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Re: [IPk] Re: ip-uk-digest V2 #485

I didn't mean to sound like I was being harsh to Heather in my last e-mail; 
my anger is towards her healthcare team who are being rather negligent. It's 
in every PCT's best interest now that the NICE guidelines have been released 
to have every type 1 in good control. Given the benchmark of 7.5 for pump 
consideration, a 7.4 is no guarantee that the patient isn't heading towards 
needing a pump--which will (supposedly now, and hopefully for real in 
future) be the complete financial responsibility of any PCT. The choice 
becomes: a) pay for good treatment now OR b) pay for complications not too 
far in the future. And as in so many things, an ounce of prevention is worth 
a pound of cure.

I would imagine that most of us with diabetes think of diabetes care in 
terms of 'Am I feeling good and is my HbA1c in range?' while many physicians 
think, 'Is this patient technically healthy, quality of life being hard to 
measure and too subjective an index to apply?' and the PCT says, 'Don't bore 
us with the details--how much does it cost?' If three members of any team 
all have different priorities while supposedly striving towards the same 
goal, it's not a sure thing they'll make it. Something's gotta give and 
someone's gonna get a short stick at some point. So many stories that get 
posted to this listserv indicate the patient getting shafted, yelled at, 
treated with general disrespect, and/or getting told, 'Everything is fine; I 
don't see what you're talking about; go away', when he or she makes some 

It's been proven that the lower the HbA1c, the smaller the risk for 
complications (and watch your blood pressure too; seems bp has a bigger role 
in some complications, esp. retinopathy, than previously appreciated). The 
International Diabetes Federation Congress in Paris last week, a conference 
of 15,000 healthcare professionals, medical students, and a relatively small 
percentage of diabetes advocates, hammered home in so many sessions that .5 
of an HbA1c *can* make a difference in the risk of complications.

The IDF's experts on intensive insulin therapy pointed out that it falls to 
the healthcare team to help devise a treatment regimen AND a programme of 
patient education that helps facilitate the lowest HbA1c possible without 
great risk of hypos. The experts pointed out that with both long- and 
short-acting insulin analogues being available, there is now very little 
reason why any Western/developed world resident with type 1 ought to be on a 
combination of NPH (isophane) and Regular, unless he or she is actually 
truly doing well clinically and has a high quality of life with that 
regimen. The honchos also said a lot about the value of post-prandial 
testing and correction in reducing HbA1c and increasing quality of 
life--it's no fun to be unwell or just a bit 'off' for 5 hours between lunch 
and dinner if you had an unexpected response or could not have anticipated 
what your bg would get up to--and that post-prandial period DOES affect your 
HbA1c just as much as what happens when you're asleep.

But so many doctors and nurses seem to think, 'Oh well, this is the best we 
can do, better not try any harder with this patient--it's like teaching a 
pig to sing', when perhaps they're being intellectually lazy and 
professionally irresponsible. Should we let them dictate our priorities?

IDDM 10+ years; MiniMed pumper 7+ years; assertive tending toward aggressive 
22 years

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