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Subject: Re: [IP] purchasing pumps

Title: Subject: Re: [IP] purchasing pumps

It has been my experience that very few Endo practices have good experience and knowledge with pumps. The Endo's that treat DM's, usually refer pump questions and problems to the CDE attached to they're office. I think Endo's do not start alot of DM's with rollercoaster BG's on the pump because pump start-up can be tricky to estimate. The start-up Basal's & Bolus's could be hard to calculate if they see no common pattern. Perhaps that do not want to be held responsible, as bottoming out with low BG's, or spilling keytones with high BG's can come quickly. Although I received my pump script from my Internist (still in search for a good pump Endo), my daughter's Endo made my wife and I sign a consent form which releases them of liability (the MM pump trainer had me do the same) They tend to want to start with "good" candidates that they will not have to pull they're hair out over. It's a catch-22 situation, as insurance companies won't pay unless you cannot control the DM with conventional treatment, but Endo teams won't put you on it if you can't control your DM with conventional treatment. It's unfair to the many diabetics that could be living a better controlled life, if they could obtain a pump, and receive the proper care from an Endo to fine tune it to the specific patients requirements. I think it shouldn't be up to the decision of the Endo to grant, or refuse such care, unless the patient is non-compliant, which would make them a more possible candidate for emergency treatment than those on injections with a background supply of insulin. If you sign the waiver, it should be totally your responsibility. When we were Dx'd and were told we needed to take injections, they didn't waiver about giving us a scrip for a box of needles. I'm not sure if it is because pumps are so expensive, the insurance co's try to discourage doc's from referring patients, or Doc's are too lazy or to ashamed to admit they don't know enough about pumps to make a referral. If your going to mis-treat yourself, you could do so either way. Let us decide.

Date: Sun, 30 Jul 2000 21:21:08 -0400 (EDT)
From: Lynn Nurczyk <email @ redacted>
Subject: Re: [IP] purchasing pumps

I don't know about the woman who began this thread, but with my HMO, and
endo had to precribe the pump.  This was a real problem for me because we
had only 1 endo and when my dr. left, this one wasn't accepting any new
patients.  So I worked with my family physician, but he was at a loss to
figure out what to do next.  So he referred me to a CDE who suggested the
pump and then referred me to the endo.  I saw him a total of five times.
His attitude was that since my diabetes was not in control, I was wasting
his time.  And he refused to prescribe the pump as well.  He told me to go
home and keep testing, and when I could show him better numbers, he would
consider it.

That was over a year ago, and when my highs and lows became more severe, I
went back to the CDE, hoping to get some more advice.  She told me that
since the dr.'s time was so limited, if I met with her, the dietician and
the other CDE, they would sign off that I was ready for the pump, and then
the dr. would write a scrip.

Some systems make it as difficult as possible to "grant" diabetics good
medical care.