Why wont they start me on a pump?!?

Hey there,
My name is Dino and im 20 years old living in North Carolina attending East Carolina University. I was recently diagnosed with T1D in early october of 2011 and have been trying to get a grip on this disease ever since. I've been interested in starting insulin pump therapy ever since I was diagnosed because I feel that using the pump would fit my lifestyle. I have been talking to the PA at my endo's office(because that is who I usually see on my visits due to my endo being so busy) about starting on a pump and I told him that I want to start ASAP. I went to a meeting where I met all the reps for the different pump companies and got do to some hands on activities to see how each pump worked. After attending that and doing much research on the pumps, I decided to go with the Medtronic MiniMed Paradigm Revel and my insurance covered it 100%!!! I received the pump in the mail a few days ago along with 3 months worth of supplies. Since then I emailed the PA I have been talking to about going on the pump about what the next steps were to get me pumping because I am very eager to start with it. He replied with that he thought it was weird I received the pump already because they only submitted a request for "preauthorization investigation." He told me I was rushing into things and that I need to establish a good pattern of reliable diabetes management first and introduce the pump into that setting. He told me to do a few other things also and that we would discuss POSSIBLY doing something with saline fluid and maybe starting some training at my next visit which is THREE MONTHS FROM NOW!!! Why are they making me wait so long to get pumping?? My control of my blood sugars is not too great at the moment and my most recent A1c is 7.4 which was a few days ago. Though my diabetes is not under the best control I feel like I am doing a pretty darn good job of managing it for just starting out. I was so bummed when he informed me of not being able to start pumping for AT THE LEAST three more months, especially because I have already received my pump and everything in the mail! I would just like some insight on my situation from some others, and feel free to ask any questions I'd be more than happy to answer because I just want to know what's going on! Thanks much!

Hey Dino,
First off, I'd switch to another doctor and start seeing a nutritionist within that same office if possible. It sounds like you have everything under control pretty well for being newly diagnosed, and the PA needs to respect your decision to go on the pump. You should call Medtronic and see if there is another doctors office where you can do your training. I learned the hard way that doctors don't know everything and to always use your common sense, so hearing that you are taking the right steps in your diabetes care and your PA is resistant makes me sick. Just stick to your guns and tell them what YOU want. YOU are the patient and you have the power to make all the decisions. Good luck!

Hi Dino, it sounds like your endo wants to make sure you understand the basics of diabetes management without a pump before you add in the learning curve of a pump. I know that's not what you want to hear, but honestly, I completely understand that approach.

The better you understand carb counting and how insulin works, the easier the transition of going to a pump will be. I think it's great that you're motivated and excited, but I think you should be patient and try to learn as much as you can in the next 3 months to prepare for going to a pump.

Pumps are awesome because you can dose in really small increments and you can set different basal rates for different times of day, but pumps are not a magic bullet and there can be a steep learning curve with pumps. The more you know about the basics before, the easier it will be when you go live with the pump. The more effort you put in early on, the better your results will be in the long term.

I would suggest that you read the books "Think Like A Pancreas" and "Pumping Insulin" if you haven't already. These books will help prepare you for the pump so it will be easier in the long run.

And as you get started, feel free to come here and ask lots of questions. There are many, many years of experience here. Good luck! :)

Thanks for the advice! I've started to read Think Like a Pancreas and I am going to order Pumping Insulin soon. I guess I will just take these few months and become as knowledgeable as possible on diabetes management and insulin pump therapy! Thanks again!

I have a mixed reaction to your situation. I agree with smile that it's better to learn the basics first before you go through learning to use a pump. A pump is not a panacea for bad control and will do nothing for you if you don't count carbs, determine your I:C ratios and your ISF's and in general know how to manage your blood sugar. On top of that learning both at once is an enormous burden and can be overwhelming.

Having said that you already have your pump and they have no right to tell you you cannot use it for three months. I only see a PCP, so when I got my pump, my doctor just signed the forms with suggested doses the Animas rep handed him and then I did all my training through Animas. You do need your doctor's signature and perhaps Medtronic will walk it through. But if he refuses yes, you do have the option to go to another doctor. It is your life, your diabetes and your pump, so your doctor can make suggestions but it is your decision in the end.

Meanwhile, yes, I would second the book recommendation. Start in the beginning if you need to and learn to accurately carb count as well as determine the correct I:C ratios for your meals to keep you in target two hours after eating as much as possible. Learn your ISF in order to do corrections if you are high. Then work with your Medtronic rep to get you going. I think more and more people are going to be starting out on pumps rather than shots as time goes by and doctors realize they are the standard of care

I don't like them making you wait and then checking saline. I suppose it must be a particularly advantageous insurance situation as with me, my insurer wanted a month of logs before they'd approve anything but the doc got going immediately. Althout I sort of cheated as I switched from a GP to an endo so my first visit was the "I want a pump visit". I think it took about a month, maybe 6 weeks from then to getting up to speed, including the 30 days of logs demanded by insurance. If your control isn't great, there's some risk with a pump as it can be difficult to sort basal rates from bolus ratios as I think there can be some overlap but, if you guess at your pump settings, it could get dicey?

I think too that pumps are useful as, at least the Medtronic one I use, has been a great "logger", sort of like R2D2 as it follows me around and I tell it stuff and it remembers and compiles the data into reports?

Thanks everyone for your opinions. Overall i think I'm going to just crack down on my diabetes management and try to get a very good idea of what my ISF and I:C ratio are over these next few months. I feel that it is good time to keep close track of what I eat/how many carbs I eat, how much insulin I take and how this is all affecting me. I'm also going to read and gather as much knowledge as I can on pumping and all other diabetes related topics. I'm ready to manage and conquer diabetes, as I know that it is here to stay.(Hopefully not though, lets keep our fingers crossed and continue to support the fight for a cure!!!) Any other info on preparing for pumping is also greatly appreciated! The more I find out/know the better! Thanks!

The whole reason I went on a pump was to get better control
I met with an educator for most of a day and was good to go after that.
My control got much better, but I don't think I got really good until I added CGM.
I would get a new doc. Call new doctors and tell them that you want a doc that can get you going on your new pump asap.

As far as being dangerous, I found that multiple injections was more dangerous than my pump. I had many many hypos on injections. I nearly killed myself several times. That may just be a personal thing, I don't know. I found that exercise was unpredictable with all that long acting insulin circulating about in my system.

I have only had a few hypos on my pump and really none to speak of since I got CGM.

I've had a couple of fairly major hypos w/ a pump/CGM. Sometimes, after I work out, it will read low for hours afterwards, I eat all my interstitial fluid or something, so I then, of course, ignore it. The ones that have crept up on me have been every bit as wicked as the MDI ones I think? I don't mind it that much but have been at it for a while. I think there's an element of guessing w/ initial pump settings but that they also use the data provided by us to help figure it out. If they guess wrong and you are overloaded, I think there'd be some risk?

I understand your frustration. You could certainly push the issue and demand to be started on the pump. They might just go ahead and do it. Or you could switch doctors. Or you could tell your current doc that right now you have the time to learn and adjust things and that won't be the case three months from now. You'd probably get your way eventually.

THAT SAID...learning how to manage things on MDI is important. Very important. Pumping is not a panacea and it is certainly not perfect. Pumps fail. Scar tissue can develop, making pumping impossible. And I can assure you that, per Murphy's law, your pump will ONLY fail when you're vacationing on a small desert island with no back-up pump and only some extra syringes, Humalog, and Levemir.

Getting things relatively stable on MDI first is, in my mind, a good way to prepare T1s for survival out in the big, scary world. An A1C of 7.4 is not horrible, and it is quite likely that once you master pump therapy, it will go down. But learning MDI is more about learning how to keep yourself alive regardless of whether you have access to a pump or just a few syringes and some insulin. I've experienced on more than one occasion just how important this can be.

Zoe-

It is your life, your diabetes and your pump, so your doctor can make suggestions but it is your decision in the end.

You encapsulate well my philosophy of diabetes care. For too long people have given doctors and other medical professionals supreme authority to make all their important health decisions. With diabetes, however, only the patient has access to all the nitty-gritty data of living 24/7 with this disease.

More importantly, only the patient suffers the long and short term consequences of his/her actions. I have little patience for doctors who are so frightened of the medical and possible legal consequences of hypoglycemia that they constantly recommend practices that keep the diabetic's blood sugar way too high. I know not all practitioners are like this but I have met plenty that fit this mold.

Once the diabetic accepts that the daily decisions are his/her gig, then that sets the stage for real, fundamental, and valuable diabetes management gains. The doctor can give advice but the diabetic makes decisions.

I think it's smart that Dino learn everything he can while waiting for his doctor to give the pump blessing but couldn't he learn all the things he needs to while also starting on the pump? He's already using insulin.

Oh my gosh...finally someone who shares my opinions on doctors.

Thanks everyone for your input. It all really helps. I'm not going to rush into pumping, as I am a new to diabetes in the first place. Getting good control of my diabetes is first on my list right now and im going to focus on that. But just wondering, I think that it would be much easier to manage diabetes with a pump compared to MDI's as long as you're not misusing the pump correct?

I think so too S&N good advice there

A pump poses some additional ways for things to go wrong, that MDI does not have. When you insert an infusion set, a teflon canula can kink, for instance. Many of the settings on a pump have to be set via trial and error, over a period of weeks.

A pump is a very powerful tool, it can do just about anything you can think for it to do, as far as insulin delivery. A pump has a built in clock, a built in calculator, and a really great memory.

It is also dumb as a brick. You have to provide the smarts!

It does exactly what you tell it to, as far as insulin delivery. You need to be good at carb counting, and you need to have a really good idea of how much basal you need and when, and how exercise and temperature affect your body.

When you understand what is in "Pumping Insulin" and "Think like a Pancreas", and are good at carb counting, you will be ready. You don't have to memorize everything, those two books make great reference books! If they talk about something and you just don't get it, ask questions until you do get it!

Best wishes and happy pumping in the near future.

-Lloyd

Dino,

I'm moving off 40 years of MDI onto a PUMP. Been pumping now for about 1+ month. Yes, you can get much much better control with a pump. And, in many ways it does make things easier. But overall, it is more work. At least for now it is. I'm looking into Constant BG Meters now to help with the pump control. My pump doesn't have them yet, but they are expected to have them in a year or so.

From some of your statements on the original post, I too would consider another Endo. If your's is too busy, well then you are too needy to get that lack of treatment IMHO. Mine is good, but also can be a bit too busy at times. It's frustrating to say the least. But, mine's got a great staff that helps when I need it. And they were very close to my pump starting, calling almost every day checking on me. With my years as a Type 1, I handled it well but could easily see someone who's not as used to Type 1 having issues. The pump is as important and eating and sleeping, if not more so.

Good luck on your pumping adventures!

I really appreciate everyones comments. Thanks again!