[Previous Months][Date Index][Thread Index][Join - Register][Login]
  [Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IPk] NICE Guidelines


I think some guidance is need regarded about the treatment of hypos by 
third parties, I would argue that it doesn't need to be treated by A&E or 
ambulance/paramedics. I think there is a very good economic/resource 
arguments to show the impact it would have if we asked all for hypos to be 
treated by medical staff.

Pre pump my HbA1c was around the 8.5 mark and despite my best efforts I 
could not get it lower than that without having hypos. I have records 
showing my BG's during this time, showing hypos etc - due to a slightly 
unpredictable lifestyle/work etc.

As current pump users I feel that we would all have enough evidence to show 
at any proposed review under para 1.7 of the FAD that

a) we meet the clinical need set out in para 1.1
b) that it would be inappropriate to be on a insulin glargine trial

This is where I would look to bring in QoL issues, ie a significant changes 
in lifestyle to accommodate going back to MDI, lack of flexibility, lack 
control, motivation, self esteem, compliance (or non compliance), poor 
control, the impact hypos (minor or major ones) would have on you, 
increased risk of complications developing as a consequence of being on a 
trial for any length of time due to the poor control that may occur during 
that period.

I have no doubt there would be many other issues that an be added to the list.

What we do not yet know is who is likely to undertake the review - whether 
it would just be your own Consultant or whether there would be others 
involved and how sympathetic they are to pumps. This would be for the PCT's 
to decide.

I can see there are going to be some interesting discussions on this.

Kind regards


>If you mean because I don't automatically fulfill pump criteria yet and
>would need trial in order to obtain funding, yes I could see powers that be
>insisting I tried it . I had A1c of 9.6 and frequent hypos but had never
>presented to A and E etc and downplayed hypos as I felt it was a sign I
>wasn't fully in control. So I wouldn't automatically qualify on grounds of
>hypos. Could they argue that 9.6 could be improved to 7.5 on glargine?. Or
>that I wasn't really trying and should be prepared to put up with hypos as
>long as not ending up horizontal. Or that bad control was due to
>unpredictability of NPH as opposed to wonder drug glargine, or that varied
>basals from 0.4 to 1.1 aren't really necessary........
>for HELP or to subscribe/unsubscribe, contact:

Diabetes Insight
mailto:email @ redacted
There are No Problems only Solutions 
for HELP or to subscribe/unsubscribe, contact: