Time For A Pump?   (February 1, 2007)

As readers of my other blog at Diabetes.Blog.com may be aware, I once stated that I’m “Still having very mixed emotions about whether to seriously entertain using a pump (although it's a consideration now and then). A pump would resolve some issues (like forgetting to bring the pen)… Maybe someday...”

I’m beginning to think that maybe someday has come.

Anyhow, the other morning, I ate my usual breakfast, and at noontime, out of the blue, found an extraordinarily high blood glucose level (at least for me; it was in the mid-200’s). In retrospect, I must have forgotten to take my morning mealtime bolus of rapid-acting insulin. But I have absolutely no way to be sure.

It definitely would have been nice to have an insulin pump with an alarm to warn me that the morning shot was due or overdue, and an electronic record that I could look at at noontime to tell whether or not I had taken the dose. Actually, I really wouldn’t need a pump, if someone would please develop a gadget to track all my blood glucose levels, and beep when it’s time to ask “Did you give your bolus shot?” and automatically keep track of whether I gave my bolus shot a few hours ago as well as all my BG test results. There have been various attempts to develop electronic logbooks (I remember one with the cute name of Merlin), but they all required remembering to manually input the data - they were not an automated way to enter the data as it’s collected, as modern insulin pumps can easily do. Besides, delivering multiple basal rates, and boluses whenever you press a button, the new generation of smart pumps can warn you that you haven’t taken a shot in a while, and will log in your blood sugar level for later review if you use a pump-meter combination.

So, whereas in one sense I’m perfectly comfortable with giving shots (when I don’t forget them!) and although I like having the security blanket of my basal insulin to assure I’ve always got some insulin on-board, I’m ready to look at switching to using a pump. But my BG control is so good with pens and syringes (my average BG is just about 100 on the nose -- and that includes a large percentage of postprandial readings), so I expect that the insurance company may put up a fight, and declare that I don’t need a pump.

What to do? Well, if my insurance company refuses to pay for my pump, I definitely will fight like the dickens with them. If that fails, I could spend a few months screwing up my control to prove that I need some better way (namely a pump) to improve my control. Or maybe put out a request to the pump companies to find out if anyone is willing to give me a free pump. Or pay for it myself.

Well, it’s time to try.