I need a second opinion. After more than 14 years with type 1 diabetes, I decided that I wanted to go on a pump. A year ago my A1c was around 13.0 so my doctor said to get the blood sugars under better control before starting the pump. I just saw my doctor, and my A1C is 6.3, and I feel great! I would, however, like to have more freedom away from the numerous injections I take everyday. My doctor still says no. I somewhat understand her reasoning, but I am really frustrated.

In May, after some critical changes in my life, including my sister’s death and my starting on dialysis after I went into kidney failure, I tried to commit suicide. I have since been in counseling every week, and I am making huge strides in recovering. The doctor says that I am not mentally stable. I am frustrated because she only sees me for 15 minutes every three months so, how can she make this decision about my mental status? Do you think that her reasoning is correct, or should I seek the advice of another endocrinologist?

There is no correct answer here. I can see your physician’s point What needs to happen is that you need to have a third party, someone who knows where you are at with your depression, speak with your physician and let her know where you are with things. It is probably true that you could do harm to yourself with intermittent injections or a pump, if you really wanted to. However, this is also about making good decisions. I do not think your physician is wrong in her posture.

The other issue to address is what is the effect of kidney failure going to have in your life. Will you be pursuing transplantation with kidney or kidney plus pancreas or islet cells? These are additional issues and the state of your emotional health will be important factors in your pursuit of these therapies as well.

JTL
Additional comments from Debbie Butler, MSW, LICSW, Licensed Clinical Social Worker:

It sounds like you have been working very hard to bring your blood sugars in better control, and it is great that you have been able to bring down your A1c significantly. I am also glad that you have a mental health counselor that you are meeting with regularly. It sounds like you are very frustrated, but I would still encourage you to talk more about this with your diabetes health care team. Are there any other team members involved in your care besides your endocrinologist? Do you also meet with a certified diabetes educator (CDE)? If so, could you meet with your doctor and diabetes educator together about the insulin pump? Then, maybe you could ask your doctor or nurse educator if they would talk to your individual counselor. Electing to start insulin pump therapy is a major decision, so that is why I recommend that everyone that is involved in your health care discuss this as a team.

DB