I raised this issue with my endocrinologist earlier this year. She said that the hospital that she is affiliated with wants to know that the patient is competent in using the pump. As a way to demonstrate this competence, the hospital staff requests that the patient do pump site change.
This seems a little short of the real competence (showing and understanding of I:C, ISF, DIA, as well as insulin onset, peak and duration) but I understand their rationale. If a patient can comfortably perform a complete set change then that infers that they know a lot more about how the pump works.
No one can control my blood glucose levels better than I can, provided I am conscious and maintain cognitive, visual, and manual dexterity function. I understand the hospital’s clinical and legal concerns but once a patient demonstrates diabetes competence, the hospital needs to respect and work with that patient to produce the best outcome. I will never let any medical person pull “medical rank” on me because what I know about my glucose metabolism dwarfs their knowledge.
If someone wanted to challenge me about my competence to control my diabetes, I would likely strongly push back and start asking them some questions to challenge their clinical and medical knowledge. Something simple, like, “Describe what a pre-bolus is and when and when not you would use it.”