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[IP] Re: insulin-pumpers-digest V6 #918

> Sure, and if you manage to get your leg lopped off, will you be
> satisfied if your insurance company sends you to a wood worker to be
> fitted for a peg leg??

Having a wooden leg would cause irritation and problems such as back
problems, etc., that REQUIRES better than just a peg leg.  For the record I
have first-hand experience on that exact scenario. My dad lost his leg about
2 years ago due to an accident that happened about 4 years ago.  The
insurance company would cover a basic leg to met his needs.  He had to pay
the difference to cover a "nicer" leg that was more comfortable as well as
looked more realistic.

> The point is that a pump is a "standard" treatment for diabetes and
> according to ALL the recent studies, control using CSII is better
> than any other method PLUS the quality of life is better.

I certainly agree with you.  But that still doesn't NECESSARILY mean it is
medically necessary. If a person can maintain good control in the sixes
without frequent lows, then the pump is NOT medically necessary.  I have a
friend from my church in that situation.  He takes 3 shots a day and his A1c
is around 6.6 without a lot of lows.  There is little point for him to
switch to the pump other that improved quality of life, and perhaps a slight
improvement in A1c. The pump, for him at this point, is hardly medically
necessary, and would merely be taking advantage of the insurance company to
pay for a better lifestyle.

> AND.... also see that study there that shows better than a 50%
> reduction in overall medical costs for diabetes care for pump users.

Uh...yes.  But that is NOT true for those who already maintain tight control
on MDI.  That is simply looking at the average.  If you compare the average
diabetic on MDI, there is going to be a lot less control, in general,
resulting in more highs and ketoacidosis requiring hospital visits, or
extreme lows, etc.  Obviously, there is less of that on the pump.  Also,
that MDI group, due to having higher A1cs in general, lead to more
complications and ultimate cost.

However, if you compare a person on MDI with tight control to a pumper,
you'll likely find that costs are far less for the person on MDI.  I can
take myself as an example.  I was hovering around 7.1 A1c on MDI, which is
pretty decent.  Over 20 years diabetic without ANY complications and only 1
emergency room visit in my life (and that one ended up not really being
necessary, but more because my parents were afraid to let me have the
"stomach flu" with diabetes at the time) in conjunction with diabetes.  My
7.1 was achieved with 4-5 shots a day and testing BGL 4 times a day.

Now, I have a 6.0-6.5 A1c range, which is improved...but I also have much
greater expense associated not only with the pump itself, but pump supplies
as well as more frequent testing.  (I now test 8 times a day on average.)
It is possible that I could have attained that 6.0-6.5 average on MDI with
JUST increasing my testing and cost less money.  The driving factor for the
pump for me was, however, getting control into the sixes without frequent
lows, which I was having probably 15% of the time.  3 months post-pump my
lows were down to 10% of the time, and now, my lows are hovering around 4%
of the time, though my A1c is probably back up from 6.0 to around 6.5. It is
an added benefit to have a "better lifestyle".  But, "better lifestyle" is
not "medically necessary".

I'm afraid the "50% reduction in overall medical costs" paints a tainted
picture when you don't consider all of the factors involved.  Though, that
is a good argument for the person who has trouble getting good control on
MDI and flexible diabetes management, because for them, in the long-term,
that is likely going to be true.

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