As someone who currently has a worse A1c on the pump than I did on 6-8 shots a day, I totally agree with this! You only get out of the pump what you put in, and the pump IS more hassle than injections in that it takes more thinking (you have a million more variables on the pump than on shots). For me personally I was never able to get an A1c below 7% on shots and am able to do so with the pump (mostly because my basal needs vary a lot throughout the day and also have rapidly changing needs around that time of the month, which the long-acting insulins can't accommodate) BUT only when I am putting in that 100% effort.
I think it really comes down to your insurance company and their views on it, which unfortunately differ widely. I'm blessed to have wonderful insurance, as a type 1 I know it was automatically a bit easier for me, but I really had NO issues whatsoever getting approval, and my supplies are covered 100%. (A bit off topic, my insurance even covers test strips 100% - it's the one thing I can get every month at Walgreens for absolutely no copay.) I work with a type 2 who is insulin-dependent and she has a pump as well. She had no issues with our insurance company, despite being type 2.
I really don't understand the logistics/politics of it. Honestly, I would think that the pump could be viewed as preventative measures (because many (not all) people have better control with a pump, thus a lesser risk of complications), and I would think an insurance company would be interested in preventing complications they'll be paying towards later on....
You have that absolutely right! The other part of the problem is the pervasive view that Type 2's not only brought it on themselves, but could "cure" their diabetes if they'd diet and exercise -- in other words, the only reason they need insulin is because they're lazy and gluttonous.
The ignorance about Type 2, not only in the media, the medical profession, Type 2's themselves, and, sad to say, Type 1's, is appalling. So why should the insurance companies do any better?
There is a well-documented loss of about 80% of beta cells in newly diagnosed Type 2's, so why are all the islet-cell transplant researchers ONLY concentrating on Type 1? Type 2's don't have the auto-immune issues of Type 1, and so could benefit from islet-cell transplants, especially when they learn to transform autologous (self) cells into functioning beta cells, when no immunosuppressant drugs would be needed. A recent research article said that they had turned cells from testicular tissue into beta cells -- aha! progress toward a cure for Type 1, but don't even think about Type 2's, in whom they would work RIGHT NOW. (Unfortunately, only men!)
In an overwhelmingly Type 1 DOC, it can be frustrating to be a Type 2 (or an other, somewhere in between, like me). So I just keep on trying to report the truth, even when it doesn't apply to me directly. In truth, I have utmost sympathy for both, and know that all of us would rather just not have it!
welllll actualy you can I am type 2 and I have a pump now,was taking multy shots and pills and etc..
I have the ping one touch contact them for a Dr. near you there is a group of people out there just waiting for you, my ins comp approved it.
I'm T2, and had no problem getting a pump. On the form, instead of checking the T2 box, my doctor wrote in "Insulin Dependent"
Donno if that helped or not, but it seems like a good idea.
I have dawn phenomenon, so maybe that made a difference.
March 7 will be 4 GREAT years pumping for me. My last 15 A1c's have been between 4.9 and 5.4.
On injections, I had a 6.9 A1c but fasting numbers 200 to 250, due to dawn phenomenon. I need 9 times as much insulin at 3 am as 3 pm, try doing that with injections!
I'm very glad I don't live in the UK, where pumps for T2 are against the rules. The government buy's the pumps, and you all have heard of the golden rule (he who has the gold, makes the rules). According to official policy there "There is no evidence that a pump will help T2's"
Ya, right. And I have some lovely beach front property in the everglades for sale.
<Sigh>
-Lloyd
Like others said, it is going to vary by insurance. I would call your insurance and ask what their requirements are for getting a pump – your doctor goes by general requirements and does not necessarily know the specifics of your plan. I have a T1 friend whose husband is T2. His endo would not sign the paperwork for a pump because he told him that his c-peptide was too good. He switched endos and the knew one said she would sign the paperwork but he would never get it approved. His insurance approved it. A big problem will be when you hit Medicare and they won’t cover either a pump or supplies for you.
In order to be covered [medicare], patients must meet criterion A or B:
(A) The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e. at least 3 injections per day), with frequent selfadjustments of insulin dose for at least 6 months prior to initiation of the insulin pump, and 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 meets one or more of the following criteria while on the multiple daily injection regimen:
(1) Glycosylated hemoglobin level (HbAlc) > 7.0 percent
(2) History of recurring hypoglycemia
(3) Wide fluctuations in blood glucose before mealtime
(4) Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl
(5) History of severe glycemic excursions
(B) The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment.
REVISED, see above
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. (Effective for Services Performed on or after January 1, 2002.)
Continued coverage of the insulin pump would require that the patient has been seen and evaluated the treating physician at least every 3 months. The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII.
6. Other uses of external infusion pumps are covered if the contractor's medical staff verifies the appropriateness of the therapy and of the prescribed pump for the individual patient.
I'm not ready for Medicare yet, but I'm still confused -- if you meet criterion B, already having a pump, do you still need to meet the C-peptide requirement?
I've never had a C-peptide, so I have no idea what mine would be (probably low, but not necessarily low enough), but I would hate to have to go off the pump because it was too high!!
I was diagnosed as a T2 and both my doctor and insurance company approved me for a pump when, after several years on MDI, I developed hypo unawareness and could not get my A1c's below 9.2.
Now, Medicare is a whole 'nuther story, and I don't know what's going to happen when I turn 65. Fingers crossed!
Ruth
Yes, for Medicare, you have to have a c-peptide test done. If you don’t meet the c-peptide requirements, the other requirements don’t matter. It also has to be a fasting c-peptide. A supply company won’t even sell you the pump supplies without that c-peptide test. I am on Medicare because of being on disability and I can’t get the insulin for my pump thru my regular pharmacy. The pharmacy I went to for the insulin had to have a copy of the c-peptide. I went to order supplies from a different company than I bought the pump from and the new supply company had to have the c-peptide before they would ship the supplies. I have read about people having pumps prior to going on Medicare but because they did not meet the c-peptide requirements, they were not able to get supplies.
I am not sure where you copied your information from, but this is from the CMS manual which sets the requirements for insulin pumps. The key words here being “In addition to” – regardless of what you had prior to going on insulin, if you don’t meet the c-peptide requirements, you won’t be able to get supplies or a new pump under Medicare.
http://www.cms.gov/manuals/downloads/ncd103c1_Part4.pdf
General CSII Criteria
In addition to meeting Criterion A or B above, the following general requirements must be met:
The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement, or, as an alternative, must be beta cell autoantibody positive.
Updated fasting C-peptide testing requirement:
• Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110% of the lower limit of normal of the laboratory’s measurement method.
• For patients with renal insufficiency and creatinine clearance (actual or calculated from age, gender, weight, and serum creatinine) ≤50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200% of the lower limit of normal of the laboratory’s measurement method.
• Fasting C-peptide levels will only be considered valid with a concurrently obtained fasting glucose ≤225 mg/dL.
• Levels only need to be documented once in the medical records.
we live in a treat first society and you are right insurance companies care about one thing and that's the bottom line, a pump costs upward of 5k for them, why would they not fight it, its the same reason they want us using one test strip a day.
Its all about immediate cost savings.. An ounce of prevention (or even a few) doesn't seem worth a pound of cure at least to me.. A pump, 5K plus supplies (roughly)... a trip to the ER for say. gastrointestinal issues such as gastroparesis... Youll probably end up with a CT to rule out other severe GI issues.. That will bring the charge for the ER visit (to the insurer) past the 5k mark...easily..
Clearly, the link I found was to older rules.
-Lloyd
The public sentiment seems similar to smokers who have health problems–that is to say if your behavior/lifestyle causes the condition, you should change that behavior/lifestyle to regain your health before you die from your illnesses. The tobacco industry defended itself for decades by arguing that their customers had a “sloppy lifestyle” which included other disease inducing activities (heavy drinking, etc) so tobacco could not be exclusively blamed. T2 Diabetics are similarly judged because even though there may be other factors in play besides BMI, diet, and exercise (i.e. the “skinny people” you know), obesity is a primary cause for insulin resistance. Diabetic Biggest Loser contestants demonstrate this as they get off meds after getting to a normal BMI.
I think this bias leads to policy decisions in some insurance companies. The bottom line is that if your doctor says you would benefit from the pump, you should be able to buy one, and your insurance company should help support it. Best of luck to you.
BSC said:
"I am actually offended that the strategy taken by both medical professionals and insurance companies is to grant insulin pumps and CGMS to only patients that have poor control."
" A pump and a CGMS is not some one button technology that fixes your control. In fact, the best candidates for pumps and CGMSs are probably patients who have demonstrated an good ability to implement an insulin regime with injections. Instead, we rewards the diabetic who can only remember to take half their shots, eats ding dongs and twinkies and won't bother to test, calibrate, set and press the buttons on these devices dozens of times a day"
I am not sure whether you are just talking about poorly controlled T2's but I had good control,. excellent even, when I was approved for the pump and CGM. In fact, the opposite problem often occurs with T1's....we often have to prove good control before being "awarded" a pump. ...
Usefull information, but my child is 13 and along way from medicare. But I bet that if insurances had nothing to with the pump for a type2 child who is insulin dependent and I was going to pay out of pocket there wouldn't be a problem with it being approved by the pump company. Wow money talks and BS walks.
Well the key thing is that insurance companies follow medicare. Basically, the insurance position is that they should not have to "volunteer" any better coverage than that offered by medicare. Most insurance policies for pumps (and other diabetic supplies) follow medicare criteria.
I think it all depends on your insurance company and what hoops they make you jump through. Some Type 1’s have to go through the same process. We have a high deductible HSA so if I wanted a pump I could probably get one but would have to pay the first $6000 of expenses each year. Quite frankly Insurance companies are businesses who need to make money so they try to deny procedures as much as possible.