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Re: [IPk] Pump Funding

Hi Melissa & Suzanne,

The stress alone sounded awful.  The stress and the hypos are unrealistic
and dangerous.  I object to the zero-sum logic of  "if you have lots of
potentially-life threatening hypos & get a good Hba1C, we'll fund your pump
(if you survive)" and "if you are healthy and sensible but have a higher
HbA1C, we won't fund your pump."

NICE is more sensible, but that doesn't save you from crazy clinicians!


On Mon, Jan 20, 2014 at 10:08 AM, Melissa Ford <email @ redacted>wrote:

> Dear Suzanne
> Re the higher target: remeber the NICE criteria for pump funding!
> "Continuous subcutaneous insulin infusion (CSII or  insulin pump ) therapy
> is recommended as a treatment option for adults and children 12 years and
> older with type 1 diabetes mellitus provided that:
>    - attempts to achieve target haemoglobin A1c (HbA1c) levels with
>    multiple daily injections (MDIs) result in the person experiencing
>    disabling hypoglycaemia. For the purpose of this guidance, disabling
>    hypoglycaemia is defined as the repeated and unpredictable occurrence of
>    hypoglycaemia that results in persistent anxiety about recurrence and is
>    associated with a significant adverse effect on quality of life
> *or*
>    - HbA1c levels have remained high (that is, at 8.5% or above) on MDI
>    therapy (including, if appropriate, the use of long-acting insulin
>    analogues) despite a high level of care."
> If you need a higher target number because of hypos, you probably meet the
> hypoglycaemia criterion right now.
> All best
> Melissa
> On Sun, Jan 19, 2014 at 1:17 PM, Suzanne Allen <
> email @ redacted> wrote:
> > Hi,
> >
> > Thank you for your comments about my pump funding problem.
> >
> > Melissa: thanks for that useful point.  I have an appointment with the
> > consultant in May.  I need to agree another target a bit higher than 7.3
> > with her as I have been experiencing a lot of hypos to get it.  Also, for
> > the last 6 weeks I have been doing two hourly blood tests through the
> > night,
> > every night, to try to get the overnight basal doses right.  The
> situation
> > is therefore untenable in the long run and I need to agree a more
> realistic
> > target with her.  I will then ask her to put that in writing to me.
> >
> > Di: You asked why I had postponed the holiday.  The reason is that I
> always
> > struggle to have good control when I'm on holiday.  I'm used to weighing
> > everything at home, which I can't do on holiday and I'm not very good at
> > guesstimating carb amounts even with the help of the "Carbs & Cals" app
> on
> > my phone. Also had problems with the app showing portion sizes at times.
> > With the holiday we are hoping to do, we'll be on the move quite a lot
> so I
> > won't even have the benefit of being in one place for long enough to
> start
> > working out the carbs from that hotel's portions.  I didn't want three
> > weeks
> > of possibly out of target results to have a negative impact on my HbA1C
> > result.  I have to say though, that that I have a few more tools to fire
> > fight with now, so may have slightly better control this time.
> >
> > Regards,
> >
> > Suzanne
> > .
> > Follow us at https://www.twitter.com/insulinpumpers
> > Make a long URL short at http://type1.org
> .
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