Insulin Pumps and how do you get one?

graflynn

Hello,
I'm on a waiting list for an insulin pump and have just discovered that I may be able to jump the queue because I'm a private patient. I want to know how difficult this might be? Does the Long Term Illness book cover all the pump supplies? Why are some doctors not eager to supply the pump? Which is the better company to go with, Medtronic or Animas?

Thanks.

philten

Hi ,

On being private patient - cannot answer this I 'm afraid. I am using Medtronic for last 4/5 yrs. I attend the mater and asked about it and got one. They were putting 2 peolpe a month on one at the time.

Does the Long Term Illness book cover all the pump supplies?

Yes - not sure about batteries though, some pharmacists have given me them on the book, others not.Although Medtronic Paradigm pump uses AAA batteries which are not that pricey.

Why are some doctors not eager to supply the pump?

Cannot really comment on this one i'm afraid. Probably depends on their experience/expertise with it and the support around it in the clinic from nurses/dieticians etc. The nurses are more knowledgeable about the ins and out of the pump in my experience!

Which is the better company to go with, Medtronic or Animas?

I have always been on Medtronic (508 initially) and now Paradigm which I find great, very user friendly and crowd in Kildare (Accuscience) look after them if anything goes wrong. replaced my old 508 on one occasion and found them very helpful.

hope some of that is useful
Phil

graflynn

Thanks Phil.
I used to attend the Mater between 1993 and 2002, before I went abroad. My endo wants the Mater to manage me with the pump and then see her the rest of the year, so I could end up there again. It wouldn't be so bad - they seem to have come a long way since 2002. The travelling to Dublin would be a royal pain though!

Grainne.

philten

No problem. Hopefully the wait is not too long for the pump. It gives you a new lease of life imo. I find the Mater pretty good - you would attend the Diabetes Center which is nicer than having to go to the outpatients clinics within the hospital (not sure if they still have those). The nurses and dieticians etc. are great. Not so happy with consultant tho. I am thinking of moving from there to Tallaght or St Vincents to get a better consultant.

Phil

graflynn

And so my quest for the pump continues....

Before I go into my "woes", I would just like to point out that my endo suggested the pump to me in the first place, so my quest is not purely self driven.

I see my endo privately but she doesn't have the facilities to do pump therapy and she had referred me to the Mater in October 2008. Meanwhile, a friend of mine, who sees her endo privately, got a pump almost overnight. With this knowledge I got some information from a medtronic rep about getting the pump through my endo and then she could set me up with the mater for annual review once I had received the training from Medtronic. This way I could fast track the way.

My endo wasn't comfortable with this either. However, she said she wouldn't be offended if I wanted to attend my friend's endo if the pump was what I really wanted. So she referred me.

Within two weeks I'm seeing another doctor who is not to my liking at all and is not even going to suggest the pump for me because the day I attended I had forgotten to take my morning insulin and had BG readings in the 20's until after lunch (this was when I figured out what had happened).

Without any hesitation or discussion with me, she increases my long acting by EIGHT units :eek: and splits the dose, AND, wants me to call her every day for the next couple of days. I think she assumes she's dealing with someone who hasn't got a clue :mad:

I left my appointment feeling abandoned, distressed, and unheard. I'm giving her a week (because I'm a nice person and I still want the pump!) and then I'm calling my previous endo to take me back.

I am the one who needs to feel enabled and incontrol and no-one is going to push me around. I expect to have discussions about my management not orders.

PS I did increase my long acting but not by how much she wanted me too. I'd rather have a few highs for a couple of days then lots of hypos

katiemaloe

Wow thats mad increasing your long acting by 8 units because of a high! Obviously you were just high cos you forgot your morning shot. There are lots of pros and cons to the pump. You do have to test lots and have the thing hanging off you all the time- which can be hard going at times! But its dead handy for corrections and snacking. And eating sweeties!
I had the pump for the last 3 years so well used to its ups and downs. Took it off a while ago cos needed a break. Might go back to it in time but loving the break at the mo!

Beaumont is a great clinic if thats any help

LegacyUser

Hey Gráinne.

Im actually going to the Mater tomorrow for an appointment in the hope of going on the waiting list for a pump. I see my doctor for my check ups privately too. Initially when I asked her about a pump she said she would be happy to refer me to the Mater for one and to manage my Diabetes still if I were to be placed on a pump. I asked her about going private to get one. She said going private would mean that I'd get my inital consultation faster but not be able to skip waiting, what seems to be anything from 6 months to 18, to get a pump. - if all goes well tomorrow that is!

Your post about getting a pump privately caught my ere!! I've asked around about this. Apparently it is possible to get a pump privately, as in pay the €6000 or what ever it is for the inital pump, but its not encouraged. If you can get it from your Health Board, why pay??! Personally I'd pay it in the morning if I could as itd be worth it to try, n I'd be afraid that if I were to wait a year to get one I'd lose my enthuasim for one! Although I dont think thats likely as there seems to be alot of positive feedback about them. And I see a pump as a part of me that would be just working for me on the outside!! But anyhow, I know someone who paid for their pump privately. Their parents had a massive fight with the doctor - the doctor was apparently very snobby, their attitude was 'Can you afford it?', and my friends parents were very insulted (he's a bank manager, but thats neither here nor there). But anyhow she got a pump.

Sorry I tend to ramble, point was, Ive an appointment tomorrow, was on doing some more homework for tomorrow, but I'll write again to let you know what the craic is!!

P

Soapy Joe

Hi I am a pharmacist and have a good bit of knowledge of insulin pumps - both professionally and as a member of mt family uses one.

Before discussing pumps I think it is important to talk about life with diabetes. You all ahve experience of this - so apologies as I am only talking about what I have observed - but in short - life with diabetes takes a considerable amount of effort - on a daily basis. As such, yo have good days and bad days, you have days that run smoothly and days when everything piles on top of you. You have days that are especially stressful and days that you just feel like pigging out. In other words you have a full and active life just like everyone else. So why we as health care professionals should expect you to use a fixed regimen of insulin every day is beyond me - and I always stress this when given the opportunity. As pointed out above it is also possible that you might forget to take insulin all together.

What flexible insulin regimes have given is flexibility - but to be felxible you must be willing to test, test and test - and correct. This is where pumps come in - they allow a greater degree of flexibilty. But the asumption here is again that you test often. This is a pain in more ways than one. In addition it has to be said that the pump is only as good as the user. By that I mean that a well clued in and motivated person can achieve good results with them - I have seen it. But it has to be said that that same person has a normal life so there will be times when they are less motovated - and as such the pump will be less useful. They can also forget to put the pump on - and they you have no insulin (yes I have seen this also - perhaps after showering and in a hurry!).

All that said, I am in favour of pumps - so long as you realise that unfortunately you still have to be motivated and take one day at a time. They offer flexibility.

As regards what type? Well, I would look at what one suits you - you will be the one using it - not what one the Diabetes Clinic are familiar with. I am more familiar with Medtronic and they promote the idea that at some stage they will be able to have a glucose monitor inserted as well. But as far as I can see that is still some way off (at present the probes they have are large, sore and need to be changed too often).

As regards getting it paid for. The LTI book covers all supplies apart from batteries. The pump can be paid for but this is where it is unfair - it depends on your own consultant. And also what area you are from. Get a consultant that is willing to and it will be paid bythe hospital. Remember that if you are motivated and can demonstrate that then you will be argue that a pump will improve your health - and save the hospital money in the long term.

graflynn

Thank you Soapy Joe for the information on getting the pump. The post before you kind of shocked me. I would also recommend that anyone considering the pump do the research. Find people who already use it - believe me there are quite a few out there, and read as much info as possible about how they work. All the diabetes organisations (eg ADA, DFI, Diabetes UK) are covering pumps at the moment. They are becoming popular.

I've had 7 years since it was first suggested to me (yeah I'm a fast mover:-)

So if you're a public patient the wait is endless (i.e. could be a couple of years), not all the clinics do pump therapy, so you will need to ask around. But it's free.

If you're a private patient, you have to find a consultant who provides pump therapy, you may or may not have to pay, and with the current HSE cutbacks you will probably have a bit of a wait too.

Soapy Joe

Sort of the lay of the land. The secret is getting a consultant who is in favour. Then it will be funded - it is a bit unfair really.

There is a GP - Tony O'Sullivan who used to be chairman of the Irish Diabetes Federation. Sorry but I am not sure where his practice is. He also uses a pump himself. Anyway, he may be able to advise you which consultants are most supportive.

graflynn

Another update on my quest for the pump.

So, my control has improved in the last 6 months - latest HbA1c is 6.9 (:D). It hasn't been less than 7 in about 2 years, so I'm happy about that. So! When I asked about the pump this time my consultant said "certainly, now that my control is better" I would have thought that the pump would be offered to people who were in trouble with their control.

Anyway, she is putting in the request for an Animas pump and we shall see. I'm not going to get excited until she rings me and says it's there.

graflynn

This is where I'm at in my quest for the insulin pump as of today.

About a month ago the long term illness section phoned me to tell me that I had been approved and that they needed my LTI book so that they could update it. I brought the book in, the lady wrote "insulin pump" on the list, returned the book and gave me a copy of the approval letter. I then asked her what was the next step. WAIT FOR IT!!! She said "oh, you probably bring your book to the chemist and get it there?" LOL for a very long time.

Needless to say, I smiled politely and walked away. Then I rang my consultant's office to see if they needed me to do anything to move the process to the next step and the secretary didn't seem to know what the procedure was.

I'm not a person who believes that other people have my best interest at heart and so I always ask "what's next?" and when I get hesitant answers I take it as my cue to follow up on it.

So 3 days ago, I finally got off my behind and copied my approval letter and my LTI book and sent them to my consultant in the hope that she opens her own post.

Then, by coincidence, the pump people called me yesterday saying that while they didn't have official approval of the funding yet, she was willing to be positive and move things along. I could actually help her do this by emailing my documents.

Today, I have decided on my pump being lime green and hopefully next week I shall be talking to the pump people again to arrange her visit to set me up.

Wahoo!

PS I have learned a lot about pumps and aquiring one in the last 12 months.

eilo1

graflynn wrote: »

This is where I'm at in my quest for the insulin pump as of today.

About a month ago the long term illness section phoned me to tell me that I had been approved and that they needed my LTI book so that they could update it. I brought the book in, the lady wrote "insulin pump" on the list, returned the book and gave me a copy of the approval letter. I then asked her what was the next step. WAIT FOR IT!!! She said "oh, you probably bring your book to the chemist and get it there?" LOL for a very long time.

Needless to say, I smiled politely and walked away. Then I rang my consultant's office to see if they needed me to do anything to move the process to the next step and the secretary didn't seem to know what the procedure was.

I'm not a person who believes that other people have my best interest at heart and so I always ask "what's next?" and when I get hesitant answers I take it as my cue to follow up on it.

So 3 days ago, I finally got off my behind and copied my approval letter and my LTI book and sent them to my consultant in the hope that she opens her own post.

Then, by coincidence, the pump people called me yesterday saying that while they didn't have official approval of the funding yet, she was willing to be positive and move things along. I could actually help her do this by emailing my documents.

Today, I have decided on my pump being lime green and hopefully next week I shall be talking to the pump people again to arrange her visit to set me up.

Wahoo!

PS I have learned a lot about pumps and aquiring one in the last 12 months.

Hi Graflynn,
I am awaiting an insulin pump for the last 6 months and everytime I call about it i keep being told I am on the list and it should be shorty although, my nurse told me that with the cut back they are only approving one pump every cycle (i assume this means every 3 months but i dont really know)

Its all a bit of a nightmare really because Im very active and have highs when I exercise. So my HBA1c has been over 8 for the last 3 years and I really worry about it. I also have highs in the morning, so this is why the pump is recommended for me.

Any ways congratulations on getting your pump and please let us know how you get on with it!!!!

robinph

I think I'm going to se if I can get myself on the list for one at my next trip to see them, but looks like it will be a long wait.

douglashyde

I was approved for an insulin pump and last week I got a call saying it had arrived.

BUT it was not the pump that my endo or I had requested.

My community care centre sent in a roche combo pump instead of a medtronic pump. Why? For the sake of a few hundred euro.

I am livid! There are various reasons as to why I wanted the medtronic pump and I think I am now going to have to turn the pump down now.

It is ridiculious that the Community care team would not take my endo advice and give me the right pump.

douglashyde

Could someone explain how private health care works with Diabeties?

eilo1

I got a call today to say my pump is in, I have to go in on the 29th to have it fitted! woop woop !
I have ordered the medtronic one so hopefully that is the one that is waiting for me

graflynn

Don't be too quick to turn down the Roche Combo! If you really want a pump just try it out. I tried to find out more about the combo but the Roche website doesn't offer much.

I'm really trying to say that a pump's warranty only lasts a couple of years probably 3-5 and then the manufacturers will recommend updating it. So at that point if you still really want the Medtronic then you can make a case to your community care team. Who knows you might even be looking for the Omnipod by them?

As an aside note; my endo recommended the Animas over Medtronic because their techical support was better and I have since heard worldwide stories about Medtronic not being very good at their customer support.

graflynn

douglashyde wrote: »

Could someone explain how private health care works with Diabeties?

Hi Douglashyde,

Private health care with diabetes means you get refered by your GP, you can request a specific endo. You get a scheduled appointment and they usually run on time but sometimes not and they cost anywhere from E70 upwards.

You also have to arrange all of the other health checks separately, for example, the eye appointment, podiatrist appointment, dietician, etc.

With the public system you are referred to a clinic, depending on where you live. The services and quality of care from the clinic varies from clinic to clinic (as with the Endo). Some clinics offer appointments to the other health checks at the same time as your diabetes appointment. By this I mean that back in the late 90's the mater used to have the optician appointments run on the same day in the same part of the hospital and you were queueing for both at the same time.

I hope this helps.

douglashyde

Thanks for the reply:

On the Pump

If I use the Roche Pump even once then it can't be used by anyone else - And I'll never get approved for another pump. My choice of Medtronic pump was based mainly on its CGM ability, which I would be willing to self-fund , However it seems to me that the Medtronic pump also has better functionality as well.

My Endo had requested the Roche pump from the community support crowd - however it would seem they know better. I’ve been fuming for the last week.

The decision is purely money based and even at that the price difference is only a few hundred euro; one of the options I am going to explore is paying the price difference myself.

In the perfect world I would consider buying the omnipod; however because the way things are unfolding I may have to self fund the entire pump system myself and may actually end up getting the Omnipod, not a cheap option considering Private health insurance won't cover it.


On Private health for Diabetics

I feel that my doctor and dietician are the only people that are able to offer me useful advice; after all I've had Diabetes for 10 years now. I also don't enjoy waiting in the Clinic. I have private health insurance and feel it would be worth while.

Does the private Doctor have the ability to do a1c tests?

eilo1

just curious why is the omnipod the best pump?

(and yes your private dr will do the HBa1c but i have no idea what it would cost, I have private health insurance but I dont think it is very helpful with diabetes)

douglashyde

eilo1 wrote: »

just curious why is the omnipod the best pump?

(and yes your private dr will do the HBa1c but i have no idea what it would cost, I have private health insurance but I dont think it is very helpful with diabetes)

Because it offers remote connection, it is tubeless and it has the ability to function with CGM.

It would cost to see your Endo privately? but then you would not be on a waiting list for 4-6 months.

eilo1

That sounds good but you can get a remote for the minimed and the cgm.

Just thinking about your pump situation has your endo/nurse contacted the hse and disputed the pump, surely there is away around being stuck with one you didn't order???
You could try writing letters etc. Ill let you know which one they give me in the hospital next Thursday. (although Im pretty sure they would have mentioned if it wasn't the one I wanted)

You could even threaten to take a case of discrimination if I get the medtronic and you dont??? (lots of hassle I know but a well worded letter can be very affective)

eilo1

speak of the devil
I just got a call from my nurse and I asked her about it, they have the medtronic one for me its the paradigm VEO minimed.
sorry mate, if i was you I would definitely contest it.

douglashyde

Thank for all the info elio, it's been a good help.

I've talked to the Medtronic district manager about it; however they can’t really help because of their position in all of this.

I'm thinking of writing to my county councillor, doctor etc.. I'm going to ring my diabetic team tomorrow to discuss.

Congratulations on getting the Medtronic Veo, it really is a good pump! If you go onto their website - you can order stuff of them, here is a list of gear you can get: http://www.medtronic-diabetes-me.com/accessories.html

If you want to order, go onto the irish medtronic site and there is a number you can call and order from.

Are you hoping on using the CGM?

eilo1

The accessories look great I definitely want the remote, I don't want to be going back to the good old days of hiding in toilets to take insulin!

Yep the only reason I want the pump at all is because I get high sugars from running and horse riding, basically with any prolonged or dynamic exercise I get a false high for up to 6 hours and then crash. So I really wanted the continues blood glucose monitor to help me figure out what is happening during exercise. I probably need more insulin when I start exercise and then less after the first hour but its very daunting trying to figure this out by trial and error.
I also wake up high every morning so the blood glucose meter should help me figure out what is going on and then I can adjust the pump to fix it. (well this is what Im hoping for)

My nurse has told me that I cant get a full prescription for the CGM sensors (arrantly they cost €45 each) but that she can give me a few every year, so hopefully one every 8 weeks or so to keep things in check.

douglashyde

Just an update for those who care:

I've tried ringing the past two days, once every two hours. That is 8 calls in two days..... phone just rings out....

I wish they had private diabetic healthcare in Ireland!!!!

eilo1

thats horrible just keep trying, are you calling your team or the hse? your nurse and endo should really be fighting your corner here.

keep us posted

douglashyde

eilo1 wrote: »

thats horrible just keep trying, are you calling your team or the hse? your nurse and endo should really be fighting your corner here.

keep us posted

Will do , appreciate the support too.

I'm calling my care team; in all fairness, I don’t know what their stance is going to be on the whole deal.

graflynn

douglashyde wrote: »

Just an update for those who care:

I've tried ringing the past two days, once every two hours. That is 8 calls in two days..... phone just rings out....

I wish they had private diabetic healthcare in Ireland!!!!

Are the HSE still on "work to rule", this might be why they are not picking up?

douglashyde

graflynn wrote: »

Are the HSE still on "work to rule", this might be why they are not picking up?

I thought that might be the case, however because this is the Diabetic day care centre and could effectively be something very serious; I wouldn't have imagined that this strike would effect them.

However it looks like it is!