Attn: Pumpers...

[bbrian]

I am new here been a member for a couple of weeks just kind of lurking about. I have been diabetic for about 8 years now Type 2 and have had pretty good control of BG's. Started seeing an endocrinologist about 2 months ago because I asked my family doctor about getting a pump and he refered me to him. My Endo says that he does not believe a pump would benefit me any better than I am doing without. I say I am turning into a pin cushion and wanted a pump to make life easier for me. After this discussion on conceed to him and ask him what options I have. He proceeds to put me on Symlin (another injection!!!!). I am going along with this at the moment but my BG's are worse than they were with the Humalog alone. I think he put me on Symlin to try and loose some weight.

Ok done venting..my main question is do Type 2s not get the pump very often, am I being unrealistic. Shouldn't the pump be my decision?

Thank you all in advance for any information you can provide. I have found this forum to be very informative.

Brian

[spike]

Only a small pecentage (around 5-8% IIRC) of pumpers are T2. I've no idea why your endo says you shouldn't pump, and it's not for me to say yes/no you should. Ask him for specific reasons why he said no and then if you feel you are being denied a prescription incorrectly, seek a second opinion. I had an endo for 10 years who said no. I finally dropped him, got myself another endo and within 30 days was pumping. And I'm a T1 with DP and swinging bg's, so my first endo was clearly in the wrong to suggest that I'd have more trouble with lows on a pump than MDI. I"m doing much, MUCH better on a pump

Again, very few T2's pump, but maybe you'll join their ranks!

[Cyborg]

If you are taking insulin, you may want to confirm that you are indeed type 2, if you haven't done so already. There are some tests that can be done to help identify the type, such as the Gad Antibody test and the C-Peptide test...

[bbrian]

Should I just ask my Endo for these tests? I do take insulin, sliding scale Humalog before meals, 20u Symlin before meals, Lantus 45u at bedtime, Avandia 8mg 1x day.

Brian

[Cyborg]

I would...

[Lynne1]

I'm a type II pumper. My endo encouraged me to pump for better control. You may want to call Minimed to find a pump friendly endo in your area.

[bbrian]

Guess what...my endo is the Minimed pump friendly endo here...go figure!

[Lynne1]

Are you in NJ? If so, I have another endo you can try.

[bbrian]

No I am in northern Ohio.

[jeggeman31]

No I am in northern Ohio.

Welcome, I from Central Ohio How far north ? Use to live in Elyria and grew up outside of Mansfield

[KAnderson]

I'm also a type 2 pumper. Was doing MDI (5X/day) and having trouble with either being high or low - you never know with Lantus how the absorbsion will go. Besides, I was mimicing the pump anyway with the Lantus 2X because it would only last abour 14 hrs in me, and Humalog before meals counting carbs to determine the units. My Dr was very supportive of getting a pump and quit being little more than a pin cushion. By going on the pump, I feel like I got my life back (this has been often said around these parts...) and have decreased my units of insulin/day by more than half since July. That has helped me to drop about 50 lbs already. It is getting to be that 140-ish BGs are high for me. My average BG is 96. Now that I've got my pump dialed in better, I have way fewer lows than before too. Asking your Dr to test isn't a bad idea either - there are dx'd type 2s who really are a late onset 1. (Though we didn't test, we suspect I may be one of them...)
Ken

[bbrian]

Welcome, I from Central Ohio How far north ? Use to live in Elyria and grew up outside of Mansfield


Jim I live in Huron about 20 minutes west of Elyria.

Brian

[Worldcrzr]

I have been a Type II since 1982 when diagnosed. I could have been a diabetic before that but I stayed away from doctors. In September, 2005 my A1c test came back 8.5 after about 3 to 4 other 8.5 or 9.0 tests. My doctor said he hated to do it but it was time to go on insulin. I had to take up to 4 to 5 shots a day and my Diabetic Counselor suggested a pump and referred me to an Endo who is very pump positive.

I went to see him with my husband as support and took all my charts and graphs. What sold him was when I showed him an article in one of the diabetes magazines about "sudden death in diabetics with small artery heart disease". Sudden death happens when the blood sugars go extremely high or extremely low. I was having both and severe angina when either happened. He agreed to prescribe the pump. This was only after I had been on insulin for five months. My Diabetic Educator said that was amazing because he never prescribes pumps if a patient has been on insulin less than a year.

My last A1c test was 7.0 and I'm working to get it lower. It is very hard because I love to eat normal food and have to cook for a non-diabetic husband. He is very good about eating my low-carb meals and has lost 20 pounds himself. He lost the weight I should have...bummer...

Next year I will be eligible for Medicare. I talked to my representative at Smith-Medical yesterday and he tells me that they are working on a contract to accept Medicare assignments and this should be completed by the end of February or March, 2007. He thinks that I won't have a problem getting Medicare to pay for my supplies since I am already on the pump. He says that Medicare only gives a new pump every five years so there is a year without warranty but Smith-Medical might offer low-cost repair for out of warranty pumps. He told me that Smith-Medical will always provide a new pump and never a refurbished one for Medicare patients. They are working on designing the packages that Medicare requires for supplies.

I have a choice of going on Medicare with Tricare For Life as a supplement with no annual premium or office co-pays or stay with my retiree benefits and sign up for Pacific Care Secure Horizons with a monthly premium of $188.22 per month and $10 co-pays for office visits. Both include very good prescription programs. Right now, I'm trying to get all the information I can to make an informed decision.

Type II diabetics do get pumps but it is a little harder for them to justify the need.

[poodlebone]

Some insurance companies won't even cover pumps for Type 2s, and require a c-peptide and/or antibody test before approving a pump. You should first see if your insurance will cover a pump for a T2 and if they will, either find another doctor or talk to a pump company rep yourself. Let them deal with your doctor.

Also, Symlin is usually prescribed for Type 1s, and another injectibale drug (Byetta) is given to T2s so maybe that's why your control is worse. I've read that many T2s have been successful in losing weight with Byetta, so maybe ask the endo about that. It still means taking another injection no matter what, though.

When I was on MDI I actually never minded taking the shots. I had my Humalog pen and it was easy enough to take everywhere, and inject quickly & easily as needed. When my CDE mentioned the pump and pushed no more injections as a big selling point, that really meant nothing to me since I didn't actually mind them. I have to say the pump is so much better, but if I needed another injectible drug it wouldn't be a big deal.

[bbrian]

I have contacted my insurance company and they have told me they will pay for the pump and supplies. That is why I am frustrated. Maybe I will try the pump company and see if they can help. My family doctor may even be willing to provide it I think he was just trying to help me by having me see an endo.

Thanks for the advice.
Brian

[JanTx]

I believe that Byetta is for those not on insulin and Symlin is for those on insulin - regardless of type.

[Worldcrzr]

I think the key to the whole pump issue is "medically necessary". In my case, only 2/3 of my heart is functioning. The small artery area is completely blocked and I'm not a candidate for bypass surgery. With extreme highs and lows, it is very dangerous for a person with my heart condition. The doctor had no problem justifying the pump, the number of infusion sets, the amount of insulin or the number of strips to my insurance company.

Once on Medicare, the whole issue will change. They are very restrictive and do require the c-peptide test for new pumps. For existing pump users, they require 4 months of testing results. They still restrict the number of strips and amount of insulin unless the doctor writes the prescription just the right way. Can you imagine being restricted to 100 strips every three months if you don't take insulin and 100 per month if you do? My prescription is for 300 strips a month and I test 8 to 10 times daily plus I use 3 vials of Novalog monthly. I change infusion sets every 48 hours which Medicare may not allow. I am very allergic to adhesive and sometimes get a bad rash if the set is left in longer. Plus the manufacturer of Novolog requires that pump users change insulin every 48 hours.