What would you say to an HCP that works in an endocrinologist's office who will not give you an insulin pump because you don’t count carbs? However, average TIR of 86%.

@BonafideCherise Something along lines of pointing out that tech benefits ppl who do not want to do manual behaviors that are less necessary with modern tech. Willingness to do manual behaviors should not disqualify someone from using technology that provides greater QOL for less manual effort.

@BonafideCherise My ? to the HCP would be: What are you trying to achieve by forcing me to count carbs, when I have an excellent track record using my own method? OR It seems as if you're not willing to work with me to establish goals/outcomes that I can thrive with, unless I do it your way.

@BonafideCherise 1. Ask for referral to CDCES, who can help frame the request and evaluate patient as great candidate for a pump. Is the patient doing basal-bolus insulin therapy (multiple daily injections of 2 different kinds of insulin)?

@BonafideCherise This question confuses me in multiple ways.

@BonafideCherise How maddening. Wow… I world find another HCP if possible, one with empathy who doesn’t patronize patients and erect unnecessary barriers. I’m sorry!

@BonafideCherise Carb counting is always a ballpark anyways, and insulin sensitivity isn’t consistent enough for it to matter much beyond a halfway close estimate.

@BonafideCherise The onus to bolus is one of the inhumane demands of diabetes. Closing the loop with an insulin pump reduces the onus to bolus. #onus2bolus

@BonafideCherise Real life footage of me carb counting

@BonafideCherise Find a new endo if possible. Inexcusable to be holding insulin hostage. I’d also report them.

@BonafideCherise With 86% TIR, it sounds like the HCP needs to listen a bit to the patient (who is doing a great job managing his diabetes). I imagine he can find a new HCP that is more supportive regarding a pump. Do they also not like CGMs? 🤷‍♂️

@BonafideCherise How is he achieving 86% TIR and not counting carbs even if it's just estimating? Does he eat exactly the same thing each day?

@BonafideCherise Wow!! Now this makes me angry. Isn’t fighting diabetes enough? Ugh!!

@BonafideCherise I'm in the Indy area. DM me if you want to discuss more. I'm an MD.

@BonafideCherise Find a new doctor. That's ridiculous! For me carb counting is less likely to yield good results than my own experience of 24 years on a pump! Carb counting works great if you eat everything out of a package! I refuse to weigh or measure my food. It takes away the enjoyment!

@BonafideCherise Just tell them you (he?) counts carbs 🤷‍♂️

@BonafideCherise Find a new provider and rpt the professional to the licensing board

@BonafideCherise Can he find a new Endo?

@BonafideCherise That it is your right. NICE guidelines. Ans that I would lodge a formal complaint and contact my MP

@BonafideCherise How does gatekeeping access to a technology improve anyone's care? Totally ridiculous. But that said, in NZ carb counting is a requirement for access to pump funding so our entire system is gate keeping, not just a single endo.

@BonafideCherise Why would a diabetic tell a HCP they don’t count carbs? That’s like telling the insurance company “no I’m set on supplies for right now.”

@BonafideCherise Get a new Dr. Or just lie and say you do count.

@BonafideCherise What is the method that is used? Does he just fast? Is he on a no carb diet? How does he got 86%? What is the range? Does he have a Dex and sugar surf to do this? Insulin dosing is a function of math, based on glucose. He should count carbs, protein and fat to use a pump.

@BonafideCherise I hate this, it's like medical prescriptivism, and I feel like it can be really harmful, especially to kids w/ diabetes who need to feel like they have some control over their situation. The job of HCPs is to help people achieve wellness, not to micromanage how they get there.