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Re: [IPk] NICE

In message <001a01c2c3df$778c4540$email @ redacted>, Abigail King
<email @ redacted> writes
>final appraisal determination is now on website
>suggests that pump therapy to be used in event of MDI incl glargine failure
>established users get funding if return to MDI incl glargine fails or deemed
>innapropriate by consultant
Can we assume that consultants will 'deem inappropriate' if the basal
rate on the pump is anything other than dead flat, or if the 'suspend
basal' function is used on a regular basis (more than once a month?) or
if more than one basal rate is used on the 508, or the basal rate is
proportionally increased or decreased on the disetronic fairly
frequently (more than once a month?) - on the basis that no basal
insulin, Glargine most specially included, can give that flexibility.

Could IMPUT provide guidelines like that to doctors - it would
particularly help the 'tolerant' rather than 'active' ones, who are not
greatly involved in the choice to move to a pump, just sit back happy
because there's a diabetic patient who's getting on with it by
themselves - they may not have the arguments or capabilities to make the
'deemed inappropriate' decision they need to.

>NB failure means A1c> 7.5 or ( i particularly dislike the way this is phrased)
>unpredictable severe hypos requiring help of others and having adverse effect
>on QOL
>so if prolonged hypo at exactly the same time everyday, as long as you can
>treat it yourself it doesn't count even if you are unwell fro 2-3 hours/
>can'tdrive/ excercise/ loose your job?
>Then I suppose you could reduce the daily glargine dose and increaseA1c but
>would you then be accused of non compliance?
>I think we need to appeal and make them put in frequent hypos even if self

Yes, because I for one will suddenly find that I can't self-treat my
hypos with confidence (all that basal hanging around, y'know), and start
dialling 999 ....

Could turn out expensive if there are a lot of under-confident people,
like me!

When does the NICE judgement become effective?   

Best wishes to all,

(manipulative, moi?)
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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