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Re: [IPk] The pump & hypo awareness

At 09-07-00 14:16 +0100, you wrote:
>My god, Jeremy, you only had one hypo in 8-9 years? That is amazing!
>And was this before home blood testing too?
No it was well after home blood testing (mid 80s-90s), sorry if I confused.

  There has been no controlled research to
> >discover the truth or otherwise of this assertion but if it is true it
> >worries me that there is such keenness to put children on pumps, at early
> >ages (other than within research), because if true it would mean that
> >control begins to go wrong at just the wrong time in life (late teens -
> >early twenties).
>If I understand you correctly, does this mean you think it's preferable
>that children start losing their hypo symptoms *earlier*, e.g. in their
>early teens? I certainly don't think it's a foregone conclusion that you
>would lose your symptoms this early anyway, and even if you did, if it means
>improved BG control for these 15+ years, then I think it has got to be
>worth it.
>I think the longer one can preserve one's hypo warning symptoms, the
>better, regardless of age (with the possibility of some exceptions in very
>special cases).  I am presuming you mean that it is the effect of the pump
>on *control* (ie the improved control and/or the ability to maintain steady
>BGs at a lower level) that increases the length of time before one loses
>one's hypo symptoms, rather than anything more intrinsic about the pump
What I mean is that I think it most (not all) cases, there can be some an 
advantage in delaying the introduction of a pump to children, for two 
reasons. Firstly anything is appreciated much more if the advantage of it 
can be compared with an earlier time without it. If a child is introduced 
to a pump soon after diagnosis they are not in a position to be able to 
realise how much better it is than conventional therapy. A comparison could 
be made with a person who was born blind, they do not know what they are 
missing and life is normal (and pleasant?). The second reason is that, from 
talking to Stephanie Amiel, loss of hypo awareness is always recoverable 
and if it does cause any harm it is very, very minor. Given this I do not 
believe that anything is lost by a child possibly losing hypo awareness, 
for a period of time. Much is to be gained in the form of experience, when 
then using a pump and recovering the awareness, we all (I think) realise 
that consultants without personal experience of diabetes know less about it 
than those who have the disease.
My concern is primarily when the pump is given to children under the age 
of  ten. What I think would be a good guideline, until there is more 
knowledge of long term use of the pump, is that 15 would seem a reasonable 
age to begin use of the pump. If my experience proves a rough norm this 
would then mean that problems would not begin until the early thirties, 
(rather than possibly while at university) when I believe the person is in 
a much better position to take them on.
I note there are exceptions, where insulin resistance is encountered for 
example, but in general I think there should be very great caution.
On a more hopeful note, I believe I am not releasing anything confidential, 
but there is now a much greater chance that pumps will be included in the 
NSF, which would then mean they would be included in NICE. The pressure 
would be to get the equipment (but not the pumps themselves) available 
under prescription.
The letters from those who wrote might achieve our aim.

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