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Subject: Re: [IP] Arguments for the pump

>Michael said:

>>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.>>

>Ryan responded:

>If a person can maintain good control in the sixes without frequent lows, then the pump is NOT medically necessary>


Michael spoke of the pump as "standard treatment" and not specifically as "medically necessary", although both may be true. 
One problem with using A1C's as an indicator of how well a person is maintaining BG control, as I am sure you know, is that you can have an excellent A1C simply b/c you are dipping into the 20's every day. This is what my daughter did pre-pump, and had totally lost her awareness of the hypo's. However, when she went on the pump, she had a much more even control, and her A1C's actually went up. This was also complicated by adolescent growth surges, but that aside, I was much more comfortable when she regained her awareness of the lows, and was able to respond to them quickly, before she landed up in the ER, or worse.

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

Many times, sooner or later, everyone will come to a point where they have difficulty maintaing good control, to one extent or the other. Life happens. When you add in all the possible complications from short and long term highs and lows...including possible cognition effects and its impact on one's future.

>Ryan said:

>> Next, is improving quality of life medically necessary?>

Who is to say that improving the quality of life not medically necessary? How many people with chronic conditions get tired of doing it all, develop depression, etc. Maybe a pump will allow them a more positive outlook, to set goals, to see a better future. If so, how much have we saved by having that one person, lead a more fulfilled and productive life?
 I don't know that I can put a price tag on that for anyone, nor do I think that it is my decision to make for that person. Or an insurance company for that matter?

Joann, Mom to Cara, age 17,
Now jumping off Michael's soapbox too :-)
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