Questions
ok so maybe im posting in the wrong forum but I am lil frustrated and thought maybe yalls could provide a lil perspective on things.
I have been dealing with diabeties for over 2 years now (i dont claim to be a vet on this subject). I have been thru multiple insulin medication changes (started at 500mg 2x day of metformin moved up to 1000 a day then put on novolog and lantus). My a1c was a 9.1 last time it was done. My sugar is uncontrolled (my last fbs was 437 and normally ranges from 200-300 believe it or not.)
Recently my PCP referred me to the endo and they knocked my insulin to lantus in the morning and evening and a set number of units for novolog. My PCP had me on a sliding scale. Is there a reason for this. I just dont see the point in a set dosage with novolog without a sliding scale.
Also my PCP believes i should be a canidate for an insulin pump. but here are my fears about that. I live on a limited income (i have medicare and medicade) and I allready have issues getting my insulin with prior authorizations. I do worry about supply cost.
anyway i should stop this post before it turns into a rant. Feedback welcomed
thanks
Replies to This Discussion
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Permalink Reply by Zoe on -
Actually, neither a set dose nor a sliding scale are the best way to dose your novolog. The best is to use and Insulin: Carb ratio; that way you can dose for the food you are actually eating.. If you are high before your meal you can add in a correction using your ISF (Insulin Sensitivity Factor). You obviously aren't on the right dose of Lantus if you are waking up that high and you need to slowly increase it. You don't say how much Lantus you are taking but you need to go up one or two units at a time and then see how it is changing your numbers for a couple days.If you wake up too high in the meanwhile you need to do a correction, or else you will just get higher all day. To find out your ISF (how much one unit of insulin lowers your blood sugar) start conservatively - say 1 unit for a drop of 20 points. If you are still high after a couple hours, try 1 unit for a drop of 18 points. If you are too low, then go up to say one unit for 22 points. Fiddle with it until you get back down where you want to be by say 2-3 hours later.
You should get the book Using Insulin by John Walsh which will explain all these things, and help get your numbers into line. I would work on carb counting and I:C ratios and ISF long before you even consider a pump. A pump doesn't solve problems without getting those skills in line.
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Permalink Reply by Zoe on
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Ok, then try increasing the Lantus to 27 units and see how that works for a couple days. Again, the "18 Novolog per meal" is pretty meaningless. Would you take the same dose for a salad or a plate of pasta? To figure out your I:C ratio: If you currently eat, let's say for a round number, 72 carbs, then your 18 units is 1:4 or 1 unit for every 4 carbs. If you are always high after your meals you might try 1:3. Another thing you might want to do is make some changes in how you eat. My example of 72 carbs is way too many carbs, and if you eat things like rice, cereal, pasta. potatoes you may not be able to accurately bolus. Try limiting your carbs a bit and then work on figuring your I:C ratio
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Permalink Reply by bobnominous on -
Get and read "Using Insulin". Sliding scale, and set novolog doses are huge red flags. You need to do basal testing, and bring down your fasting numbers, though based on personal experience and a lot of reading, do it slowly in stages. Aim for 180 fasting to start perhaps. After a month or so, go for 140, then down to 120, and in six months, you should be able to hit around 100 regularly. I'd also ask about switching to levemir maybe, and splitting the dose. Pumping is great tool to help control diabetes but you should get stabilized first in my opinion. I'm not a doc of course, etc. Also, a cgm can offer wonderful insight and help with bg control. Asking here is a wonderful first step, prepare to learn more!
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Permalink Reply by MyBustedPancreas on -
Definitely some good advice above.
Regarding a pump - yes, pumps do come at a cost. However, I believe Medtronic offers some assistance programs if your endo completes the certificate of medical necessity (basically, the form that says they are recommending you get a pump). If you're interested in a pump, you can call Medtronic/Minimed directly to find out if they have any assistance that they can offer you. Make sure to tell them that you are on Medicare & Medicaid.
Medicare does have more stringent insulin pump requirements (compared to private insurance companies). I do not know what Medicare's requirements are for T2 diabetics.
In addition to the cost of the pump, you also have to factor in the cost of the pump supplies (reservoirs, infusion sets, tegaderm, etc). This can all really add up.
I agree that the first thing you need to do is get off the sliding scale regimen. That is not used anymore. Learn about dosing based on the amount of carbs you eat. Doing that will set you up for using a pump in the future if that happens.
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Permalink Reply by Sam Iam on -
Being an uninsured freelancer, I called Medtronic at CDE's suggestion and asked about the assistance program. To qualify, you can't be working at all, but not unemployed for more than a certain time 6mos or a year, I believe. Also, you need proof of income and a letter of dismissal from your previous employer. Basically, the point of this program is not to help anyone out, rather to appear charitable, IMO.
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Permalink Reply by Zoe on
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Animas too has low income help. You can get money off the original purpose if you have a co-pay (mine was 20% which they waived) and you can also get money off your monthly supplies (I got an extra 30% off my 20% share)
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Permalink Reply by Doris D on -
I have Medicare & Medicade myself and they will cover the MM pumps. It would be great for u it has helped me alot. U have to turn in a log for 30 days every 6 months that covers a month and shows how manytimes u test a day and what ur bs's run. ur dr must order that u need it too.
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Permalink Reply by Doris D on
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I'm just going to advise u on the Medicare & Medicare info here. U will also have to do an A1C done by ur dr every 3 months to get ur supplies for the pump
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Permalink Reply by Josh on -
Medicare actually gets that information now cause i am testing more then the allotment for a diabetic
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Permalink Reply by Sam Iam on
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Second all Zoe's advice.
I've been D 25yrs. pumping almost 3 years, now I think.. The past year without $ or insurance. I've found some tricks to make supplies go further, but it took some figuring out.
I'd suggest diet is the most effective and easiest thing to change. Then, proper insulin dosages, based on IC ratio. Then, moderate, consistent exercise.
Once you do these, the the pump can make life easier.
Good luck. Be patient. You can do it.
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