THIS JUST IN: Controlling Your Diabetes = Not Medically Necessary

CONTENT WARNING: Sarcasm ahead along with non-sarcasm. Good luck.

"Dear Member:

The purpose of this letter is to confirm that pre-auth [for your insulin pump with CGM] has been denied for the following reason(s):

Your provider asked us to provide a special type of insulin pump that can also continuously monitor your blood sugar. This was requested to help control your diabetes. This request has been denied as not medically necessary."

Neat! Did you guys know controlling your diabetes isn't medically necessary? Wow, what a relief. All this time I've been worrying about this garbage A1C that I have, but it turns out I shouldn't have to care at all.

Okay, in all seriousness, the letter goes on to explain they cover "these types of insulin pumps" for people with recurrent, life-threatening low blood glucose levels and also poorly-controlled pregnant women.

Maybe they would cover a pump without a CGM and a separate CGM system. I've never had trouble with pre-auth for Dexcom, surprisingly. Buuuutttt they would probably also say I don't need an insulin pump because my diabetes is poorly controlled in the wrong direction (highs instead of lows).

Just remember, kids, in the US of A we have the GREATEST HEALTHCARE SYSTEM IN THE WORLD where NOTHING IS EVER WRONG and PRESIDENT OBAMA RUINED IT FOR ALL OF US. It is sheer, tremendous, tremendous, big perfection.

Insulin Pump MacGyver

You may have seen that I got hooked up to my new t:slim this week.  Actual impressions on the pump will be forthcoming, after I've been able to use it for several days and give some opinions.  In the meantime, I still feel like I'm in pump transition from my Cozmo.  Additionally, I think my brain is still in transition from last weekend's vacation.  Why?  I ran into some odd pump-specific trouble this morning.

I drove to work knowing I needed to refill my pump and change my site this morning.  I had a box of supplies in my tote bag, left over from pump training two days ago, so I figured I'd be fine.

Whenever you say "I'll be fine", you should probably accept that there's a chance something is going to go awry.  In that sense, I was correct.

After doing some things at work, I pull out my t:slim to refill it.  I can't slide the cartridge off right away, so that was a bit frustrating until I popped it out with a coin.  I open my box of supplies, pull out a new cartridge, and realize I am missing a fill syringe.

With the t:slim, the cartridge isn't like your usual reservoir.  It's different than loading insulin into the cartridge of a Medtronic, Animas, or my old Cozmo.  You get a big ol' 3mL BG syringe, and you inject insulin into a port on the t:slim cartridge, which you've just installed into your pump.  So there I was, the Syringeless Wonder. 

Image found at:  intrepid.com.au

But!  My Cozmo was still in my purse from training two days ago.  If I couldn't refill my new robo-pancreas, I could just use the old one!  They both have a luer-lock connection so my infusion set would fit either pump. I pull out my trusty old purple pump pal, ready to remove the reservoir, screw on the spare reservoir needle and plunger I keep in my test kit, fill it up and kick it old-skool pump style.

Important Sidenote:  I AM NOT A MEDICAL PROFESSIONAL.  NONE OF THIS IS MEDICAL ADVICE, JUST THE SHARING OF MY OWN EXPERIENCE.  WE NOW RETURN TO THIS BLOG POST, ALREADY IN PROGRESS.

Yes, with my Cozmo, and even my Medtronic years ago, I'd keep a spare reservoir needle and plunger in my purse at all times.  You never knew when it might come in handy, and it was easier than carrying an extra reservoir for emergencies.  It also meant if I had to change out a whole set before schedule, I could save the insulin left in my reservoir.  Nobody encourages reuse of pump supplies, but I have a feeling a lot more of us have done it than we admit.

But I digress.

So I pull my handy-dandy Cozmo out from my purse only to find it is dead.  Dead for a ducat, dead!  (I don't mention it often but I'm a Shakespeare lover.  Digressing.  Again.  Unprofessional.)  I realize at my pump training Wednesday morning, I had a low battery.  I now had on my hands a dead battery, and not another AAA battery in sight.

So I've got a pump with no filler at a 75% charge, and a pump that I can fill but no power.

This is when the reservoir in my old pump, combined with the needle and plunger, came brilliantly into play.  I filled my old Cozmo reservoir, stuck the needle into the t:slim fill port (after a test that the needle itself would fit), and muscled some insulin into it.  There was a lot of resistance, I couldn't get all 3mL out of the Cozmo reservoir into the t:slim cartridge.  Cozmo reservoir needles are not meant for injecting, obviously.  I managed to get about 2mL into the t:slim and called it good enough.

I ran the priming sequence on my t:slim, and so far it's working just fine.  I'm anticipating a big SWAG-gy, carb-y dinner tonight, so most likely I'll have to refill again tomorrow.  With the proper new needle, of course.

I feel like MacGyver.  I took the parts available to me, and I made it work.  No explosions necessary, though some kickass 80's background music was most likely playing in my head while I worked this whole thing out.  While I am mullet-free, I am now, once again, full of insulin.

What have you wrangled up in a diabetes emergency for yourself?

All in a Twist

Seriously, how does this happen? What was my pump tubing doing all night? Must be quite the game of Twister you're playing there.

Thankfully it didn't stop insulin delivery.

If I ever wake up with it in a braid of some sort, I am going back to injections, because surely supernatural forces will be the ones governing my pump tubing. No human amount of wriggling could make that happen overnight.

We are serious about soft pretzels here around Philly, but this is not the kind of soft pretzel I had in mind.

Processing Times May Vary

Over the past 2 days, I've contacted both Tandem and Dexcom.  2013 is a year of New Diabetes Gearstuff here at Dorkabetic. 

Now I just need to wait, wait, wait on processing and companies contacting my suppliers.  Then I will wait, wait, wait on shipping.  I am not the greatest at being patient about such things.  Here is an approximation of what it looks like when I am waiting for something via delivery [USPS, UPS, FedEx, specific responses to emails, etc]:

Found via Google Image Search via some awesome person at iambrony.com

Here's hoping the waits aren't too long.  And don't worry, readers o' mine, I will certainly have plenty to say about my new diabetes "toys" when they arrive.  I apologize in advance to anyone without diabetes in my life for all the yammering on I will surely be doing about all my new gadgetry, but hey, listen in.  You might even learn something.

Let the mailbox checking begin!

New Pump Consideration Post 2012

My Cozmo is finally out of warranty.  If you've never realized how long my blog has been around, I definitely blogged about getting it four years ago.  Honestly, it's been four-and-a-half.  My little Cozmo has been well-loved, but it's time to move on to the next pump. 

This is where I am having a little bit of trouble.  I want a Tandem T-Slim.  I think it looks great, and I love that they still have potential to integrate with Dexcom in the future.  (Dexcom G4 = drool.  Not yet for me, but maybe early 2013?)  A lot of things I read about it and the handful of things I actually know about it just make sense to me.  Is it going to be as fabulously intuitive as an iPhone or a good Android phone?  I'm not sure, but hey, I've been dealing with regular clunky insulin pumps for so long, I just think you can't really get any worse, right?

On the other hand, a Medtronic would also be a practical option for me.  I've had a Medtronic in the past.  Two of them, in fact--my first and second insulin pumps were from Medtronic.  I know they are durable, but I also know they can be sensitive to static shocks.  I know I would have to use proprietary supplies.  I know I would be wasting their technology by using my Dexcom instead of their CGM system.  Yet, I can't shake the fact that I should be considering Medtronic.  They've been in the business a long time.

For practicality's sake, I am limited to a larger-sized reservoir, 300 mL plus, otherwise I'd be refilling my pump every day or every other day.  This makes my options very limited.  I can have a Tandem, a Minimed or an Accu-Chek combo.  I have not had my hands on a Accu-Chek.  I am not sure how I feel about the pump itself.  I personally think it still looks a bit clunky, although I do like the Bluetooth meter-remote concept and the 315 mL reservoir capacity.

Why am I saying all this?  Well, since it's National Diabetes Awareness Month, it seemed like a good time to talk about this and get your feedback.

Do you love your T-Slim, Medtronic or Accu-Chek?  Have you blogged about it somewhere?  I'd love to see some DOC feedback on these pumps so I can work toward a more educated choice for myself.  Post away in the comments, friends!  I want to know what you love and what you don't.

Wordless Wednesday: The Smell of Band-Aids

Ah, that frustrating moment when you realize something is wrong with your pump site. Who knows how much of that bolus actually hit your bloodstream? Sigh.

Purple Pump Pride!

Smiths Medical stopped making my pump, the Cozmo, almost two years ago now.  Scott J lost his job; I lost the manufacturer of my favorite pump by far.  In a year or two, I will most likely be getting rid of my dear, beloved Cozmo for something less satisfactory.  In the meantime, I'm still covered under warranty.

And may I just say that dear Lord, I have needed that warranty several times now!  No offense to you, Smiths Medical, but I think maybe your diabetes business could have fared better if you had chosen better manufacturers for your plastics.  I have suffered at least two, possibly three cracked cartridge caps during my pump's lifespan.  I have had to exchange my pump for a refurbished one at least one other time that I can remember.

This week, I had to exchange my pump yet again for the same reason that I exchanged the previous pump.  The part of the plastic that is under the cartridge cap, basically the threading for the part that secures the insulin reservoir, was cracked.  Having an engineer for a husband, I recognized that this was stress cracking.  (Wikipedia offers a relatively scientific explanation of stress cracking here.)  Stress cracking, for lack of a better description, is basically any crack you see in plastic that isn't caused by a direct blow.  Ever see a crack in a clear-ish piece of plastic or glass that isn't caused by dropping it?  It's the kind of crack that looks like it started on the inside. 

Well, I will tell you, it certainly does not belong in my insulin pump, a life-saving medical device!  If this particular crack went any further, a part of my pump would certainly just fall off.

I called Smiths' customer service line yesterday and talked to a fellow who sounded like he was moments away from taking a nap.  Despite his lack of vocal variety, he was relatively helpful.  He made sure that I would get a replacement pump sent out to me overnight.  He also informed me they were out of blue pumps the same color as mine.  I could choose from "green, a different blue, black that looked like a pager and, uhhh....purple."

Tonight, I go home and program my new purple pancreas.  It doesn't do anything the old one doesn't; it is merely a crack-free version of my current pump.  I can't say I'm terribly excited, but hey, it's purple.

And it beats the pants off of having to switch to the competition's pumps.  I'm not ready for that yet.  I am not ready for the limited choices due to reservoir size and having to take multiple boluses at mealtimes because bolus maximums are too small.

Deltec Cozmo is dead; long live Deltec Cozmo.