I have had T1D for 40+ years!! Always been on pens and before that, yikes glass syringes!!! I have deferred on using a pump, my control is OK, could be way better. Am considering a Dexcom CGM only, would love some info on cost, usage, and general coverage especially with Medicare as that is only a few years away! anything else that may help me decide?
Hi Helen @Kiwigirl,
first off, congratulations on living 40+ years with diabetes and surviving those glass syringes to which you attached “horse-needles” to mess up your dermis and leave scars. The glass syringe that I used for years before U-100 was invented had n orange color U-40 scale on one surface for Regular Insulin and a green U-80 scale on another for NPH; yeah, I learned arithmetic quickly so as to properly dose with only one spike-stick.
Now for your questions on Pump and CGM: the CGM is a great tool for seeing your patterns at a glance and for calculating and administering micro-bolus corrections and for suggesting that you eat something - two hours ago I just had an interesting discussion about CGM with the endocrinologist. The BIG reason for me to wear one is the auto-alert when I’m headed toward hypoglycemia and also when coupled with the proper pump to suspend of modify basal insulin flow. The doctor is suggesting that as soon as Medicare allows me to replace my out-of-warranty pump that I move to a pump with auto-suspend.
As for a pump, I can see now that delayed too long before switching from pen to pump now that I’ve been pumping for 15 years. Reasons in favor of a pump:
A. Flexibility. Using a 24 hour long-acting basal insulin almost demands that meals follow a particular time table. The pump allows great flexibility in real life schedule - such as when I was business executive I could get caught on long meetings without worry.
B. Better Management. Over the course of a day, basal insulin needs vary - think about the BGL spike when you awaken and get out of bed in the morning. I use nine basal rates over the course of a day - I’ve got them “tuned” so that, baring an unusual event" I can live a normal life for more than twelve hours without eating or administering a bolus for correction. My pump allows me to have three programs from which to select depending on levels of anticipated activity - such as spending a day cycling.
C. Body Preservation. Preserving a shrinking amount of body space that will still allow absorption of insulin. According to my charts for the year before I began pumpling I poked myself with a needle more than 1,488 times; with a pump, I change the infusion only once every three days. Heaven, or close to it.
This is just my three primary reasons for recommending a pump; there are more.
Thank you Dennis, thank goodness for all the new medicines, however I must admit that I do not go to any support groups or keep up with all this new stuff, my fault entirely and ignorance on my part. I think I’m more scared that I won’t be able to handle it carefully. Does one need to have the pump as well as the CGM? If you have both do you also need separate sites for the inserts? Approximately how much does it cost monthly compared to pen needles (which are also getting more expensive every day) The closer I get to retirement the more I worry about these kind of costs and the thought of getting all this arranged and then find out I can’t afford it!! Yikes!! :o What kind of pump are u using? You are very well informed, are there some other sites I might try to inform myself as well?? I’m guessing starting out with a CGM would be a good start 
How does Medicare fare in treating diabetes?
Hi Helen @Kiwigirl .
I have made it a vocation for many years to study all aspects of diabetes but it has only been in recent years that I’ve been involved in support groups. I was fortunate enough a little over 50 years ago to be put [forced?] into the hands of some awesome doctors researching, teaching and providing care for persons with diabetes - The Joslin Clinic which had been in operation well before the discovery of insulin. While receiving care there, I volunteered [my body] for several research projects the most frightening of which when I volunteered in 1966 to let a doctor shoot a modified weapons grade ruby laser beam in my eye to arrest retinopathy - also my most fortunate privilege because I still have eyes that work quite well.
Certainly you may use either CGM or pump independently - it is not a both or none. I do not use CGM but I’m considering two different devices - just yesterday I discussed their use with my endocrinologist - but I have continuously used MiniMed [Medtronic] pumps for 13 years; at present a MiniMed 523 which essentially is 2002 technology. As soon as Medicare will permit subsidy of a replacement pump I hope to move to newer technology that includes “auto-suspend” which will then require me to resume CGM use; my endocrinologist said she is ready to write the prescription as soon as I / we decide which is best for me. Currently CGM and pump infusion sites are two different pokes through the skin, at least two inches apart; years ago I “test drove” a non-invasive CGM which didn’t work accurately for me.
Which brings us to Medicare. I hear both gripes and praise. I delayed my retirement until age 70 figuring I needed the employer group insurance plan in order to afford my necessary health care - I WAS WRONG - my current medical care, and I see six specialists, cost me less now than what it did while working. An example, every 90 days 800 BG Check strips are delivered to me without out-of-pocket cost, every 90 days my pump supplies are delivered without cost. Pumps are covered under DME [durable Medical Equipment] which has a cost to user of 20% of adjusted/allowed Medicare cost; insulin for me is expensive - $147 each quarter, but all my other medicines are $0 co-pat. I do have a Medicare Complete {Advantage] Plan for which the government sets a maximum monthly premium deducted from Social Security; beginning 2018 that maximum is $134 per month. Primary care physician visits range from $0 to $10 and specialists cost $35 per visit.
A good source for diabetes information, other than here, is DiaTribe Newsletter [diatribe.org] which has trustworthy information [I don’t always agree fully] and links from its articles to supporting research; Diabetes Connect has good current podcasts of interest. SugarSurfing has excellent information and coaching for aggressive diabetes management [similar to what I’ve been practicing for years] ; it was begun by a practicing endocrinologist [35 years] who himself has had TypeOne for over 50 years - he together with the hostess of the Diabetes connect were featured speakers last December at the TypeOneNation Summit.
Kind of a long reply, but still just touching the surface.
Once again thanks for your reply, you have given me lots of info that I will look into thoroughly. Appreciate it
Hi Helen,
Although I’m not as close to Medicare as you, I am both a pump and CGMS user, and for all the reasons Dennis mentioned, plus 1. I like to eat but don’t like the 8+ shots a day I was on.
I can’t add more than you can trust Dennis’ advice.
Be well!
Helen,
I have had T1D for 48 years. I am now on my 3 insulin pump (I used the first and second pumps for 5 years each but neither and made any longer). The one I have now is a Medtronic 630G with a CGM. The Medtronic CGM is about the same as the Dexcom 4 that I used for several years. I like the 630G pump mainly because it will suspend delivery of basal insulin when I run low.
Medicare would pay for my insulin pumps, but not for the CGM’s. However, I have secondary insurance that picks up most of the cost for the CGM and supplies. I have heard that Medicare will pay for a Dexcom 5 CGM, and I think some others have been approved as well. You can check that out easy enough.
I would recommend that you get a CGM if possible. I would not want to be without mine.
Good luck!