Tired of giving yourself multiple insulin shots every day? Perhaps you would benefit from having an insulin pump. But convincing your health insurance company of the benefit of pump technology can be a frustrating hurdle. 

Many health insurers will pay for patients with Type 1 Diabetes to have an insulin pump, but their approval criteria are not always clear. In general, you might be a good candidate for an insulin pump if 

• You cannot adequately control your blood glucose levels with multiple daily injections
• You have frequent hypoglycemic episodes
• You have hypoglycemic unawareness

If you are unable to achieve acceptable control of your blood sugar levels using a regimen of multiple daily injections and you have frequent hypoglycemic episodes or hypoglycemic unawareness, you should discuss the benefits of an insulin pump with your doctor.

Guidelines and Criteria

Current guidelines by the American Association of Clinical Endocrinologists (AACE) recommend insulin pump use for those who are willing and able to follow the self-care regimen necessary for Type 1 Diabetes: 

• Frequent monitoring of blood sugars
• Carbohydrate counting
• Insulin adjustment

An insulin pump can adjust the rate of insulin administered hour-by-hour. You may benefit from this feature of an insulin pump if you are insulin sensitive, you are unable to sense when your blood sugars are too low and you have high morning blood sugars.

However, health insurers and third-party payers typically have their own specific criteria. They will reimburse for an insulin pump if

• You have Type 1 Diabetes.
• You are under the care of an endocrinologist who manages patients on pumps.
• You are taking at least four shots of insulin a day and monitoring your blood sugars at least four times a day, but you are still not achieving optimal control of your blood glucose levels.

The goals for optimal glycemic control are usually

• Having an A1C of less than 7 percent
• Avoiding hypoglycemic episodes
• Avoiding high morning blood sugars

However, those with Type 1 Diabetes rarely meet all three of these goals all the time. In that case, the insurer will determine whether you have been on a reasonable insulin regimen and are compliant with home monitoring.

To be eligible for insulin pump therapy, insurance companies usually require you to complete an education program about how to use and operate the pump, as well as how to count carbohydrates. Insulin pump therapy can be ideal for certain Type 1 Diabetics, but you must be willing to put in the time and effort needed to use a pump effectively.   

Seeing the Light 

As more studies demonstrate the ability of an insulin pump to control the frequency of hypoglycemia and hyperglycemia, as well as improve A1C values, health insurers and third-party payers are becoming more receptive to reimbursing for insulin pumps.