO "bass-ackwards" stupid . Thanks for the link MYBustedPancreas. I will read it, Now. SO MAAD!!Sorry for the caps, know I am violating Internet etiquette.. But do they( Insurance comPanies) just want us to wither away and slowly die? or maybe just not live to our fullest capabilitiEs, because we are diabetic and that is just how we are supposed to be? GRRRR
God bless,

Hannah, we will all be anxious to hear how your appeal goes. Good luck to you

I know it's completely ridiculous! Insurance companies only want to insure healthy people.... : ( .... I lost my brother to diabetes in 2004 (he was 24) and I'll be damned if I can't get my pump back. A pump could have saved his life! I'm doing OK on the pen right now. It's just trial and error.

No I haven't heard back yet. Stilling waiting....impatiently. Thanks for the concern! : )

Still waiting, but I will post when I know. Thank you! : )

I think its pretty dispicable that the first thing your doctor didn't do was offer to write an appeal to your insurance company. In addition to being the Mom of a diabetic toddler, I happen to be a veterinary endocrinologist. I have written letters to get my clients out of jury duty so they can give insulin to their cats (it doesn't always work, by the way). I agree with the posting that you need to find another doctor/CDE who will actually be your advocate and partner!

Have you considered contacting someone outside of your insurance company? Like your state insurance commission? I don't know what they can do, but even just contacting some outside entity might put pressure on the insurance company.

Also, have you talked with your insulin pump manufacturer? I know when I was going through the process of getting a pump the last time, Medtronic/Minimed told me that if I was denied coverage, they would help me fight to get it (and the rep I spoke with stated that this usually works). The bottom line is that if a physician has said that a pump for you is "medically necessary," the insurance company should pay for it. This is not some new/experimental treatment; insulin pumps have been around for quite some time and they do wonders in helping with control (which does wonders in helping prevent death and horrible complications from diabetes).

Hey! When i switched from pen to pump, the doctor said to me that i needed to take 25% less insulin than before. Because some insulin is lost with insulin on a pen. Nearly all the insulin get into your body with pump.

I'm sorry to hear that your forced to go back to pen. In Norway we get Insulin Pump on our free health service. Guess I'm lucky there! Good luck!
Greetings from Norway!