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  • How do you convince your doctor you need a pump?

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    Old 04-08-2010, 12:30 PM   #1
    cassa82
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    Question How do you convince your doctor you need a pump?

    I have T1DM and am struggling to convince my endo that I should have a pump. I want an omnipod but doctor keeps putting it off. I am currently on MDI with Lantus and Apidra.

    What is she not telling me that makes me not qualified? Is there something I can do to convince her?

    I test 6 times a day, but my A1C readings have been over 8.0 frequently. I have hypoglycemic unawareness, frequent lows and highs, dawn phenomenon, etc.

    Is it normal for it to be this difficult for a doctor to sign the medical necessity paperwork?

    What kind of tasks/information did you have to do/provide to your endo in order for them to agree?

     
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    Old 04-08-2010, 01:17 PM   #2
    Cora1003
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    Re: How do you convince your doctor you need a pump?

    Some docs are very pro pump, and others are indifferent or against them. Sorry, but testing only 6 times a day is not sufficient if you want to get your a1c down with a pump. For some docs you need to prove that you can carb count correctly and test enough. Here is what I did while testing:

    1. am fasting
    2. 2 hours post breakfast
    3. pre lunch
    4. 2 hours post lunch
    5. mid afternoon
    6. pre dinner
    7. 2 hours after dinner
    9. before bedtime.

    In addition to that I would periodically fast and then determine if my basal rates were correct. This also involved testing in the middle of the night to make sure that my basals to control my dawn phenomenon were also acceptable and set at the right times. Many docs will also want you to take additional classes before and during pump training.

    Basically, if you want to know why he isn't more cooperative and what you have to do to get a pump you will have to be frank with your doctor and ask him outright what the problem is.

    Sorry I can't be more help.
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    Last edited by Cora1003; 04-08-2010 at 01:18 PM.

     
    Old 04-08-2010, 01:31 PM   #3
    cassa82
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    Smile Re: How do you convince your doctor you need a pump?

    Cora,

    Thank you. That is helpful. I used to test 10 times a day and I can easily go back to doing that. A previous doctor had told me it wasn't necessary and that I was maybe a little to reactive to what I saw when I tested. But, perhaps if I test more it will be easier to convince my doctor.

     
    Old 04-08-2010, 02:18 PM   #4
    Cora1003
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    Re: How do you convince your doctor you need a pump?

    Good luck to you. Testing a lot is the best way to stay in control and keep your a1c down (although a pump is a wonderful tool). You may have to be careful to not micro manage, but you do need to keep a careful eye on what your sugars are doing and how you react to food. The only way to know for sure if your ratios are ok is to test a lot. Don't forget that your insulin: carb ratio can be different at different times of day.
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    Old 04-09-2010, 07:53 PM   #5
    cassa82
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    Re: How do you convince your doctor you need a pump?

    Well, I just had an appointment today with a new endo and it went really really well. So, nevermind about it being difficult. I guess it was just that particular doc. Now the question is, which pump do I get! I am also getting a CGM which I've already decided on the dexcom.

    I'm torn between the omnipod and the animas for the pump. So excited that my dr. said we can go ahead with it, it feels like Christmas morning!

     
    Old 04-09-2010, 08:10 PM   #6
    Cora1003
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    Re: How do you convince your doctor you need a pump?

    Congratulations. I loved my pump. It made my life so much easier to deal with. Best of luck and keep us posted. I had a medtronic and it comes with it's own cgms. But from what I have seen, all pumps are quite similar.
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    Old 04-21-2010, 05:05 PM   #7
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    Re: How do you convince your doctor you need a pump?

    Hi Cassa,

    All pumps are not really created equally. The decision is ultimately yours, but if you're deciding between the Animas and Omnipod, I'd go Animas. My preference is Medtronic, but Animas is a nice pump. Here's why I don't like Omnipod...

    Yes, you have a tubeless pump, but it's not worth it. So the only way to bolus on an omnipod is via your meter... this means that if you lose your meter, you're in trouble. Also, correct me if I'm wrong, but I dont think you can refill a pod. So, if you run out of insulin somewhere, you have no ability to refill. When you run out of insulin in a pod, the whole thing stops working after a few hours, I hear... so you end up in the event of an emergency not even getting basal insulin.

    Animas is nice because you can give very very precise doses on insulin. They also have nice screens, and are easy to use. Again, I like the medtronic... it's super easy to use, but otherwise, I recommend the Animas. It also comes in pretty colors

     
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