Why are Doctors so hesitant to give type 2's a pump?

[Deltagirl1976]

Well I'm one of the lucky type 2's to have a pump . I found that it practically takes an act of congress to get a doctor to give a type 2 an insulin pump instead of MDI. Any thoughts as to why this might be? My hubby is having such a hard time trying to find a endo who will be pump supportive.

[JediSkipdogg]

Because the added cost of the pump when a type 2 doesn't have as hectic of pattern changes of a type 1. There are exceptions to every rule. Very very few type 2s require both a basal and a bolus insulin, and using a pump to just give one is in a sense pointless (my opinion.)

[Dewey]

Well I'm one of the lucky type 2's to have a pump . I found that it practically takes an act of congress to get a doctor to give a type 2 an insulin pump instead of MDI. Any thoughts as to why this might be? My hubby is having such a hard time trying to find a endo who will be pump supportive.
Hi Deltagirl & welcome to the forums. I'd say the issues lie mostly with some doctors (not all) & the medical community's way of thinking (I call it the "blanket theory"). They often think that Type 2s can be treated solely by pills and/or insulin injections. However, they fail to look at individuals, and fail to see that some individuals cannot maintain good blood sugars on injections or pills alone. Sometimes patients, regardless of what type of Diabetes they have, need insulin pump therapy to gain & maintain better control of their Diabetes.

It's taken the medical community a very loooong time (& in many cases, they're still NOT there), but they're slowly coming around to realizing that what works for one, may or may not work for others - and that patients, first & foremost, are individuals and have different needs.

Here's hoping you find a good endo for your husband, and that he or she will support you & your husband in treating his Diabetes by whatever means possible.

Once again, welcome & glad you're here.

[steamfan261]

Well I'm one of the lucky type 2's to have a pump . I found that it practically takes an act of congress to get a doctor to give a type 2 an insulin pump instead of MDI. Any thoughts as to why this might be? My hubby is having such a hard time trying to find a endo who will be pump supportive.

If you Google Type II and Insulin Pump, you'll discover lots of literature that says that an insulin pump may be an appropriate therapy for Type II diabetics. The endocrinologists I've seen (2) both were dismissive with comments like "Oh well, you're a Type II, why would you want a pump?"

My PCP, whose wife is a T1, on the other hand was very supportive, printed out a LOT of internet information indicating that pump therapy can be enormously beneficial for T2's who don't do well on MDI, then went to bat for me with the insurance company.

I'm delighted with my pump and CGMS, and delighted with the numbers I'm seeing. I can hardly wait for my first post-pump A1c.

Good luck to you.

[Blue Knight]

As a T2 myself I too met with some resistance from my endo when I suggested pump therapy over MDI's. I had to convince him that with my havy business schedule and trips that I take both within the US and overseas and that MDI's were not practical. I had to attend a 4 week training class that covered everything on a pump and keep detailed records over the time on carb counts, meds, exercise and multiple BG testings per day. In the end I got the pump and a year later the endo could not be more happier with the results. My last A1c was 6.5, down from 6.8 from 4 months previous and before going on the pump it was 7.5 - 7.8.

It was a pain in the butt, but the outcome could not have been any more better :D

[fgummett]

My specialist was against pumps... he felt they were just another way for "big pharm" to make money. In fact, when I approached the local MM rep she said, "good luck" as he wouldn't even meet with her. Anyhow he had already started me on MDI which was working pretty well but I was convinced that by using a pump my control could be even better. I marched in to see him, armed with as many studies as I could print out and told him what I wanted to do and why... he listened and said, "no problem!" Now at each 6 month check-up he proudly tells me how many more people he has on the pump! I gather I was one of the first type 2's in Atlantic Canada. I definitely do benefit from both basal and bolus especially around dawn phenomenon.

[fgummett]

Because the added cost of the pump when a type 2 doesn't have as hectic of pattern changes of a type 1. There are exceptions to every rule. Very very few type 2s require both a basal and a bolus insulin, and using a pump to just give one is in a sense pointless (my opinion.)
And you are entitled to your opinion :) but this sounds like it is based on facts... I just wondered what they were? Surely the insulin resistance frequently seen in type 2 affects both basal and bolus requirements... 70% of my pumped insulin is basal. I also have 3 different basal rates set throughout the day (could probably use more for fine-tuning) and I use temporary basals when exercising. Both my basal and bolus requirements change through the day, with the season and mood etc... I need to use a square bolus for foods like pizza or pasta (on the rare occasion)... so frankly (Hah!) I'm puzzled by your statement. I know I'm unique (just like everyone else :D ) but I don't think I am in a very very small minority of type 2s :confused:

[notme]

I think doctors are just now realizing that there is more than just two types of diabetes. Not everyone who is type two can control their blood sugar with diet and exercise. Many can't control with medication and insulin is the only option. I suspect Dewey is correct that the "blanket theory" is in effect with many doctors.

I think anyone who is on insulin injections to control their blood sugar should have the option of pumping insulin.

[fgummett]

For myself, insulin was not the only option.. :) we did not exhaust all other avenues before deciding that it would give me the best control and best chance of a long and healthy life. In fact I wish more doctors would treat type 2 more aggressively up-front instead of waiting for things to get worse before taking extreme measures.

[notme]

I guess I should have written "best" option. Sorry Frank! ;)

[Lloyd]

27% of T2's in the US are on insulin. That is 2 1/2 times as many as there are T1's. Many are on basal only, but many are not.

T1 or T2, either way, if you have dawn phenomenon it is the only sure way to bring your fasting numbers in line, unless you have a very mild case.

I'm T2, I had no trouble getting a pump, and it dropped my fasting numbers 100 points on since first night I used a pump.


-Lloyd

[fgummett]

I guess I should have written "best" option. Sorry Frank! ;)
No need to apologise Nancy... what you wrote is the common and unfortunately prevailing thinking of many medical health specialists; that it is the last resort treatment... this also works against its acceptance as a treatment: so many folks have horror stories of "uncle so-and-so" who was put on insulin and within 6 months he was dead.

[Scrabblechick]

Yeah, and what people don't realize with uncle so and so is that he probably already had massive organ damage and probably had been uncontrolled for years, hadn't stayed on his diet, etc., etc. Insulin would have helped him had he been put on it 20 years earlier.

If I ever become insulin dependent, you bet your sweet bippy I'm going to look at a pump!

[Funnygrl]

I think anyone on basal and bolus MDI who is willing to put the effort into pumping safely and effectively should have the option. If you don't really have a use for a pump or aren't going to put int he effort though, it's just a waste of money.

[fgummett]

I think anyone on basal and bolus MDI who is willing to put the effort into pumping safely and effectively should have the option. If you don't really have a use for a pump or aren't going to put int he effort though, it's just a waste of money.
Agree 100%... it is not a universal panacea and still far from an artificial pancreas, but it is a very powerful tool if you are willing to work with it... and probably work harder than you would with MDI

[RobiJo]

I think doctors are just now realizing that there is more than just two types of diabetes. Not everyone who is type two can control their blood sugar with diet and exercise. Many can't control with medication and insulin is the only option. I suspect Dewey is correct that the "blanket theory" is in effect with many doctors.

I think anyone who is on insulin injections to control their blood sugar should have the option of pumping insulin.

Ditto. Anyone on insulin should have this choice.

[Lloyd]

Agree 100%... it is not a universal panacea and still far from an artificial pancreas, but it is a very powerful tool if you are willing to work with it... and probably work harder than you would with MDI

I agree, with the caveat that most of the hard work comes in the first 2 months.


-Lloyd

[Funnygrl]

I agree, with the caveat that most of the hard work comes in the first 2 months.


-Lloyd
Not for everyone. I can never really be settled into one pattern of settings, I'm changing and re-working my settings monthly.

[fgummett]

Not for everyone. I can never really be settled into one pattern of settings, I'm changing and re-working my settings monthly.
Yup... the D it is a-changing... all the time. :)