Update and Question--Feedback Wanted

[Lea]

Hi All!

I joined the forum back in April and have mostly been a lurker. I did post back in April when I was looking for some feedback on Lantus dosing (feedback was very helpful). At that time I was switching from NPH and Regular to Lantus and Novolog (after 24 years on NPH and R---yuck!). This was 6 months ago and I feel like I have finally got into a good place with my basal (Lantus) and carb counting and boluses(Novolog)---with absoutely no help from my previous M.D.

So here's where the feedback comes in---last Monday I finally got an appointment to see my new endo. I really like her. She spent a lot of time with me, we talked a lot, she did a thorough exam and I felt like we could have a good Dr.- patient relationship. However, she stated from the start of the appointment (once she found out I am a type1) that she thinks I should be on the pump. I told her that I was not totally opposed to that idea and that I had considered it last spring before I made the switch to Lantus and Novolog, but that I was not too thrilled with the idea of being hooked up to something 24/7. I had brought copies of my last 2 bloodwork panels in for her to review ( FYI 3/06--A1C was 6.8 w/NPH and R; 7/06 A1c was 6.2). When I left the appointment she told me she would see me in 4 months and would send me a copy of the lab results I had drawn that day. She asked if I would mind if she "looked into" (or something to that effect--there's a bit of a language barrier there) the idea of a pump for me. I said that would be alright. I just assumed that I would be sent some info. or possibly contacted by one or all of the pump cos. or possibly be contacted by the Nurse Practioner who works for her to discuss it. I should have clarified what she meant.

Fast forward to Thurs., and I called her office because I wanted to know the results of my blood tests. The NP called me back and I was thrilled with the results. My A1C was 5.7 and everything else including microalbumin results were within normal limits. The NP did not mention the pump and I did not inquire becasue I had told myself after the appt. that if my A1C was below 6.0, I would not consider the pump at this time. Everything is not totally perfect, but I am very pleased with the results I am achieving with the new insulins I am on . Moreover, I feel like the past 6 months have been quite an adustment getting everythig sorted out w/ lantus and novolog and am not really interested in making another major change that will take months to get sorted out so soon. I don't think there is much for me to gain with insulin pump therapy--at this time. I feel like the Lantus has provided me a new life--ability to skip meals, no hypos at night or hypers in the morn., etc, etc... I realy feel like this needs to be MY decision

On Friday a rep from Medtronic called my home and left a message in regards to the prescription that my new endo had apparently written and forwarded to them! Medtronic has already checked into my insurance benefits and want to speak with me to discuss. I got home too late to return the call Friday, so I will do so Monday and also call the endo's office and inform them of my decision to not do the pump at this time.

My question is what do you guys think about this whole situation? Am I off-base here? There was obviously some miscomunication here, but my concern is that the endo will not be supportive of the Lantus/Novolog regimen I want to continue, in which case I'll have to find another endo. Have any of you run into this situation? The problem is I really like her. Any feedback???

P.S. Sorry so long---brevity is obviously not a skill I possess! :)

Lea

[BlueSky]

The endo probably thinks she is doing you a favour. Don't let it bother you. Phone her and tell her that you don't want a pump. You are obviously doing very well on the MDI regimen and I am sure the endo will respect your decision. :)

Keep up the good work!

[troop'er]

I've been on Lantus/Novolog for about four years now. I've been interested in the pump, but I don't see the need for it right now (other than convenience, according to many who post on this forum).

And, as with your diabetes, YOU are the one in control of what you want to do with your body. Don't let a physician make that decision for you. YOU are the one living with this.

I hope BlueSky is correct and the endo. is just thinking they are doing you a favor. But, you have the final say.

Either way, I would at least let your endo. explain herself and why she made that decision. There could be many reasons why. And, if you feel comfortable with her response and your explanation of your feelings, there's no reason to start hunting for another endo. On the other hand, if you feel you're being pushed into doing anything, maybe it is time to start looking for someone who will listen to you.

Good luck with your choice!

[Harold]

Hi Lea,

Unless your having lots and/or bad highs and lows with an A1c of 5.7 it may be difficult to convince the Insurance Company the need for a pump. Since your not keen on the idea and your not having those bad lows and highs you should probably stay away from it untill you are ready.

[Tsukia]

well personally I have been on lantus and humalog for a few years. I personally even with my poor control believe that you have more control with the shots. The pump however convinient i still see as a obstacle. For me i move around alot in my sleep and what if my pump came out and jabbed my husband. I realize that for some it is a god send but not in my opinion.

as for the endo I believe that she probably sees a lot of good in using one but personally I would take the advice of those that use or have tried it persoally.

If you like her just explain your feelings and as long as you blood work keeps coming back good there should be no reason to change your meds or how you do them.

[grace girl]

I'll repeat what you've heard so far....just talk to her and tell her how you feel! My endo is somewhat of a pump pusher herself, but once I told her that if I ever got the the point where I could not achieve good control with MDI that I would consider it, she backed off.
I think it's an important thing for you to clarify with her so you will know that you can have a good relationship. I got rid of my last endo because once he found out that I wasn't interested in the pump he seemed to lose interest in me, as well.

[jenet]

I'm really thinking she was trying to help you out by doing a lot of the paperwork and contact work for you. If you really liked her, I would talk with her first before changing endos, as others have suggested above.

One other point: if you do ever decide that you want a pump, be sure to look into all of different pumps and get the one that is a best fit for you - not just the one your endo prefers. After all, you will live with it 24/7 for years - not her. The major ones are all good, and I would take any of them before not having one at all, but there are differences in how their buttons work and their feature sets.

Good luck either way! I hope it was just a simple misunderstanding, and that you have a long happy relationship with her as your endo.
cheers,
j

[poodlebone]

While I think the endo thought she was doing you a favor, I still find it weird that she'd send an actual prescription. When my endo/CDE suggested a pump last year they also contacted Minimed on my behalf. At the time I knew nothing abut pumps or that there were multiple companies making them. Seems my CDE only deals with Minimed and I don't know if there's any sort of financial incentive for her to do that (i.e., getting a commission from MM for every patient she puts on a pump). I would definitely tell your endo that you are not interested right now and when you are, you'd like to look at all of the options before making a decision.

On the other hand, even Lantus & Humalog wasn't working all that well for me and the pump was a major improvment. I love my Minimed and would not go back to shots now.

[Funnygrl]

Just tell Minimed you're not interested at this time. They should be fine with this.

FYI, my a1c was 5.7 when I started the pump. 3 months after starting I was down to 5.0. :-

[poodlebone]

well personally I have been on lantus and humalog for a few years. I personally even with my poor control believe that you have more control with the shots. The pump however convinient i still see as a obstacle. For me i move around alot in my sleep and what if my pump came out and jabbed my husband. I realize that for some it is a god send but not in my opinion.


If you pulled an infusion site out, most likely it would not be a danger to anyone. Most of them are just a tiny plastic tube under the skin. There are a couple of sets that do have metal needles, but most people use the teflon cannula sets. You wouldn't even feel it if it was jabbing into you.

Seriously, if you are in poor control with shots and have never had a pump I don't know how you could possibly say the shots are better. I was on shots for 18+ years and never got control until I went on the pump. I move around all night and nothing has ever happened to the pump. It's perfectly comfortable to sleep with and the only times I ever really have to worry about it is if I have it clipped to my jeans and need to pull them down to use the bathroom. I often wrap the tubing around the pump, so I just have to unclip the pump and stick it on my shirt to pull my pants down.

[Funnygrl]

I'll go on the record as saying I also think all type 1s should pump, though I realize sometimes the obstacles are too great.

[Lea]

Thank you for all the responses. I certainly do not feel that my endo had any malintent with her actions, but I do feel she stepped over the line so-to-speak. As I stated before, there is a bit of a language barrier there, so hopefully it was a simple misunderstanding. I plan to address this tomorrow. The bottom line is that I am very happy with the control I am achieving (and I'm working very hard to do so) on Lantus and Novolog and am ust NOT interested in pumping at this time. If I really felt I had a lot to be gained from pumping, I would move forward with it. I did look into it pretty seriously 6 months ago and did a lot of research and read almost every thread on this board in the pumping forum. However, I decided to give Lantus and Novolog a shot ( no pun intended) first and am very pleased with the results.:biggrin:

[Lea]

I'll go on the record as saying I also think all type 1s should pump, though I realize sometimes the obstacles are too great.

I hope I have not started a "pump vs. MDI" debate. I think it can sometimes be dangerous to make a blanket statement like that without looking at the individual patient and the circumstances. If this is my new endo's take on things, I will be looking for another one:frown: I do have a medical background (RN) and the only "obstacle" to pumping in my case is great control with MDI and thus a lack of desire to pump.

[Funnygrl]

I hope I have not started a "pump vs. MDI" debate. I think it can sometimes be dangerous to make a blanket statement like that without looking at the individual patient and the circumstances. If this is my new endo's take on things, I will be looking for another one:frown: I do have a medical background (RN) and the only "obstacle" to pumping in my case is great control with MDI and thus a lack of desire to pump.
I didn't intend to start a debate either. I use obstacle in a lose sense. If you aren't comfortable with pumping and are happy with MDI, I see no reason for you to consider it.

I say I feel almost every type 1 should pump simply because mosdt people have basal needs that vary too much to be handled well with mdi. It appears you are doing well though.

[poodlebone]

I say I feel almost every type 1 should pump simply because mosdt people have basal needs that vary too much to be handled well with mdi. It appears you are doing well though.

Ditto. Being able to vary the basal is incredible. Not just as a daily setting, but for things like exercise or illness. I could never do any of that on injections.

If you have a schedule that rarely varies from day to day I can see how shots might work very well. Me, some days I'm up at noon and some nights I don't even go to sleep, or I wake up at 4:00am. Some days at work I sit at my desk all day and other days I'm constantly getting up and going in & out, doing other things.

[Lea]

Ditto. Being able to vary the basal is incredible. Not just as a daily setting, but for things like exercise or illness. I could never do any of that on injections.

If you have a schedule that rarely varies from day to day I can see how shots might work very well. Me, some days I'm up at noon and some nights I don't even go to sleep, or I wake up at 4:00am. Some days at work I sit at my desk all day and other days I'm constantly getting up and going in & out, doing other things.

My schedule does vary from day to day and that is the beauty of Lantus as a basal and carb counting for me. I realize that not everyone has the same results with Lantus, but for me it has given me a new life.;)