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Re: [IPk] NICE Guidelines

Hi Pat

>The way I read it, 'any 2 combinations, one of which must involve

At the moment I would beg to differ that any two combinations has to 
include glargine. The reason for this that it says in the FAD "where 
appropriate, the use of insulin glargine"

> >
> >One query regarding the treatment of disabling hypos by third parties, is
> >does third parties include anybody capable of treating a person with a hypo
> >ie family, friends, work colleagues, passers by etc or would be restricted
> >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

I agree that there is a need for some vagueness and if disabling hypos 
isn't changed then some form of guidance may be required otherwise there 
could be inconsistencies between Trusts and individuals.

>If we push against this now, NICE may come down with the tight decision
>of 'treatment by the medically qualified'.

I don't particularly want push this one either  but we as patients and the 
healthcare professional involved in pump therapy need to have these 
discussions. If NICE did come down in favour of "only treatment by 
medically qualified staff" then there are significant cost and resource 
implications for each Trust - as most of us would probably call out the 
paramedics every time we had anything but a very minor hypo. I would hate 
doing it, as I don't like wasting resources.

Best wishes


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