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Got a letter from the state insurance board, almost didn't want to open it because I was afraid that it might tell me that I was finally and unrevokable denied on reimbursement for the pump.
But it wasn't that. Just told me they were working on it and who was in charge of the case.
The same nurse who I'd talked to on the phone.
My doctor passes -- does yours?
This is interesting because I've had panic attacks, but I've always had a good reason for them. The first, I was trying to repel at AFROTC Camp and had one -- though I had no real height problems before -- I always figured all the stress induced throughout the 4 weeks was part of it.
I also had one when I lost my car in a parking gargage, and will admit that it led me to a bit of agrophobia, but I always linked that to the stress I was going through while my dad was dying of a terminal illness (the diabetes induced one).
Also a few associated with dentists.
So are those true panic attacks or something else?
I have known people who have had panic attacks too, and they are usually fairly level grounded people.
So how DO you get a pump, after you have decided to get a pump?
If you are a lucky you are going to an endo who will guide through the whole process. I would suggest that you look at ALL the pump companies though, and not just pick something your doctor likes. YOU are wearing it, NOT him.
If however, you are dealing with a primary care physician and they haven't done it before, here are some hints.
And try not to be on an HMO.
Well, first, your doctor has to agree, and write a letter of medical necessity. However, the pump company will help you with that. They have done a bunch of these before, and they know how to do it.
You will either get accepted or denied. If you get denied, then you need to decide if you can afford the pump and its supplies. My insurance company denied both, which is why I have filed a complaint with the state. The state of Texas requires that pump supplies be paid.
If you can afford the pump and supplies -- and I will warn you, I'm spending about $600 every 3 months on supplies -- then you will buy everything yourself.
Here again, I advise using the pump company.
If you get denied and you think you shouldn't have, and you can afford it, go ahead and get the pump like I did, and just keep filing paperwork at them. It's fine to take a few weeks to take a breath, I did that several times, but keep at them.
I still haven't gotten mine paid, but I have given up. I'll keep everyone abreast with one is going on with this and I would love comments from others on it.
Here's where I am at.
I've got a complaint in to the state insurance board, and I have an independent review in to the insurance company.
You have to think before you get out of bed. It can get kinda of weird, because my CPAP hose will often be wrapped around my neck, and sometimes the pump gets wrapped in it too, especially when I have on a really long tube. (They come in different sizes, and I usually wear the shortest, but I've been having trouble with those sites).
So when you wake up, the first thing you do is locate everything.
Showering can be interesting, I do one of two things, hook the pump via the clip to my Diabetes necklace or disconnect.
When I get in the hot tub, I disconnect. Same thing at the gym for the shower/whirlpool, sauna, etc.
I usually wear it when I swim -- though swimming isn't likely for a few months.
I do wear mine in my bra, and am hoping to make it cross town to a lingerie place that does custom alterations to their bras and plan to get them to sew a pocket in my pump. I should see about getting a pocket sewn in all my bras, actually. That would make life easier and slightly less lumpy.
I find it gets bumped off less often if I wear it in my bra and that I get the site pulled off less often when it is there too.
Anyway, it's not bad, and better than injections.
The more I talk to people, the more I realize they haven't got a clue -- and these are very educated people, very technology minded and sometimes even medical people.
First, the pump only pumps insulin. It's only a pump.
The pump holds a given amount of insulin. Some cartridges hold 200 units, some hold 300 units.
It pushes the insulin down the tubing and into a cannula -- a small piece of plastic tubing that is inserted into the skin with a needle. It's slightly worse than a regular insulin injection and loads better than a cortizone injection in the foot.
The pump doesn't do anything "automatically". You program it to deliver a basal dose. Mine is around 1 unit an hour, and the pump divides that into how every many times it delivers insulin an hour. So you get a fraction of that insulin every few minutes. This replaces the long acting insulins, which use chemical to slowly release the insulin.
You also have to enter a bolus for whenever you eat depending on your insulin to carb ratio. Thus, if I want to eat 40 carbs, I divide by 8, and program the pump to give me 5 units of insulin. Rapid acting insulin works about the same speed as metabolisming the average meal.
My goal, throughout the day, is to keep my blood sugars as stable as possible. If the basal amount is programmed correctly, my blood sugar will stay within 20 points, provided I don't eat.
If I calculate my meal correctly -- and there are variables on that -- my blood sugar should be in the 140 range two hours after a meal.
Therefore, what I do, is throughout the day, check my blood sugar with a normal, over the counter blood sugar device, and make sure that my blood sugars are in the right range.
There are several factors that can through it off ....
First, hormones, an being female, hormones especially can cause blood sugars to be erratic. Both internally produced and externally delivered hormones can change blood sugar.
Stress -- which causes hormone and adrenal production (isn't that a hormone), can also change blood sugar.
The make up of food -- high fat foods tend to slow absortion down, cause the insulin curve to be faster than the food curve -- though that can be fixed with an extended bolus. The pump has an extended bolus feature that lets the delivery of insulin be divided by a time period. Works great for pizza and mexican food.
Pure sugar has the opposite effect. I still get a short sugar buzz off of things like Lifesavers or Gummi Bears. In that case the food gives off sugar faster than the insulin works.
Just being off on the calculation. Let's say I go to Wendy's. Well, if the person serving the fries gives me 3 fries less than what has been measured and recorded in the FDA database, or 3 fries more, I'm going to be off on my carb to insulin ratio.
And sometimes the database is wrong, or the food doesn't have the same ingredients.
Yeah, it isn't fun, but better than the alternatives.
... but it's still better than the alternatives.
Last night I started going to bed, did my nightly blood sugar test and was 234. Yeah, I'd had a headache and didn't feel well, but I ttributed it to the week from hell and being in two different school buildings. I am really allergic to dust and different buildings really get to me.
So site change time. Had to check periodically through the nice, but it was dropping nicely and was at 105 when I woke up.
I love my pump.
It took a LOT longer for my blood sugar to go down when I had a shot failure. However, those were usually from eating the wrong thing, not taking a shot, or just some weird system stuff.
And of course, medication didn't budge the blood sugar at all.
So yep, I still love my pump.
They have a nice website where you can track what is going on. The podraist has been paid, Animas has been paid -- I do own them some money but haven't gotten a bill yet and no problems.
Even the pharmacy isn't too bad, but I haven't had them process an allergy script yet.
One of my coworkers had problems as it has to be precertified with additional paperwork.
Just read an article in Diabetes Forecast about Type 2's being resistant to going on insulin.
Well, DON'T BE!
The most frustrating time in my life was the few months I was on diabetes medication. I swear to GOD, that the blood sugar was run by a random number generator ... nothing I did seemed to affect my blood sugar, it just was what it wanted to be.
Insulin is a pain, and the pump makes it more complicated, BUT I feel better. Plus, I'm in control, not some silly little pill.
Thanks to MedicMom, I went to http://www.htmlkit.com/services/favicon/ and made a Favicon, SO if you bookmark my site, you'll get a tiny little picture of my insulin pump with my listing in the favorites.
Yeah, I'm such a geek!
TheraSense | Investor Relations
Here's the important quote:
We are also pleased to announce that the pre-market approval application for Navigator, our continuous glucose monitoring system, has been granted expedited review status by the FDA," said Mark Lortz, President and CEO of TheraSense.
Good Site!
Agent, Consumer, Industry News from the Texas Department of Insurance
They have an online compliant form, which I've filed out and I've requested an Independent Review of the Pump Rejection.
I'd LOVE to have the pump covered -- the policy covered up to $3500 in durable equipment expenses, and I've spent less than $200. Especially since I've found out that the humidifer is a rental, not a purchase. Weird.
So the max I can get back on the pump is probably $3250 or so. It's still over half the cost of the pump.
I'll of course, be happy for the supplies alone, but I should get at least one of them.
And it's diffently been worth the full cost.
So far, so good. I've been to my primary care physician twice. Once for update on scripts and blood tests, and once because I was having a crisis with my GERD and needed doctor's advice.
I've been to my podrist for a cortisone shot for heel spurs.
I've ordered 3 months of supplies from my pump company.
I've filled 3 prescriptions -- one on the way, two delivered.
So far, everything's been smooth, and no problems.
Blue Cross/Blue Shield of Texas PPO, through the State of Texas teacher's insurance program.
Head To Head Study: Pumps Versus Glargine and Fast Acting Insulin
Actually it isn't because they went further than just finding out whether or not the patient perferred the pump. What they found out was that the patients had at least the same numbers, if not slightly better with the pump.
Be VERY careful on how you get your doctor to write your supplies. I swear my prescription says to test 8-10 times a day.
Medco has choosen to interpret this as test as many as 8 times a day and is sending me 7 boxes of 100 test strips. Instead of 9.
At least so far, they have not tried to get me or the doctor to change brands.
I check -- between January 1 and January 15, I had 129 entries in my log. That means I have been testing 8.6 times a day.
Typically I check when I wake up. Two hours after meal. If I am driving without eating or checking. Before and after exercise, and sometimes during if things aren't right -- I tend to go low exercising.
Yep, that's a lot of holes. Bring on the continuous blood sugar monitor device. PLEASE!
I was asked to look at this program.
I'll start out though by saying this is probably not a program I would use because I'm extremely efficient. I am not going to use a program that is not going to automatic download my pump and blood sugar meter data. That said, I did download this program and give it a try.
UTS Diabetes software for Palm pilot
The install program is very nice. It leads the users by the hand. Too many Palm programs have poorly designed installation programs.
The insulin calculations set up is very tedious but then that's something that you don't do often, and don't change much.
I also don't see how to calculate carbs / insulin rations.
It's got a very good user interface -- much better than EzManager.
A nice program, but not that useful for a pumper. Would be great for someone who used multiple daily injections and didn't carb count, or great for someone on medications.
This is something that has made my life infinately easier. They now have a free version, so give it a try.
I really like the web interface, and it is great because I'm on multiple computers.
Got a call from Animas today. They had to talk to me about my insurance. I just KNEW they would tell me that I wasn't covered...
BUT, nope, they had to tell me the terms on my insurance policy and make sure I understood them before they shipped.
Should have them on Friday.
Told my mom, and she said -- and yeah, if you'd waited you might not be here today.
I don't think I was that bad, but still.... I've avoided at least 5 months of possible complications.
Several years ago I did VERY VERY well, going to the gym every morning. I've been good about going in the afternoon, but it's a drag, it takes up all my after school sunlight etc.
SO, yesterday I got up, went to the country club gym (that's the replacement for my old one). I was warned, but was a bit alarmed to see a large number of cars in the lot.
But there were enough treadmills that I could get in my 42.5 minutes.
However, there was a line for the shower! The good news is that I was the first in line. Then there was only one hair dryer downstairs and 4 of us.
I still got out and got to school by 7:45. I like to get there before my tutoring kids come at 8:00.
Today, I made it again. In fact, made it a few minutes earlier. Not as many cars, but again plenty of treadmills. It was touch and go for a few minutes, but I still managed to do 42.5 minutes uninterrupted.
This time, no line for the shower, and I was the only one downstairs. One of my fellow teachers came down -- come to find out she teaches some classes at the club. Good news -- she figured out that I couldn't make it to her class and make it to school -- sorry, but I really don't like the group exercise thing.
Okay, here's the truth, every time I've done the group classes, I've cut down on the cardio and they just don't burn the same number of calories, and hers is a stretch class.
... The bad news, truck is in the shop, getting a repair on something that was fixed last October (2002).
Diabetes In Control Dot Com. The weekly newsletter for medical professionals in Diabetes care.
Health Insurance Plans Discourage People From Taking Their Meds
Reason for Rebound Weight Gain Found
This is pretty interesting. Wonder how it can be used to fix the problem.
Had an interesting day. Got up, checked blood sugar and it was 135. That's the highest it's been in the morning for a LONG time.
Checked site, things looked a bit red (change was due tomorrow). Didn't give it a lot of thought.
Went to the gym at 6:00 -- walked for 42.5 minutes, went through the shower, hot tub, etc. normal gym routine.
Since I had not eaten, I expected a dip in blood sugar. However, it was still 135. Thought that's weird.
Got to school, ate breakfast. Did a bolus, changed insulin as was almost out. Checked blood sugar two hours later and it was 205.
Huh, must be bad insulin, so I shot in 3 units of humalog (nasty stuff -- it itched! but I have tons of it in pen insulin). Check blood sugar a half an hour later, and was still at 205 -- well, it must not be the insulin.
Pulled off the site, put a new one on, checked the blood sugar 30 minutes later, and I'm down to 152.
The reason it is a milestone, is that I diagnosed and solved a problem without panicking and without requesting help, even from the insulin pumpers list!
That's also the first 200+ I've had in weeks.
I was a bit worried, as I was afraid I'd go back to having blood sugars in the 120-180 range, rather than the rather nice 90-140 range I've been seeing lately, but my BS went right back where it should -- around 90 at lunch and around 90 at dinner.
Interesting change -- I went to the eye doctor today and she said my astimigatism changed from 75% to 60% cylinder. Changing the contact DID help the vision.
And I'm now wearing a bifocal contact in one eye. It isn't bad. I've lost a lot of far vision to get good near vision, but I was corrected 20/15 for over 20 years. I think wearing these a few days will help a lot too.
Probably moving my monitor closer would be a good idea also.
My eye doctor -- who has Lasik services at her office was saying essentially the same thing.
She said that the prices on the radio are without any astigmatism, and that they always find some and charge more for it.
Texas actually spells out what has to be covered!
Someone in the diabetes network told me that a) the FDA isn't approving pumps with more than 200 unit cartridges anymore and b) the Humalog had finally been approved for the pump -- which a group of pump users are allergic to, me included.
I related this to my husband, who exploded -- and you have to know him, he rarely reacts strongly to anything. He response? How can they regulate insulin so strongly but keep ephedra on the shelves.
Yeah, I want to know too.
First, cartridges cost money, and yeah, I'll be reusing them. Second, changing insulin every day and a half is a pain. One of the reasons I have the pump I have, is that it is a 300 unit pump.
Also, I care about the humalog thing, because I'm afraid my insurance will try to push the Humalog issue. I'm sticking to state law, reminding the doctor endless I'm allergic to humalog, etc. Yeah, it's $80 every 90 days instead of $50, but the crap makes me itch! Even injecting in the site makes me itch.
ARGH!
Unfortunately there isn't a web link for this article -- it came from the ADA -- Diabetes E-New Now!
Insulin: Early and Often
Insulin will lower your blood glucose levels whether you have type 2 or type 1 diabetes. When you maintain lower blood glucose levels, closer to the nondiabetic level, you lower your risk of the long-term complications of diabetes. The U.K. Prospective Diabetes Study (UKPDS) showed this was true for people with type 2 diabetes in 1998. The Diabetes Control and Complications Trial (DCCT) showed this in people with type 1 diabetes in 1993.
Yet even today, insulin is not used early enough in the course of type 2 diabetes. And it´s not used often enough (three or four shots a day instead of the usually inadequate two shots a day ) in type 1 diabetes. The result is too many people with vision loss, kidney disease, and amputations.
If I do find a web link, I'll post it.
For me, this shows I made the right decisions -- going to insulin when I first saw that drugs weren't doing a thing.