Diabetes Self-Management Blog

This week, Eric continues with Part 3 in an ongoing series of entries about his recent transition to using an insulin pump (click here for his first and second entries). He’s trying to be somewhat comprehensive about his insulin pumping experience, and that’s why, thus far in his blog, he hasn’t even received his pump yet.

By the end of my diabetes education class in April of this year, I knew I wanted an insulin pump. And, as I said at the conclusion of last week’s entry, I discovered that obtaining a pump entailed jumping over some hurdles. Here’s a truncated, edited, mostly e-mail simulation of how I finally got ahold of the pump. Join me, now, as I relive a rather tedious few months of going through the pump-getting process.

April 25
To: Glee [my dietitian]
From: Eric

Kathryn and I have discussed moving to a pump and we think it’s the right thing for me. I spoke with Dr. Kumagai about it yesterday as well, and he agrees. Four weeks ago, when I was diagnosed, my C-peptides were at the low end of the normal range (I think they were at 2.0), so if they’re still there, then we’ll probably have to wait until they drop to file the insurance work.

My HbA1c is down to 11.0%, which, after only four weeks, is pretty good (given that I was at 14.5% when I was diagnosed). In fact, Dr. K said something to the effect that if he had to define the ideal way for how a newly diagnosed Type 1 would handle his first month, I’ve gone beyond even that scenario.

Anyway, in your experience, what can I begin doing to facilitate the move to a pump when my C-pep levels are pumpworthy? I’m pretty sure I’ll do the CozMore pump. I’m also waiting for Amazon.com to deliver Pumping Insulin by John Walsh.

April 26
From: Glee
To: Eric

Hi Eric, I think you’ll do fabulously on an insulin pump. The first step toward getting the pump is to do a seven-day food/glucose/insulin record (forms attached). It is important that it be seven consecutive days. After you’re done with it, call me to set an appointment. We’ll get all the pump paperwork completed and get you on your way to a pump. Thanks, Glee.

May 24
I see Glee at the diabetes clinic, then I speak with Linda, my certified diabetes educator. Linda’s in charge of actually getting my pump, as well as guiding me through the first few months of wearing it. “What do I need to do now?” I ask them, after receiving my insulin-to-carbohydrate ratios based on my seven-day charts. Linda says she’ll get the application forms in the mail to me soon—insurance information, mostly. She’ll also send me a spreadsheet for tracking my blood glucose; they need four weeks of blood glucose values to send in with the pump order. (Thankfully, I find out my glucometer stores up to 500 readings, so those are available to download.)

May 30
To: Eric
From: Linda

Hi Eric, I received the pump application forms you sent. Your C-peptide on May 23 was 2.2, which is still too high for M-CARE [my insurance provider] to cover the cost of the pump. I am going to ask Dr. Kumagai to write a special letter, though, and see if we can get it through. Linda

June 12
To: Eric
From: Linda

Eric, I ordered your pump today. Dr. Kumagai gave me the letter he wrote yesterday and hopefully it will help! Linda

June 14
From: La Neta [clinical pump representative]
To: Eric

Hi Eric. We are the insulin pump company that Dr. Kumagai referred you to for your Cozmo pump. We received a denial letter from M-CARE for the insulin pump. La Neta

June 15
From: Eric
To: La Neta

La Neta, does M-CARE give any reasons for the denial, and if so, are you allowed to share those with me? I was under the impression that because my endocrinologist wrote a letter that I would have a pretty good chance of acceptance. Eric

From: La Neta
To: Eric

Good Morning, Eric. The reason M-CARE gave is that there was no six-month regimen of insulin therapy and six-month follow-up. Your insurance provider requires six months of intensive insulin therapy. La Neta

To: Linda
From: Eric Lagergren

So, Linda, is the next step to simply wait a few months, test my C-peptides again, and see where they are? Eric

From: Linda
To: Eric

Eric, I have a call in to M-CARE to discuss this first, and then we can appeal if necessary. I’m sure Dr. Kumagai will be glad to do it. I am also giving Dr. Kumagai M-CARE’s medical director’s number to call directly. That may help. Knowing him, he will call this week! Don’t give up! Linda

June 21
From: Dr. Kumagai
To: Eric and Linda

Good news! I just got off the phone with the medical director of M-CARE, who approved Eric’s starting the pump as an exceptional case. I told him that your (Eric’s) physical activity and professional schedule put you at risk for hypoglycemia, and that in my nine years as the director of the Intensive Insulin Therapy program, you are the first patient I’ve felt confident in transitioning to pump therapy within such a short time. Congratulations!

June 21
To: La Neta
From: Eric

La Neta, my CDE told me she would be contacting you guys today to let you know that M-CARE has authorized a pump for me. Thank you very much for your correspondence throughout all of this. It’s nice to be kept in the loop about something so critical to my health. Best, Eric

June 26
From: La Neta
To: Eric

Eric, Thanks for your e-mail. I can feel your excitement and that is what makes my job so rewarding. I sent an e-mail to the M-CARE case manager on the 21st to fax over the approval # for the pump and supplies. I also phoned her today requesting the same information and even told her you were inquiring as well. Will keep you posted when I hear back from her. Just can’t wait to be able to send your pump out, Eric. Have a wonderful day.

July 2
From: La Neta
To: Eric

Hi Eric, I have your Cozmo pump ready to ship to you. Once you have been trained, please call me with the infusion set choice that you have chosen and I will then ship out the remainder of all supplies that M-CARE approved.

July 2
From: Eric
To: Linda

Linda! They’re shipping my pump out next week. I should get it after the holiday. Have a happy Fourth!

July 5
From: Linda
To: Eric

Congrats! We will schedule your training. I have an opening on 7/16 at 1:30 PM. Would that work for you? Linda

From: Eric
To: Linda

Works for me. See you then! Eric

Next week, I’ll go through what it is like to become familiar with the pump—the experience of receiving it and playing with it before training, and the training itself.

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Priming the (Insulin) Pump (Part 2)
Priming the (Insulin) Pump (Part 3)
Priming the (Insulin) Pump (Part 4)
Priming the (Insulin) Pump (Part 5)
Priming the (Insulin) Pump (Part 6)
Priming the (Insulin) Pump (Part 7)
Priming the (Insulin) Pump (Part 8)


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