Getting a Pump: Part 1

I met with the CDE at the my clinic. She was great.

Bottom line, she thinks I can get a pump, and may even be able to bypass the insurance company's "on insulin for 6 months" rule. The clinic supports all six major pumps currently on the market. She said that the insurance company recently told two of her patients that they were no longer going to pay for the Omnipod because it is not "durable medical equipment" in their opinion. But the CDE thinks that they have straightened it all out.

Next steps are for me to:

1. Go pump shopping. I left her office with product brochures for each of the six pumps, and am reviewing those and surfing the 'net for other reviews. Other bloggers' stories have already been incredibly helpful in navigating what each of the features mean in real life
2. Meet with my Endo in a couple weeks. He will start documenting my medical record with all the tidbits that will help get me through the insurance process. Things like: being sensitive to insulin (I'm still at only about 40-50 units for my TDD); Dawn Phenomenon; going hypo and hyper; my preferred method of excercise (biking).
3. From there, he sends of the prescription for the pump of my choice to the pump company, who then sends it to the insurance company. From there, lots of wrangling I suspect.
   

In the end, I might have to wait the 6 months (late October), and even then I'm not sure if the insurance company requires all this extra rationale or not.

In the meantime, she interviewed me at length about all D-related activities, meds, insulin and eating, and carefully reviewed my meter history. Based on that, she calculated my carb ratio (2 units per 15 carbs) and my correction ratio (40), and had me adjust my basal (take night time dose later, and reduce amount of morning dose). I'm carefully logging everything, and will fax her my info in a week and adjust more from there.

Gotta Wait 5 Months to Pump

Well, a little research and I answered some of my own questions. According to my health plan, I must be on insulin for at least 6 months to be considered for a pump. I've got 6 weeks under my belt, so about 5 more months to go. There are other requirements, which I don't think I'll have any problem meeting.

The only requirement that could get dicey is having an A1C of than 7.0. I'm currently at 7.8. I guess I could possibly get down to 7.0 but I doubt it, since I don't yet to seem to have a very good insulin regimen. An A1C of 7.0 or lower could still be considered if there are enough documented hypos to account for the lower number. It all boils down to lacking tight control to a high enough degree to qualify. Crazy.

There is an option whereby the patient has been on insulin "less than 6 months but more than 3 months and the patient has documented extenuating circumstances. These cases may be reviewed on an individual consideration basis." But I'm guessing there ain't nothing special about me or my life or my health right now that be construed as an extenuating circumstance.

Who Switched the Insulin??

Oops. I did!

I'm traveling this weekend, and this is the first I've done so with insulin out-of-town. During the ride in the car, I was talking about d-stuff to my hubby (which is, of course, all I talk about these days), and I mentioned that I read how others had accidently taken one type of insulin instead of another.

And then what do I do this morning? Exactly that.

I took more than twice the mount of bolus insulin as usual, thinking I was injecting my basal.

As so I enjoyed a huge carbo-licious breakfast to counteract the dose. So far so good.

My sister offered to smack me if I had a low, hoping that was an accepted treatment!

Watch Your Frio While It Soaks!

I recently purchased Frio insulin wallets in several sizes (Individual, Duo and Small). The very first time I used one, I let the case sit in water for just a minute or two longer than recommended, and it puffed up so much I couldn't use it for several days.

I'm leaving on a trip later today, so I had to get out the next size wallet and activate it. I stood and watched it carefully this time while it sat in the water. Perfect results.

My experience so far with the Individual wallet is that it has stayed cool for 6 days now. We'll see how the Duo does on my long weekend trip. So far, I think this is a great accessory.

(For the record, I wish I could find it in red, as advertised on their website. I suppose I could have bought it online straight from Frio, but it was somewhat less expensive through other online stores.)

Belly Lancing?

Belly Lancing? No, that's not a typo.

I sat down to go through the whole d-routine before dinner. I mindlessly got out all the various d-paraphernalia, while chatting with the hubby. Next thing I know, I'm squeezing some of the belly fat with one hand, and getting ready to attack it with my meter lancet in the other!

Oops! Wrong sharp object!

Just in time I realized what I was about to do. After a couple laughs, I got back on track. Poked the finger, stabbed the belly with insulin, and all was well.

The post title was just too good to pass up.

A Great (Insulin) Math Book!

This book was recommended on a number of d-websites and d-blogs, so I made the purchase at my local bookstore:

Using Insulin: Everything You Need for Success with Insulin
by Walsh, John
Paperback - $23.95

It is great. It has a tremendous amount of detailed information about how various insulin (and insulin regimens) work. Most importantly, it has the math!

When I was first (incorrectly) diagnosed as Type 2, I skipped (or at best, skimmed) all the "insulin" chapters in all the books I purchased. But even just in skimming and seeing insulin mentioned on the web, it was clear that insulin treatment is a tricky thing. Lots of calculations including your weight, your A1C, your BG reading at the moment, your anticipated carb intake, your target BG level, and so on.

When I was re-diagnosed as Type 1, along with that came basal insulin and the instruction to "start at 10 units, and titrate every couple of days with a goal of getting your FBS between 90-100."

Easy enough. That accomplished, I was still having big spikes with meals, and reported that via email to my d-Doc. Here was his reply:

"You probably should stop the Amaryl, and start meal insulin. You can begin with 4 units each meal and titrate to a 2 hour post meal target of 140 mg/dl. As your bedtime readings should come down, you may need to reduce the Levemir, as it will most likely over correct you and cause you to go low. I can e script the prescription for Novolog pen for meals. Take it 0-15 minutes prior to the meal. Let me know how it goes in a few days."

Easy enough again. But what about all that math??? I go back to all my books. No specifics about how to fine tune a dosage.

Hence, the "Using Insulin" purchase.

It is great. Very detailed information about how all of the various factors fit into calculating a correct dosage of the various types of insulin. It will take several readings to really digest it all, but I'm looking forward to doing math for the first time in my life.

Luckily, my husband is a math wizard. He's offered to learn the formulas and be my human calculator!

Liraglutide - Clinical Trial

I recently participated in a Phase III Clinical Trial for Liraglutide, which is a product of Novo Nordisk. This is a "sister" drug to Byetta, the difference being that Liraglutide is long-acting and only requires one daily injection.

My participation began last October, and the trial was scheduled to conclude in August. However, I dropped out a few weeks ago (more on that in a moment). I am assuming that I received the trial drug (and not the placebo) because I experienced the reported side effects of Liraglutide. [But who knows...the mind is a powerful thing!] I then experienced additional side effects which ultimately led me to discontinue my participation. I just couldn't take it anymore!

I should clarify that the trial was for Type 2 patients, and I recently was re-diagnosed as Type 1.5. So no wonder the trial drug wasn't doing anything for me! So please don't take this post as any particular endorsement or criticism of Liraglutide. Hopefully it will indeed be very effective and on the market in the next year or so.

Being part of a clinical trial was very interesting. I got quite the full health screening. They drew nine vials of blood at the beginning and end of my participation, and a few times in between, so I had just about every lab recommended for diabetes patients. I had a monthly A1C, which was nice information as well. At every visit (which varied between bi-weekly and monthly), my blood pressure was taken not once, but three times. And during blood pressure readings, I had to sit with my legs un-crossed and rest. I found this interesting because this kind of care has not always been taken in other settings when I've had my blood pressure taken. They also measured my waist and hips at each visit (and again, not once...but three times).

Big positive- everything was free. All my appointments with the doctors and trial coordinator, all my lab work, all the medication...all of it was free. I also got to keep the meter and supplies that were provided, and a few little gifts as well (a gym bag and a portable clock).

Big bonus - I got paid! I quit the study early, so I only made the $275 of the $300 I was suppose to get, but that's still a nice check!

Liraglutide is an injectible drug. I thought that I might someday need insulin, so this clinical trial was also an opportunity to learn all about injections. Turns out the finger stick is much worse! And, since my re-diagnosis, I've started on insulin...so at least that was one skill I had mastered.

One negative to report. The oral meds which were part of this study (metformin and Avandia) came in cardboard blister packs. I got sores on my fingers from punching out each and every pill!

Overal, this was an enlightening experience.