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[IPk] Re: problems

I think that many people who feel 'ok' with aventis/MDI/glargine/Lantus
etc do not have great HbA1c, or if they do, only at the cost of a lot
of hypos.

And I don't think it is necessarily an issue of 'not admitting' to
hypos and hypers. Given that hypo sensitivity goes down if you are
frequently hypo, they themselves (and certainly their doctors) may not
be aware how often they are hypo, until/unless some disaster situation
Likewise, in my experience, if one is frequently hyperglycaemic, the
threshold at which one becomes aware that one is hyper and not feeling
that great, also rises - so they are also blithely unaware, at least
some of the time, of the extra glucose flowing around their body, to
the detriment of their competence and sense of well-being on a day to
day basis, and increasing their risk of complications in the long term.

As things stand now, probably not so many people would come forward to
demand pump therapy because pumps (at least in the UK) are still new
and unknown, and therefore somewhat frightening. And some diabetics
(like my brother), and doctors, in the UK, have bad memories of early
pumps, images of large devices, unreliability, site infections etc. And
if people hear doctors' uncertainty about pumps, never mind that they
may well hear doctors who they trust well for other things, actually
bad-mouthing pumps, of course they will be put off. GP's who are not
diabetes specialists are unlikely to be updated about pumps. I happened
to see a different GP one time, before dealing with the immediate issue
which brought me to see her, she asked about chronic conditions, so I
told her about the pump, and she said, oh yes I know I know (not
wanting to admit ignorance presumably). Then when she was examining me
she came across the tubing and the site and jumped 3 feet in the air in
shock, asking what on earth was this thing!

Not being in the UK at the time of diagnosis, I was started on a regime
of MDI (using Humalog) + NPH for the nights (at one point tried NPH for
the days too, but after a week refused to take it because the
unpredictable extended hypos scared me too much and ruined my working
hours). When I still had HbA1c around 9, and lots of hyperglycaemia, it
was suggested after about 6 months that I consider a pump. I was very
frightened indeed of the idea of having something always attached to
me. Partly I suffered from lack of clear information - at the back of
my mind was some concern about whether there was some minor surgery
involved to permanently attach something - after all I heard that
people were often admitted to hospital for the first days on the pump -
I think this is much less common now than then (only 5 years ago). When
I found out (from a friend of my daughter who had a pump and was
willing to answer my 101 pump trivia questions) that there was no
permanent attachment, I was still scared of the large needles for
inserting the sets - I continued to be nervous of inserting sets for at
least the first year on the pump, even though after the first 2 days I
was so impressed by the benefits of the pump that I was determined to
keep going.
>> cope, but why so many people do manage very well - it must take huge
>> amounts of self-control, and putting up with both restrictions and
>> discomforts.
>I hearso many people ranting on about how good MDI/ glargine are...
>Do you think people on them routinley don't admit to having hypos?.../
>hypers on a v. regular basis
>or do their bodies really do what aventis ( glargine manufacturer),
>consultants not really pro pump, and the NHS, would like them to?...
>If pumps were universally available to those who could be classified
>" a
>lantus failure" eg daily hypos  even if recognised by the patient ( as

>proposed guidelines suggest), would more and more people come forward 
>they would like to try pump therapy?  and would they then be accused
>manipulating things or exaggerating so they could get a pump???

Nanette (Chana) Freedman, Ph.D.
Hadassah University Hospital
Department of Medical Biophysics and Nuclear Medicine
Kiryat Hadassah, P.O.B. 12000, 91120 Jerusalem, ISRAEL
Tel:972 2 6776 720, Fax: 972 2 6421 203 - work
Tel:972 2 5636 174, Fax: 972 2 5619 235 - home
Email: email @ redacted, email @ redacted

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