Diabetes, Insulin Pumps, and PD


#1

Hi all,

I have been on PD for four and a half years. I have been diabetic for 35 years and have been using my insulin pump for seven years.

I have found that if you calculate the dialysis fluid dextrose by 50, divide by 65% which is absorbed then divide by the amount of insulin you have to use to lower your sugar you will come up with the amount of units to put into the bags of fluid which will regulate your sugar.

ie: 2.5 solution times 50 = 125. 125 times 65% = 81.25 divided by 60 (the amount 1 unit of insulin drops my sugar level) = 1.35 units of insulin every hour the fluid is in me.

You would have to check with your doctor first to make sure this calculation will work for you. My blood sugars are always around 75 - 80. my a1c is at 5.9.

Chris
christopermichal@aol.com


#2

Chris,
I’m a caretaker for my husband who was diagnosed with ESRD Nov 2018 and has been on PD since Dec 2018. He is a type II diabetic and has been one for about 20 years now. We are considering using the insulin pump along with a CGM, which is now covered by Medicare. Do you know if the insulin pump is covered by Medicare if the patient has type II diabetes? I have heard that Medicare does cover insulin pumps but only if it is deemed medically necessary and the patient is type I diabetic. Any information you share will be appreciated. Thank u!!
Nic


#3

Medicare covers an insulin pump if prescribed by a doctor for a patient who uses insulin. Here’s information from CMS (Medicare) written for providers about the coverage of insulin pumps and other diabetes equipment and supplies…

Here’s information on the Medicare website for people with Medicare.
https://www.medicare.gov/coverage/infusion-pumps-supplies


#4

Beth,

It’s still not clear from reading the CMS document under what conditions does a diabetic patient qualify for an insulin pump. The document does not specify what these conditions are. My nephrologist says people who use low dosages of insulin do not quality for insulin pumps(and I fall into this category) but I cannot find that in the CMS literature. IMHO, an insulin pump and CGM for PD patients are essential in helping to manage blood sugar, i.e; during PD sugar level can spike if being absorbed. How can I get the doctor to reconsider? Have him call the Medicare provider line and ask Medicare for clarification on insulin pump coverage?

Nic


#5

I found a CMS Decision Memo that is lengthy and describes the background, history of Medicare coverage, and more. Under Decision Summary it states this:

"CMS has determined that the evidence is adequate to conclude that continuous subcutaneous insulin infusion (CSII) is reasonable and necessary for treatment of diabetic patients: 1) who either meet the updated fasting C-peptide testing requirement or are beta cell autoantibody positive; and 2) who satisfy the remaining criteria for insulin pump therapy detailed in the Medicare National Coverage Determinations Manual (Medicare NCD Manual 280.14, Section A.5).

CMS has determined that fasting C-peptide levels will only be considered valid when a concurrently obtained fasting glucose is ≤ 225 mg/dL. Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method. Alternatively, for patients with renal insufficiency and a creatinine clearance (actual or calculated from age, gender, weight and serum creatinine) ≤ 50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200 percent of the lower limit of normal of the laboratory’s measurement method. Levels only need to be documented once in the medical records.

CMS will also continue to allow coverage of all other uses of CSII in accordance with the Category B IDE clinical trials regulation (42 CFR 405.201) or as a routine cost under the clinical trials policy (Medicare NCD Manual 310.1)."
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=109