Planning for the future – pump??

[rebecka]

Hello everyone,

I have been reading these boards for awhile, but I wasn’t quite sure how to introduce myself until now. I am almost 24 years old and I am a Type 1 diabetic. I was diagnosed when I was 10. I currently take Lantus and Novalog to control my diabetes. I have been on this regimen for years, and it works okay (not great).

I let myself go when I was in college and my test results have not been great for the past few years. I did not have insurance in college and had to work with what medical care I could afford. I had my A1c tested about a year ago and it was a scary 10.7:eek:! Yep, that’s what happens when you don’t pay any attention to your diabetes. I would take my Lantus, but rarely tested my blood sugar levels and sometimes I forgot to take my Novalog when I ate. Anyway, when I had it tested three months ago, it was down to 8.5 (better, but still not good). I’m supposed to go back this month for another A1c and hopefully it will be better than last time (it should be anyway)!

Anyway, I have insurance now and I’m looking into getting a pump. I realize that it will be a lot of work, but I need to do something to control my diabetes! I am in a long-term relationship and we are considering having children. I have already told him that I refuse to do this before my numbers are in the “normal” range! I just can’t risk the baby’s health like that! I would like to wait at least a year before becoming pregnant just to make sure that my diabetes is under control.

So yeah, I guess my questions are regarding pumps:

1) Which pump do you recommend? Why?
2) I have Anthem BC/BS insurance. Do you have any experience with this? How hard was it to get them to approve the pump/supplies? Have you had any problems out of them?
3) Are there any specific things that I need to do in order for the insurance company to approve the pump OR is it enough just to have my doctor tell them that I’m planning for a pregnancy and must have better control before conceiving?
4) How inconvenient is it to wear a pump? Does it ever get in the way while you’re sleeping?
5) Any other thoughts on pumps? Anything that I might need to know?

Thank you for any help that you can give!!

Becky

[Shannonb]

Hey. I went thru a similiar situation during college - I had insurance, but I was too busy living it up. I went on the pump a few years later. It definitely makes life easier. I use the Minimed paradigm pump. I would highly recommend this pump. I have Carefirst BC/BS insurance and they cover everything - pump, supplies, etc. I don't pay a copay for these items, which is awesome b/c the pump alone is like $6K and the supplies are in excess of $1K/every shipment. I imagine your insurance would cover similiar items. I think your doctor does have to write a letter stating why you need the pump - for me they accepted quickly. It wasn't a long process. My doctor put me in touch with the local Minimed representative and this person helped me thru the entire process, including showing me how to use the pump. I don't really like people to see my pump, so I wear it in my bra (sounds crazy), but it can clip on in the middle. When I sleep I just clip it onto my waistband. I never had trouble getting used to it. In the end - the pump makes life a lot easier. It does take some adjustment time in the beginning, but you'll be glad that you made the change. I hope I answered all your questions!!

[JediSkipdogg]

1) Which pump do you recommend? Why?

There are quite a few pumps out there and it's hard to recommend one. They all have their own pros and cons and if you check out the pumping forum there should be a sticky post near the top that compares all models out there. I also highly recommend you try each pump out for a few days to see if you like it. I haven't found a pump company (besides Omnipod due to it's design) will let you try out a pump for a week. Remember, you have to live with it for 4 years, so if you make a bad decision, you'll stuck with it or giving up on it till 4 years is up.


2) I have Anthem BC/BS insurance. Do you have any experience with this? How hard was it to get them to approve the pump/supplies? Have you had any problems out of them?

Every insurance company is different and even different plans on the same insurance can hugely differ. I find obtaining a pump to be very easy though. Since it is a high cost item it will require a letter of medical necesity from your doctor. I've used 3 pumps now and have never had a problem with insurance.

3) Are there any specific things that I need to do in order for the insurance company to approve the pump OR is it enough just to have my doctor tell them that I’m planning for a pregnancy and must have better control before conceiving?

That should be enough.


4) How inconvenient is it to wear a pump? Does it ever get in the way while you’re sleeping?

That's a tough one and varies for some. Some just lay it under a pillow or in bed next to them. Depending on what you wear to bed you may be able to clip it on to that. It's really not that inconvenient during sleeping or any other time. I think a woman vs. man perspective may be different though so hopefully a woman can chime in on the troubling times.

5) Any other thoughts on pumps? Anything that I might need to know?

It will take quite a bit of work at first. It's not rocket science but patience. It can take months to fine tune and get you back in control. Other than that, it's a life changing experience in my opinion, for the better.

[rebecka]

Thank you both very much!

Knowing that you guys didn't have too hard of a time getting your insurance to approve it makes me feel a lot better about the situation!

Also, I will check out all of the posts about pumps and see what I can find...I'll probably end up going with the Minimed Paradigm, but I'll definitely do some more research before I make my final decision.

I appreciate your comments regarding the convenience of having a pump...My boyfriend was starting to make me think I would hate having it with me all the time, but I'm pretty sure the benefits of having it outweigh the hassle...

I have an appointment with my endocrinologist and his team (including a pump specialist) on September 8th, so I'll be sure to keep everyone updated!

Thanks again!
Becky

[JediSkipdogg]

Becky, I'll give you a little more info/tips.

DO NOT pick a pump based on what your doctor wants you to get. If I did that, my doctor would only give me one option instead of the 4-5 models out there. They may be able to help you more on certain models, however, we can probably help you more than your doctor can.

Also, with regards to being connected all time...you can disconnect for up to an hour.

Anymore questions and we'd love to help.

[xMenace]

1) Which pump do you recommend? Why?

Are you going for a CGMS? If not, they're all good.

4) How inconvenient is it to wear a pump? Does it ever get in the way while you’re sleeping?

Not an issue.

5) Any other thoughts on pumps? Anything that I might need to know?

There are many pumpers with bad A1C's. There's a certain amount of work you need to do to get a pump tuned right. It's more about working smarter, not harder. Unfortunately many DE's and Endo's don't know how to set a pump properly. Listen to them, but also listen to other pumpers. Much depends on how wonky your rates are.

Once a pump is tuned and you are experienced with the various problems that can arise, then it's actually very little work. This will take at least three months and possibly a year.

A 6.0% or better A1C is worth it!

[rebecka]

I would love to have a CGMS, but I really don't think my insurance will go for it...lol...

As I'm sure you can tell by now, if the insurance won't pay for it I probably can't afford it :(

[JediSkipdogg]

I would love to have a CGMS, but I really don't think my insurance will go for it...lol...

As I'm sure you can tell by now, if the insurance won't pay for it I probably can't afford it :(

Since you brought up money....here's one thing you have to look at. You need to check with your insurance on where it would be covered. 99.999% of the time insulin pumps are covered under durable medical supplies. Depending on your insurance is how much you may pay out of pocket. My first two pumps it was insurance covered 80%, my current pump was I paid 100% of pump until I hit my max out of pocket (which at that time I already hit so pump was free.)

Supplies will 95% of the time be covered under durable medical as well. The other 5% they may be a prescription item. Then depending on who you order through and how the company is is how much you will pay out of pocket. It gets really tricky there. If you have an 80% payment under durable medical you may end up paying around $140 every 3 months. Some companies may even take the 80% payment from insurance as paid in full, they of course do this by jacking up the cost on supplies and then writing the 20% off, which in a sense is illegal by the company, but not your problem on that issue.

[rebecka]

Yes, I believe I'll end up paying a $300 deductible + 20% of the remaining cost of the pump + 20% of the pump supplies + co-pay for insulin and testing supplies...

Definitely cheaper for me to continue taking shots, but I think I'd be more stable on the pump...Ugh, such a hard decision considering I don't have a ton of extra money laying around! I need to sit down and look at my finances tonight and see what I can do...I'm pretty sure I can make it work!

[Subby]

Stability, in itself, it worth mentioning, as beneficial in it's own way, as well as any improvement in A1c. When I first went on the pump, my A1c actually got marginally worse. Yet, I was feeling human and healthy for the first time in years, due to avoiding a certain amount of fluctuation from day to day. It was a strange day that day in the endo's office, he was petulant and dissapointed that my A1c had not improved (literally kicking himself over it - guess it threw out some set of data that was relevant to his ego, be my guess). While I was saying (on deaf ears) "it doesn't matter right now! It's already given me so much improvement, actual A1c improvement can and will come down the track..." as it did.

The pump doesn't solve everything by any means, but it sure can provide the ability to keep things more consistent. Usually this might be reflected in A1c - but not always, and not always proportionately.

I guess there are certainly people who can get really good results (both stability / standard deviation, and A1c) from injections, so whether you are one of them or not, would have bearing here.

[shamrock27]

I am a 29 year old diabetic and was diagnosed at 24 with type1. I got on the pump within 3 months and cant even imagine being back to needles and multiple shots. I was very strict with my numbers and my endo said I was a good canidate for the pump.

Not only will your numbers improve but life with dibbates is easier. I wont say sleeping with it is fun, but you do get use to it. Also, clothes can be tricky to buy as all the styles are long and a pump makes that a little difficult. But your health and happiness is well worth it.

I can relate to the no insurance and high A1c's. It is not affordable to have diabetes without insurance. So congrats!

I am currently 8 months pregnant and could not be happier with my pump. I have the minimed paradigm 712. I was not really given any options by my endo this is just the one she recommends and my dibates center mainly trains on.

Hope this helps and good luck with your decision and A1c's

[rebecka]

Thankfully, one of my co-workers is married to a Type 1 diabetic and she has gone through pretty much the same issues that I have/am...She has invited me over to her house to go through their bills associated with the pump so I can see just how much it will end up costing (since she has the same insurance as I do)! She also has said that she doesn't care at all to show me the pump and the supplies and how everything works and explain whatever I need help with! They just had a baby last November and she said the pump was a huge help through the planning and the pregnancy! She said that she would love to sell pumps as a career just because she believes in them so much...

Thanks for all of the input, everyone! It really does help to have opinions from people who have gone through similar situations (rather than a doctor who really doesn't know about the day-to-day issues that arise from the pump)...

[sarahspins]

I just wanted to chime in and say that I highly recommend the pump for pregnancy... I've been through 3 pregnancies, my first on a 2-shot R and N regimen (I was newly diagnosed and this is what they wanted me on, I asked about MDI and I was told NO! They didn't even want me taking Humalog, stating it could be "dangerous"), my second pregnancy on a pump, was a breeze.. increasing insulin needs? No problem.. just push a few buttons and it's taken care of. This was the only one where I didn't totally crash after delivery too. My 3rd was on Lantus and Novolog because I stopped pumping a few months before he was concieved due to infusion set issues. That pregnancy ironically probably had the best control, I was almost paranoid about controlling my #'s, wheras with my daughter (baby #2) I was much more relaxed, but being on MDI was more work than pumping. He ended up being my biggest baby at over 9lbs too, but I don't really think that was D related - I blame DH's genes since his sister was over 9lbs at birth and my MIL is tiny.

However, I also want to say that being on a pump does NOT automatically equate to a better A1C.. it can make it easier to get there, since you can make changes much more quickly (and it doesn't take days or weeks to make basal changes like on MDI), but it's not automatic - you still have to do the work.

[rebecka]

I don't have a problem doing the work...I've been testing regularly and taking 4 or 5 shots per day just to make sure that my levels have improved on the Lantus/Novalog combination that I'm on...I mean, I still may not end up getting the pump and my levels had to come down no matter what! lol

I realize that the pump isn't an instant fix for anything and that it requires a lot of work, but I feel like I would have a better chance for long-term stability with the pump...

[David]

1. I don't recommend any specific pump. As already mentioned, all of the pumps by the three major companies pump insulin and all do it with near equal reliability. The differences are in 1) the bells and whistles and 2) the specific menus where you tell the pump what to do.

One example of a bell and whistle is Medtronic's integrated Continuous Glucose Monitoring System. Another is the Omnipods's lack of tubing (although the pod is at least as intrusive than the tubing is to me.) If either of those interest you, you'll want to put that one higher on your list.

To me, each pump's menu is important, after all, I have to use it many times a day. You'll want one that seems most intuitive to you. When each pump rep visits you with their products, ask them to show you how to perform a few basic functions and then do them yourself on their pump. Different functions you could try are setting the carb/insulin ratio, filling/loading the reservoir, setting a basal rate and giving a bolus using a BG of 150 and 30g of carbs. Which pump seems easiest to use? You want whichever pump's menu is the best match for you.

2. Sorry, no experience with Anthem.

3. Planning for a pregnancy is a good reason to get a pump approved, but they MAY want more. Keep good records of BGs, injections etc. My insurance wanted to see that I was diligent but was still unable to have good control. Even with a "decent" a1c, I showed them that my peaks of 300 going down to 30 and back up again repeatedly wasn't good control. Your a1c is a little high, so while that's not good in itself, it may help push their approval.

4. That's a matter of getting used to it and perspective. I don't consider it inconvenient at all to wear a pump during the day. At night I set it between my wife and me, not at the edge of the bed. It would be inconvenient if it fell off the edge. Some clip it to clothing, sheet or under the pillow. My wife will occasionally roll over on top of it. Waking her to roll off is more inconvenient for her.

5. I can't thing of anything else right now. Great questions.

david

[Lizzie G]

not got time to write much but just to say i clip my pump in my bra between my breasts; works really well, not sure how it would be with small breasts (bit of a personal question to ask you whether you have them!!!!); i wear a slighty too big soft cup sports bra at night as i prefer not to let in hang! very comfortable, just take it all off for s*x

[rebecka]

Thanks David! I will be sure to "play" with each one before I make my decision and see which one works best for me :).

Ok everyone, I think I have the financial situation worked out...I'll just have to wait until the beginning of next year to get the pump...I can sign up for a Flex Spending plan at work and they'll pay me back immediately (which helps a lot)! As an addional bonus, this will give me plenty of time to get the necessary data together, talk to my doctor, and make a decision on which pump I want! :)