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December 2003
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January 2004

Scary letter

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.


Panic Attacks

Panic Attacks

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.


Dealing with Insurance

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.


What's it like to actually WEAR a pump?

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.


What's it like to pump?

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.


Pumping isn't a no brainer ...

... 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.


Yep, the new insurance is working!

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.


Type 2's on Insulin

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.