My *original* instructions
While rearranging some clutter, I came across page 2 of my *Insulin Pump
Therapy Criteria* from 1983. I have often said I have been kept in the
guinea-pig stage. Perhaps these instructions will help clear up my reference:
PUMP THERAPY
Patient Education
1. Physician gives patient a list of criteria he/she will have to meet:
a. Be willing to self monitor blood glucose at home and to record data 4-6
times daily until stabilized and then 12 times per week.
b. Understand potential hazards of insulin pump therapy:
b.1. hyperglycemia, ketosis secondary to pump failure, infection,
illness.
b.2. hypoglycemia - especially at night.
b.3. local infection at site of needle insertion.
c. Be willing to visit physician from once a week to once a month until
stabilized.
d. Understand to contact physician immediately in case of emergencies
(glucose <60 or >240).
e. Have someone in the family who understands how to manage diabaetic
emergencies.
f. Be willing to wear pump 24 hours a day and be willing to live with its
limitations (contact sports, changing sites of 48-72 degrees).
g. Be able to manage pump costs, maintenance, follow-up.
2. Patient given selected literature to read.
3. If patieent meets criteria and decides to pursue the pump therapy, the
physician refers him/her to the diabetic educator.
4. The diabetic educator conducts 4 sessions with the patient and, if
possible, a family member or significant other.
a. Counseling regarding pros and cons of the pump, benefits, limitations,
risks, expenses and instruction in glucose self-monitoring. Instruct patient
to obtain proof of insurance.
b. Review of diabetic management and dietary evaluation.
b.1. Evaluation of glucose record.
b.2. Visit with the Business Office re: Insurance.
=======
Back then there were no Certified Diabetes Educators. My D.E. was one of the
first group to become Certified - then her church decided she should transfer
to a retirement home for nuns and be their director. What a waste of talent -
in MY humble opinion. This was back when most of us cut our BG strips in 1/2s
or 1/3s to cut costs and compare the results to a color strip on the side of
the container. I suppose the *12 per week* is why my endo slightly shook his
head negatively a month ago when I asked for 6-8 a day. He did it, but I could
detect his feelings it was not necessary.
One a.m. I had a BG reading over 600 and caled him. He returned my call at
5:00 p.m. I asked why it took so long. 1) The message was put on the pile
until he went through it. 2) "If you don’t know what to do, I don’t know what
to do."
I am seriously considering finding a new internist (don’t like the other endo
in town) who deals with pumps and DM. What questions and/or features should I
inquire about when choosing one of 10 whom my ins. covers? (~_^)
December 28th, 2006 at 12:59 am
<<
I am seriously considering finding a new internist (don’t like the other endo
in town) who deals with pumps and DM. What questions and/or features should I
inquire about when choosing one of 10 whom my ins. covers? (~_^)
>>
Hi Jan:
Couple of things I thought about when looking for my endo:
Is he board certified in endocrinology?
Has he/she published in any of the endocrine journals?
Are they familiar and encourage use of pumps.
Does he have an education team: CDE/RN and CDE Nutritionist?
What pumps is he familiar with?
Does he have an active relationship with the pump reps? or lean toward only
one brand.
What does his first 2 visits consist of? Full physical and medical
assessment including: full blood work, A1C, urine for microalbumin; 24 hr
urine collection.
Just of few thoughts….Joan:)
December 29th, 2006 at 3:41 pm
Jan, The most important thing to me is….Will he/she LISTEN to me when I
ask questions or ask for advise. A lot of ‘em seem more interested in
getting on to the next patient. This is unfortunate.
fp
December 30th, 2006 at 9:52 am
My nephrologist does the monthly & quarterly labs on the above so I would balk
at this. That would probably immediately label me as *noncompliant*. My file
is the size of an unabridged dictionary. <VBG>
January 28th, 2007 at 7:06 am
Jan,
In that case I would suggest you check with both the front office and
nursing staff re: the doc’s attitude in consulting with other docs.
Will your nephrologist forward all test results to the new doc? Is
that acceptable (some endos get fussy about where tests are done)?
Who will make the ultimate medication/treatment decision in case of a
difference of opinion? Also check with your nephrologist and see if
he/she recommends any of the endos on the list over any of the
others. It sounds like a good working relationship with your
nephrologist is a true requirement here.
Also, quiz the nursing staff about their pump knowledge/experience.
Sometimes this is more important than the doctor’s knowledge. If the
doc knows his/her stuff and is truly current and professional he/she
will have nursing staff that are informed and understand the ‘lingo’
and special circumstances that come up with pumping. Also if the dr
is unavailable what are the back-ups? His/her nursing staff?
Another doctor in the practice? Are they sufficiently knowledgable?
If the nursing staff is uncomfortable or hesitant discussing pumps,
then I would be hesitant to choose that doctor. Either he/she
doesn’t do much with pumps, or the support staff is not sufficiently
trained for that office. (I’ve learned this the hard way!)
February 6th, 2007 at 8:12 am
Suzanna wrote:
Dunno - but endo complains he gets too much info about me from neph.
> Who will make the ultimate medication/treatment decision in case of a
> difference of opinion?
Right now neph makes the final decision about meds - my choice. Endo kind of
leaves all my care up to me. If he Rx’s an anti-biotic I check w/neph and it’s
usually nixed due to kidneys and something else Rx’d. Endo doesn’t ask about
my reg. medication routine, hasn’t asked to see a BG log in ever so long. I
insist they print off my Accu-Chek Complete and the nurse does only 2 weeks
worth! He asked me why I jump around all over the place (laying blame on ME).
I said cuz I haven’t been taught my carb/insulin ratio. He changed subjects.
There is only one other and I don’t care for him. There are 10 internists and
some are issuing pumps. A local CDE told me yesterday she’s getting so bogged
down with pump patients she may have to call any more off. There’s another CDE
with another hospital (who works w/my endo) whom I met once with someone else
and she advised the newbie to cut her basal in half if she tested under 30 for
a half hour. I say we don’t always have the puttogethers to figure that out
when that low. She said the newbie wouldn’t have any *background* insulin if
she cut it off. I said she’d get only 0.2u in the half hour since she runs
0.6u hr. and cutting it in half would be 0.3 and that would mean 0.1 straight
up and 0.1 20 min. later. The CDE argued that the MiniMed pump delivers every
3 minutes. NOT!!!! Don’t think I’d get along with her if I had a CDE.
> It sounds like a good working relationship with your
> nephrologist is a true requirement here.
It seems to be that way now.
> Also, quiz the nursing staff about their pump knowledge/experience.
That could get tricky since even lay people think they *know everything about
DM* cuz their great aunt Myrtle had it and both legs were cut off then she
died. She ate a candy bar once and that’s what did her in. Now, try
questioning a nurse/staff about their knowledge and woohoo! Trouble in DM city
fer shur.
> Sometimes this is more important than the doctor’s knowledge.
I agree. One a.m. (several years ago but same staff) I was over 600 and awful
(not ever told to check ketones - learned that from the ‘net 2 yrs. ago) and
called. I didn’t get a return call until 5:00 p.m. I asked what took so long.
He said if I didn’t know what to do he didn’t know what to do. (Argghhhh!)
I agree - mine only cares about the A1c and the BG at the moment of visit. I
was congratulated for an 8.2 once. That was down from 11-12 but I still should
have been worked with for a more normal control. After 18 yrs. (next mo) I
finally got into the low 6’s and I attribute that to the 17 or so things I
have learned about pumping from the ‘net in the last 2 years! 15 years ago
endo had about 2 dozen pumpers. Now he has about 24. That’s *progress.* (~_^)
February 8th, 2007 at 1:47 pm
<< 15 years ago
endo had about 2 dozen pumpers. Now he has about 24. That’s *progress.* (~_^
>>
If he treats all his patients like he does you I feel sorry for all of them.
He sounds like an idiot. Sorry but geeze….Sounds like your paying him for
nothing. What a jerk. Sorry it just makes me mad that a doctor can have the
attitude he has. Sounds like he doesnt know what hes doing regarding DM.
This is an endo right? Where did he graduate from school of loosers!!!
Sorry Jan Im just mad. How can he be so inept? You mean there is only one
other endo where you live? Are you in a small town or something? Chrissy