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

Re: [IPk] NICE Guidelines


No I will not go on a trial of glargine but then I have already been on it. 
(I got it from the States for a year and came off it about the week it 
became available here).  Unforunately my Consultant was happy with my BGs 
and HbAic and thought I was on the best treatment.  He ignored the fact that 
I thought I was still having night hypos (dripping wet sheets) as I had no 
BG proof.  If I woke up and tested my BGs were good - they could have risen 
as a backlash.  So the trouble is my interpretation of how I coped with 
Glargine is different from that of my Consultant.

My basals vary from 0.2 during the night to 0.6 mid morning and then 0.4 in 
the afternoon, I suspend or reduce basals for gardening (always a problem 
area) and use square wave or dual boluses about 4 times a week.  I still 
haven't got gardening sussed - I think I need to reduce basal for the rest 
of the day and possibly the following day as well.

I self fund. Would I have any hope of convincing my Consultant that he was 
wrong and that Glargine really didn't suit me?  I don't live in hope.


>From: Pat Reynolds <email @ redacted>
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: Re: [IPk] NICE Guidelines
>Date: Mon, 27 Jan 2003 19:27:58 +0000
>Insulin Pumpers is made possible by your tax deductible contributions.
>Your donation of $10, $25, or more... just $1 or $2 per month is
>needed so that Insulin Pumpers can continue to serve you and the rest
>of the diabetes community. Please visit:
>     http://www.insulin-pumpers.org/donate.shtml
>Your annual contribution will eliminate this header from your IP mail
>In message <email @ redacted>,
>Steven J Sexton <email @ redacted> writes
> >Hi
> >
> >I am very wary of setting criteria to define when existing pump user 
> >switch back to MDI for a trial period. How long should that trial period 
> >for?
>But criteria are needed, or people will be switched back in
>Given the criteria we've come up with here, is there _anyone_ on this
>group who would be switched to a glargine trial?
>Remember, that means someone who: has a near-flat basal rate, and only
>very occasionally uses temp basal, suspend, profiles or basal rate %
>variation, and never uses square or dual bolus.
> >
> >I would argue very strongly that for existing pump users that previous
> >HbA1c's and medical history should be used and that should include 
> >of life issues.
>Er, that's a criteria based decision. Or was your point that 'previous
>HbA1c's and medical history should be assessed against criteria', with
>the stress on the past, rather than new evidence against the criteria?
>As I read it, they expect consultants to do exactly as you say, use the
>past to make a judgement as to whether a glargine trial is likely to
>give a good hba1c, without 'disabling hypos'.
> >
> >Presumably for most pump users who are currently funded by their Trust
> >there was a "clinical" case for the PCT/Trust to fund them. Hopefully 
> >the FAD in its current form they would continue to receive funding, as 
> >clinical case had previously been made.
>What NICE is getting at is that when many people were put on pumps,
>while there was a clinical case then, glargine wasn't around then, and
>so everyone should go and have a trial with glargine before being
>allowed back on a pump.
>The patent stupidity of that for anyone with varying basal rates (for
>example) needs to be spelled out in the criteria.
> >
> >For those of use who are self funded, I would hope that our previous
> >history would be sufficient to demonstrate that it would be extremely
> >difficult to achieve an HBA1c of less than 7.5 on MDI without disabling
> >hypos occurring.
>No, it won't be enough, unless you have tried glargine.
> >
> >The difficult area would be for those people who switched to a pump 
> >personal choice but previously had HBA1c's of less than 7.5 when they 
> >on MDI.
> >
>Again, if they got their under 7.5s with glargine, but had 'disabling
>hypos', however that gets defined eventually, they are fine.  If this
>was with another basal insulin, even if they had a string of ambulance
>admitals, they could be forced to go and try glargine.
> >The way I am reading it at the moment is that people would be recommended
> >for CSII where MDI has failed ie people cannot maintain an HBA1c of less
> >than 7.5% without disabling hypos occurring. MDI would be any combination
> >of short/medium/long acting insulins.
>The way I read it, 'any 2 combinations, one of which must involve
> >
> >One query regarding the treatment of disabling hypos by third parties, is
> >does third parties include anybody capable of treating a person with a 
> >ie family, friends, work colleagues, passers by etc or would be 
> >to medically qualified people?
>I suggest we don't poke at this one for the moment - if we can get it
>changed so that any significant hypo is a 'disabling hypo' - whether or
>not it's self treated, unqualified treated, or medically qualified
>treated, this won't be an issue.  If it goes through in the current
>form, we need the vagueness, so that enlightened doctors can interpret
>it as generously as possible (e.g. 'asked my husband to make me dinner
>as I was feeling a bit shaky two hours later' could count as
>If we push against this now, NICE may come down with the tight decision
>of 'treatment by the medically qualified'.
>Best wishes,
>Pat Reynolds
>email @ redacted
>    "It might look a bit messy now, but just you come back in 500 years 
>    (T. Pratchett)
>for HELP or to subscribe/unsubscribe, contact:

Stay in touch with absent friends - get MSN Messenger 
for HELP or to subscribe/unsubscribe, contact: