scared! had to go on novolin and I have a pump

[geek0]

Hi. This is really important. I had to go on county insurance because I lost my job, and they wont cover Humalog or Novolog. The only fast acting insulin they cover is Novolin R. The problem is that I am on an insulin pump. I know this stuff is different than what I was taking (Humalog, or the equivelent Novolog), but I don't know what it is going to do to me. My doctor isn't knowledgable and I'm stuck with her. I can't go anywhere else. My question is, what's it gonna do to my blood sugars if I have this stuff being pumped in me every 3 min at the same basal and bolus rates as Humalog? I just had to start it today. I can't switch back to taking shots because I'm brittle.

[JDRF-Team-LRS]

Hello Geek,
I didn't see your msg until today and hope I can be of some help to you.  I'm not a physician, but I have been a pumper for ~9 years and  have had DM for ~35.

When I starated pumping, the only insulins available were "Regular" insulin and the main difference, as you know, is "how quickly" the insulin starts working, when it peaks and how long it lasts.  Regular normally kicks in later than Novolog or Humalog will.  Regular stays active for longer than Novolog or Humalog, too.

I was able to work with a CDE (Certified diabetes educator; not a physician) when I transitioned in the opposite direction you are going.  Be sure to have a written record of your current basal settings.  You may need to shift-in-time my basal settings.

For example, let's say I had a basal rate of .5 from 12midnight until 4am when I was using Humalog in my pump.  To get a similar basal coverage, I would "shift" that time to say ... 11pm - 4am. And do the same "shifting" for all my blocks of basal rates.  Write 'em all down.  Test often and watch for patterns that suggest you need to tweak it some.

For boluses, I didn't find much need to change the quantity, but rather the timing.  Again, I'd try to bolus sooner before eating the carbo portion of my meal.  With Novolog/Humalog, I'm okay bolusing right at meal time if my BG is wihtin my target.  With Regular, I'd bolus 15 min ahead of time.

If you were ever taking insulin by syringe and used Regular, you can apply those same principles with your pump.

I can imagine how upsetting it is to be forced into a medical change because of insurance change.  I'd like to reassure you, however, that you can have excellent BG control using regular in your pump.  Prepare that it'll take some time for you to adjust and to feel comfy with the new routine, but I'm certain you will get there.

You might like to see some "insulin profiles" to help you figure out how to do "time shifts" with your new insulin.  
http://www.joslin.harvard.edu/education/library/insulin_action.shtml
If you can possibly find a CDE, that would be terrific.  In addition, many of the pump reps have "templates" that help us compute our basal timing based on lotsa stuff.  The pump reps info will be free.

Will you check in again & let us know how you're doing?  You sound scared, for sure, and I'm  hoping this info will help you 'til you can find a doctor who "has a clue"  An endocrinologist/ diabetologist is the right person to look for.

Hope today is better, geek!
LRS.apparently a geek, too ;-)

[JDRF Team SGG]

I am not a doctor, but am also a type 1 who has used Regular insulin in the past. I have no experience using it in a pump, but have done some research on your question. Please check out this web site, which compares the action times for the two insulins. It suggests that folks who inject Regular insulin do so 30-45 minutes before a meal because its onset is slower than the digestion time of the food. You may want to try doing your mealtime bolus earlier than you usually do becuase of this. Here is the web site:

http://www.bddiabetes.com/us/yourinsulin/intro_performance.asp

You MAY find that the peak action  and the continual working of Regulaar after the peak cause your glucose numbers to be more irratic than they were with the Humalog or Novalog. I would keep a careful record, takng glucose readings before and after meals (a couple of hours after the meal) and write down your readings. In a week or so, you will have data that might proved whether this will work for you or not. If it causes extreme highs or lows ( the same brittle condition you experienced with shots) then you would have some paperwork to plead your case to your insurance agency in an appeal.

I would also suggest that you keep juice and glucagon handy at ALL times in case you find yourself having lows in between meals beause the regular insulin doesn't match your digestion time. And if you have a low, WIRITE it down in case you need to appeal to the insurance company. Only with good records will you stand any chance of a possible change of policy in your case. Please let us know how this works for you, for the question is a first for us.

[JDRF Volunteer WAK]

you can fight the insurance company.  Your doctor needs to supply  aletter  of medical necessity.  It is illegal for the insurnce company to not let you have the right insulin for your pump.   your doctor needs to get on the phone with the insurnce company.  and so do you ask for a supervisor.

[JDRF Volunteer WAK]

I have had problems with insurance companies not paying for what the doctor wanted, from the correct insulin to the correct pump.  YOU NEED to fight them.  YOU can win.   You can fight the insurance company.  Your doctor needs to supply a letter of medical necessity.  It is illegal for the insurance company to not let you have the right insulin for your pump.   Your doctor needs to get on the phone with the insurance company.  And so do you ask for a supervisor.

[nurse12hr]

Insurance companies often deny first, figuring that the average person will meekly accept their decree.

Appeal, following your insurance companies policies.  I had a huge claim denied once, called the insurance company.  THEY were the ones who told me how to appeal, gave me the addresses, etc.
I wrote an appeal (you will probably have to get a letter from your doc saying you were stable on the previous regimen, and how suddenly introducing a new regimen may cause you to have complications)--about 2 weeks later, my claim was approved.

They just want to get away with paying as little as possible.  Your job is to get them to pay as much as possible.  

Good luck!