Hostage of Ignorance

It was an odd call, to say the least. On the other end of the line was a nurse who works for my patient’s health insurance company. They were trying to decide whether or not to deny my patient’s insulin pump supplies.

Now this Patient has been on a pump for about seven years. She’s actually a type 2, but she might as well be one of us. Pre-pump she took multiple daily injections of two kinds of insulin. She’s brittle as hell. She struggles with her control. There’s a lot of variation in her BGLs, but her A1Cs generally run in the low sevens, not a bad outcome for her efforts.

Apparently the insurance company had been looking at a recent visit note. On that day, my patient had suffered a pod failure, and just like one of us, in a matter of a few hours her BGL had rocketed up, up, up to 463mg/dL. She had changed the pod, took a correction, and was waiting for the resumed flow of insulin to take effect. As a T2, her risk of DKA from a hyperglycemia this brief was nil, so her main health issue was that she was PISSED off. Madder than a wet hen, in fact.

But I guess the insurance nurse didn’t look at the most recent pump downloads that show my lady tests 6-8 times per day, that her numbers generally run between 80-250 with a good solid average of 130,  OR that less than 5% of her readings are above 250 mg/dL. Instead, the nurse at the insurance company was totally focused on this one high BLG reading, and told me they were wondering why they were paying so much money for insulin pump supplies if this was all the better the results were.

I was stunned for a moment. Everyone has a screaming high number now and again. That’s the cost of doing business with diabetes. Taking someone’s pump away isn’t likely to improve that. Probably, the opposite is true. So I pulled up the note, glanced over it, and explained to the insurance nurse that my patient had suffered a pod failure a few hours before, that’s all.

To which the nurse asked me: “What’s a pod?”

Oh. But it gets worse. It turns out this nurse knew pretty much nothing about insulin pumps of any kind. Actually, she didn’t seem to know very much about diabetes, either.

Well, at least she called to ask, rather than just getting out her red stamp pad. And, luckily, it all ended well. The nurse was polite and courteous to me, and I was able to lobby for the value of the supplies and she cleared them for shipment.

But in the course of the conversation she happened to mention she’d soon be attending her 50^th reunion at her nursing school later in the month.

Let’s see…. 50 + probable student age of 20 is 70.

So a 70-plus-year-old nurse who knows nothing about pumps and diabetes is holding my patient’s supplies hostage? Not that there’s anything wrong with advanced age. Experience counts. And I plan to work well into my 90s, as I don’t have a dime saved for my retirement, but why was someone with no knowledge of pumps in a position to be making these kinds of decisions?