February 28, 2004
A1c (Glycohemoglobin, HgbA1c), Insulin Pumps
Question from Seattle, Washington, USA:
I’ve had type 1 diabetes for 13 years. Previously, I was on a pump and had excellent results,. My A1c was consistently under 7.0. Because I was returning to college and didn’t have good medical coverage, I had to discontinue using the pump. I now take four injections a day, and my A1c is very poor, 14.0-15.0. I would like to go back on a pump, but my doctor is telling me that I am not a good candidate right now. I have been in the hospital in DKA two times in the last three months. In addition, I was hospitalized for a severe hypoglycemic reaction one time, as well. I admitted to my diabetes educator that I struggle accepting my diabetic diagnosis at times, and I am frequently depressed about it. She told my doctor, and now they are convinced that I am not mentally stable enough to deal with the pump. I am frustrated, and a bit upset that my admission about depression has caused them to deny a prescription for a pump. Why would this happen, and what can I do to change their minds?
Answer:
I am somewhat confused as to why your physician is not recommending the insulin pump. Your situation is similar to many of my patients in the past. The pump seems to be the appropriate mechanism for you.
Many of my patients who have had difficulty with medical insurance in the past have been helped with the companies’ patient assistance. I would ask your diabetes team again for the opportunity to use the pump. If they refuse, I would seek a second opinion, but from a specialist who has extensive experience with pump therapy. I would talk to the physician directly and alone, without the educator, as the ultimate decision is yours and his/hers. Do not let “things” go through a third party to the physician. The translation could be lost in the shuffle.
ABS
