How does an endocrinologist make the descision that a pump in needed?

ive been type one diabetic for about 5 yrs now. my a1c's have been really bad for as long as i can remember my docotor keeps uppin my insulin but it doesnt seem to be working. ive heard that one of the qulifications of the pump is for ppl who have uncontrollable blood sugars im due to see an endocrinolgist this month and im very interested in going on the pump in hopes i can gain some control of my sugars but i was wondering if there were any other things endocrinologists look in to before making sure im would be a good canidate for the pump??

Before agreeing to the pump, most endos make sure you know what you're doing. Getting control with needles can be a lot of work, but it is definitely possible. If you aren't carb counting correctly, aren't testing often enough, etc etc, they likely won't agree to the pump until you've shown your doing what you need to do and know how to.

On the other hand, a lot of endo's are into putting people on the pump because they don't like the current technology level. My endo is like that, he wants to see it be able to deal with my insulin levels on it's own like a real pancreas (so like the artificial pancreas).

The pump isn't a "magical" device that will suddenly make your levels better. It takes a lot more work than needles (imho) and you need to know what you're doing first. For some people it just doesn't work but for the people it does, it's a great tool...but it's just that, a tool.

I went on the pump after 16years of needles and discovered it wasn't for me, because it actually made my control worse. I may not have a "perfect" a1c level, but it's stable and we're working on bringing it down. the hourly basal rate system with the pump was really hard for me, because we couldn't pin down numbers that would work even 2days in a row without sending me super low and then spiking up. I had to pretty much fight my endo just to try it for 3months and then ended up going back begging to be back on shots.

hi Stephanie,

I'm in Canada, so thinkgs might be a little different here, but....  first of all, I want you to know that although a pump does help with control, you still have to work at it!  Also, A1Cs can be deceiving:  even a great A1C result doesn't necessarily mean good control.  Remember that the number is an "average" only, so if half of the time you are high, and the other half of the time you are low, then sure, your A1C is going to be good, but it doesn't mean you are in good control.

So first things first, you have to bring it up to your endocrinologist.  Depending on the insurance of whatever other funding you have, you may be able to try the pump, then if you don't get the desired results, go back to MDI, as some people have done.  Again, the pump is not a magic wand solution!

As far as your current results and your doc's idea of increasing your insulin all the time, I have a suggestion:  if you're not already doing it test a lot, and I mean A LOT!!!  It's the only way that you'll really see the patterns that your BG follows and understand how the insulin reacts with the different foods that you're eating.  Also, along the same lines, keep detailed records of what and how much you're eating, as well as activity, emotions, etc.  It sounds to me like your endo wants to figure out why your numbers are wacky before trying something completely different.

To end this reply, I just want to mention that I am by no means a medical professional!  Everything I wrote is simply from observation and experience!  Best of luck!

Haha!  I think I just echoed everything that Batts said!  We were apparently typing at the same time, but she hit the Post button first!  You win, Batts!  :)

thank you for the feed back im deff taking what was said in to concideration im meeting with my endocrinologist next month so ill be sure to keep everyone posted

[quote user="Nads"]

Haha!  I think I just echoed everything that Batts said!  We were apparently typing at the same time, but she hit the Post button first!  You win, Batts!  :)


I love #winning! haha ;) It's always good to have someone back up what you're saying!

And you added the part about the A1C I forgot to mention!

I had mine go down to 7/5 (normally between 8.2-8.5) BUT it was because I was dropping below 3 at least 3 times a week, sometimes 3times a DAY! and then I would spike up as high as 23 after correcting. I had a low blood sugar the morning I went to see my endo to get rid of the pump, then had another low in his OFFICE while talking about the pump and then went home, had a 2hour nap and woke up low! My A1C was better, but it's not the number you want to be focusing on. If you're bouncing all over the place, you can still get an a1c of 6.5 but you're not actually in control. I never focus on only my A1C when I judge how in control I am.

I think Batts and Nads made really great points. Some endos will not allow patients to start on a pump until they have a certain A1C or have demonstrated some really strong work on trying to bring an A1C down with shots. One big thing for pumping is that you will test at least as much, if not more with the pump than you are with shots. We test my son 7-10 times a day.  

The main thing our clinic - which is very pro-pump - makes all patients who are considering the pump is take several classes and do some 'homework' before they will send in the pump prescription. None of this was difficult, it was a few classes (that were just an hour long and free) and submitting a weeks worth of BG logs, carb counts and insulin doses, and some questionaires. Logging is just as critical with pumping if not more so to be able to attain good control. (The pumps do make it a little easier, because you can download them, but you actually have to DO that too.)

I would start now on testing more often - like 6-8 times per day and logging everything. (include some middle of the night checks) This kind of pre-committment may make a difference in your endo's decision and even if it doesn't, it cannot hurt as it should allow you to gain some better control with your current MDI plan (maybe with some adjustments.) Good luck!

Call the Pump manufacture they will set you up with a doc they work with I fought for years with my endo and finally went to the pump companies within 3 months had a nice new shiny pump