I spent a considerable amount of time reading through posts here, but many are quite dated. I have a few questions regarding the use of a Pump for an insulin dependent Type 2. My insurance plan (THANKFULLY!!!) covers all diabetic supplies including DME at 100% with no copay.
Can I as a Type 2 (Am I still a Type 2?) even get a pump without taking injections for at least 6 months?
As far as "proof" that I could live healthier, what do I need to provide or does the Pump Rep deal with the insurance carrier? I travel roughly 50% for work and on my own time I am rarely indoors. During the spring and summer I am not near land as we spend weekends out on the boat on the hook.
I am going to a new Endo on the 7th (that in itself is a long story)so I have no idea what she will be like as far as keeping up with new technologies and procedures so what are my options if she does not agree that I need it? That brings me to my last questions - Do I need it? Would I benefit from it enough to really pursue it? Like I said - I am very active outdoors and need to have a flexible solution that will allow for hot / cold, far from home, difficult meal schedule, MUST be able to use near and in the water and in a tree stand lol!
Looking forward to hear some new opinions and personal recommendations. I am currently on Humalog and Lantis which are adding up to 5 - 7 injections a day and putting a serious hit on my personal life.
Gary, I did an advanced search here and we have 145 members who are type 2 on pumps. and meet another Gary, one of them:
I can't answer all your questions, but I can definitely say that even though you are on insulin, you're still a type 2 (this is a very common misconception, I never could get my type2 dad to get it). Also I've found the pump reps are more than willing to help you with the insurance. I use the Accu-chek Combo (love it), but it is not waterproof, although it's easy to disconnect for short periods of time. You might want to look at the Omnipod (and others). I think you will like the flexibility the pump gives you to vary eating times, lower basals for exercise, etc
Hi Gary, I am also Type 2 and I just started using a pump last week. I decided to pump for the same reason as you, I'm not in an office or a factory all day. I work as technician for a gas company and might be all over town during the day or in my workshop weekends. The flexibility is what I was looking for.
I had no trouble getting approved for my pump because I also have good insurance. My Medtronic Rep took care of the insurance all I had to do was get my doctor to approve. I did that by proving to him that I understood how to use insulin. I counted carbs religiously, I kept detailed logs and managed my best A1c ever. Once he was convinced that I understood basal rates, I to C ratios and correction factors he was very agreeable.
Your question about whether you need it comes down to a simple factor, are you insulin dependant and use both basal (long acting) and bolus (meal time) insulin. A pump is just a delivery method just like injections are. The decision to pump is based on personal preference. I will add that some forks are able to achieve better control when pumping.
For your active lifestyle and love of water sports I would suggest you look at the Animas Ping brand pump because it is water proof. My Medtronic's pump is not but that wasn't an issue for me since I'm not into water sports.
Like I said earlier, I'm only a week into using a pump. So far I'm loving it. I'm still getting used to the being connected factor but that's not a deal breaker. It's just a matter of getting used to the mechanics of things.
Plenty of T2s on here have pumps. I think a lot has changed from years ago (when only T1s could get a pump, and even then it was hard!).
Here is what you should do:
1. Find an endo who is pump friendly. Tell them you want a pump. Some justifications people have used for needing a pump include variable/hectic work schedule, dawn phenomenon, and being very active.
2. Your endo will write you a "certificate of medical necessity," which is basically a physician saying that you need this device.
3. Insurance companies all have different requirements. Some require that you be on injections for a certain period of time, some do not.
4. Pick a pump that you feel best meets your needs. Minimed does a great job of working with insurance companies to get approval. Usually, a certificate of medical necessity is all the insurance company needs, but if they deny your request, the pump manufacturer will work to appeal.
5. Make sure you have at least 3 months' worth of blood sugar and insulin logs. You should also have proof that you've taken a course in advanced carb counting and/or met with a dietician. Sometimes insurance companies ask for this, sometimes they do not. But endos usually require these things anyway.
That's a good point about reservoir size. I choose the Medtronic 723 for just that reason. My TDD was 65-70 and I didn't want to be changing sets every 2 days. Funny thing is that since I started pumping my TDD has decreased to where I could go three days on 200 units. Go Figure.
I have struggled with this same issue. As a T2, have been using insulin for two years and I still struggle with certain things like Darn Phenomenon. I inject 4-6 times/day and test 6-8 times a day and am very diligent about my diet, all of which my endo is aware of.
But getting a pump from my insurance is no cake walk. The immediate answer will be no and it will require my doctor establishing the medical necessity of the pump. My insurance (Aetna) policy follows Medicare and allows you to either be grandfathered in by having a pump before joining Aetna or to satisfy a set of conditions:
1.The member has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin dose for at least 6 months prior to initiation of the insulin pump*; and
2.The member has completed a comprehensive diabetes education program; and
3.The member has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump; and
4.The member meets at least one of the following criteria while on multiple daily injections (more than 3 injections per day) of insulin:
a.Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dL; or
b.Elevated glycosylated hemoglobin level (HbA1c greater than 7.0%, where upper range of normal is less than 6.0%; for other HbA1c assays, 1% over upper range of normal); or
c.History of recurring hypoglycemia (less than 60 mg/dL); or
d.History of severe glycemic excursions; or
e.Wide fluctuations in blood glucose before mealtime (e.g., pre-prandial blood glucose levels commonly exceed 140 mg/dL)
I can easily satisfy the first three conditions, but the fourth condition requires me to display what I consider to be poor control. I consider myself very good at using insulin to control my blood sugar. I know that if I had too, I could use syringes and vials of R/NPH and attain reasonable control. I am just a bit angry as a T2, that the patients that display poor control are granted a pump rather than patients who could benefit the most.
And this last statement, in my view is most important. A pump is no better then injections if you don't use it effectively. The data I have seen suggest that T1 patients moving to the pump reduce their A1c by 0.5% on average (whoop dee doo). There are many patients that get greatly improved control. Those are the patients that "really" use the pump. To really use the pump, you need to make dozens of more decisions each day (over injections). I'm not always clear that a patient who doesn't properly count carb, test and inject their insulin will do any better using a pump.
In the end, I suspect that my endo could make the case that a pump is warranted for me through the necessary proof of medical necessity, but for right now, I consider insulin pens easier for my active life. I travel a good deal and am outside, a pump requires more supplies and backups. I just grab a few pens, a bunch of pen needles and my frio and I am fine.
You left this requirement off your list:..."Diabetes needs to be documented by a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method."
Many type 2's have a hard time meeting this requirement when they first start insulin...but eventually many stop producing insulin at some point.
You are correct, this is an additional requirement that is part of Medicare (See Section 60-14 of the CMS guidance). In the case of Aetna, they have dropped that requirement, but they follow almost exactly the rest of the Medicare guidance.
Each insurance company (and sometimes even different plans from the same company) have different policies. Many insurance companies make these policies readily available on-line, even for non-members.
I was required to supply a C-peptide test to United Health Care for my first pump, but later UHC approved my CGMS with just a Rx to MiniMed and at that time my doctor said UHC had disapproved all of his prior requests for CGMS coverage. I have BCBS (Anthem) now and they have never asked for any documentation from my Doctor.
I have BCBS also and had no problem getting my pump the only glitch was a mistake on my birthdate and BCBS said they I was not insured. After that was corrected things sailed thru. I did not try for a CGM because my Medtronics rep said it's hard for T2's to get approved for a CGM with BCBS. I really didn't want one anyway so I let it go at that.
Thanks Everyone! Some great information here. My visit is on the 7th, so we will see what she says and what the Insurance Company says and then I will let you all know.