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[IPk] Re: Withdrawl of funding?? Advice Needed.

Yes this happened to me too - the details are different because I don't
live in England at present, but at some point, around 2 years ago, I
had to go and see the diabetes specialist of the health fund (rather
than my usual endocrinologist) to get agreement for continued funding.
I found it hard to know if I was more upset or angry by his reaction to
my HbA1c around 7.9 - and in my case records showed that it was
generally around this level (though more like 9 pre-pump), not a once
off reading as in your case, which is much more likely to be due to lab
error or to illness or other irregular occurrence. 

He said I was obviously not making good use of the pump if I could do
no better than that. Fortunately for me, this was one of the few times
in my life when I thought of the right things to say at the time and
not just after the event. Despite my anger, I acted all meek and sweet
and said that I was at least as distressed as he was that my HbA1c was
not better, and what could be done about it. He first said that I
should come to him for a series of appointments so that he could
"manage" my control. This was a horrible prospect, so I persuaded him
that first I would return to my usual endocrinologist (who fortunately
he knows and has a high opinion of) and listen to and apply all his
words of wisdom. And despite boiling up inside, I continued to act like
an appropriately chastened student who was just waiting to learn from
the masters, and agreed that if things did not improve I would return
to him. 

Although I believe that the threat was inappropriate and wrong, maybe
this did make me aware that I had to make some changes for my own good
- in any case, things have got better since, with most HbA1c's around
7.2-7.5, probably as a consequence of my reluctantly adopting a diet
somewhat less high in carbohydrates, and then the last amazing value of
6.4 - funny that when they turn out high one starts thinking of lab
mistakes, but not when they are low - in fact, as I wrote a couple of
weeks ago, I am convinced that this low value is real, and is due, not
to words of good advice from any doctors, but due to adding linseeds to
my diet (initial motivation for that was that it might lower
cholesterol - it did that too!)!!!  

Good luck with dealing with this - it seems to me that with just one
high HbA1c, repeating it 3 months (which is exactly what my
endocrinologist said about my single recent really low HbA1c) is indeed
the sensible thing to do - but this should be done before taking it
seriously in any way whatsoever. Did he look at blood glucose records
as well - do those numbers indicate any deterioration of control? have
you been ill, and/or do you have any sense of control having been worse
lately? or have you been having many fewer hypos (which would really be
good of course) without improving control of the higher values? if none
of these things are true, it really looks more like a lab error, and
that it might have been more sensible to do another measurement now
rather than waiting 3 months. If you do think your control has been
worse, do you have any insight into how to improve it? or anyone you
can discuss this with? so that you don't have to live in fear and dread
of the next HbA1c?? Did he ask you any of these things - his raison
d'etre is supposed to be to help you the patient, not just to find ways
to save on the budget.


 > I went for my diabetes check up today. Unfortunately the normal 
> not there today. I saw his SHO instead. My hba1 was 8.1!!!! normally 
over the
 > past year or so they have been between 6.1 and 7.5. He made the 
 > I should come off the pump and also if I refused, funding may well 
 > by my PCT, who, might I just add, were very much against funding me 
in the
> place..
>  I spoke to a diabestes nurse later in the day who informed me that 
on this
> occassion it should be ok, but it is expected that it should be down 
in three
> months. If not it will have to be looked at again by the PCT.
> Has anyone else experienced this?
> ----------------------------------------------------------

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