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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
>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
The letters from those who wrote might achieve our aim.
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