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Re: [IPk] NICE Guidelines

In message <001201c2c565$d3e404e0$email @ redacted>, Abigail King
<email @ redacted> writes
>I don't believe glargine would be aywhere near as bad as ultratard due to the
>fact that it is supposed to be predictable , but I would not expect success
>with it unless basals are fairly constant and you do not often need to set a
>temporary reduction

And this is one message which we need to get to all the formal
consultees: return to mdi / trial of glargine should _only_ be
considered for those who's optimised pump use (and 'optimisation' should
be 'after a year of use') entails a pretty level basal rate (varying no
more that 10% over 24 hrs) and, even if a level basal rate is used, does
not entail regular (more than once a month) adjustment to the basal rate
for a temporary period (e.g. increase of basals by 20% at menstruation,
or reduction of basals by 30% for 4 hrs after exercising).

If NICE do not believe that use of non-level basals, or varying basals,
is a very safe predictor of the benefit of pump use over glargine, they
need to commission some research, and keep on pumps those who want to be
kept on pumps, in the interim.

Best wishes to all,

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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