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Re: [IPk] Pump Funding



Hi Belinda and Suzanne

In England at least, a second opinion from a different healthcare
professional can help people get out from under the care of clinicians who
don't necessarily understand the pump criteria, or with whom the patient
doesn't communicate well for any reason.

In most of the problematic situations I hear about, there's more to the
story than a clinician being crazy. Sometimes it's lack of experience or
lack of understanding; sometimes there a personality clash or bad history
between the patient and the clinic.

Melissa


On Mon, Jan 20, 2014 at 10:32 AM, Belinda Washington <
email @ redacted> wrote:

> 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!
>
> Belinda
>
>
> 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
> > .
> > Follow us at https://www.twitter.com/insulinpumpers
> > Make a long URL short at http://type1.org
> .
> Follow us at https://www.twitter.com/insulinpumpers
> Make a long URL short at http://type1.org
.
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