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Re: [IPk] The pump & hypo awareness
At 10-07-00 18:24 -0800, you wrote:
>My interpretation of your message is that you wish to withold
>a treatment for a chronic disease from someone based on their age so
>that they will appreciate the treatment at some later date. Did I
>mis-read the message?
Yes! I was stating that information has not been collected yet about long
term use of the pump and I do not believe that anything should be pushed
forward, with too much haste, where children are concerned until such
information is collected. Situations can also arise in which machines fail
to work, this can happen when away from home, on holiday for example. So
called normal control (MDI) does not involve machines, this is one reason
why I believe a person should have some experience of controlling their
diabetes by MDI, so that they can do this easily, if needed. Please note I
am not trying to suggest that just because someone has never controlled
their diabetes by such means they would not be able to, but it is much
easier to do something if you have done it before and have experience of
its failings. I note that my pump (older version) once stopped working when
I was in Russia and I only had quick acting insulin (Actrapid) with me.
Would I return to UK, that day or continue my holiday, injecting many times
each day? I chose the later, health services in Russia do not support pump use.
I also think that ALL information on children should be collected, to
discover if problems are apparent. You are probably in a better position
than medical experts to build such a database, especially given your
interest in pumps. I will ask you the same question I asked John, how many
people do you know that have been using a pump for over a decade, or 15
years. Given where you live you probably do know some, this again could be
a very important source of information. I do not know of any information
collected about long term use of the pump. Just because it proves to be an
excellent form of treatment, for some years does not mean that it will be
so for ever (until a cure is found).
My thinking is that until information similar to the above is gathered
caution should be used with pumps and children. For some it would not be
welcome, I know that when at school I was involved in sport, of the form of
football (soccer) and rugby, six days a week. There is no way I could have
done either with a pump connected or even a tender, the result would have
been that I was involved in more injections every day than without a pump,
but that is simply a personal view. Most diabetics do not need a pump and
can maintain reasonable control without.
There are several situations where a pump would provide untellable
advantage to a child - I am not suggesting that a pump should be withheld
in such cases, but they are small in number. Too much promotion of pumps
for children can lead to situations where the parents are over enthused and
believe that a pump is the only thing for their child. The child may not
want, or need the pump, but they are still minors and want to keep their
parents happy and thus accept a pump. As far as the parents are aware the
child is happy with it. Please do not <rant> about my last sentence, I
realise such situations are very few, but they do occur.
My concern is that there may be, as yet unknown, problems after using a
pump for x years. Given that most children can be at least reasonably
controlled by MDI, I think there is a gain to be achieved by trying to
control one's disease by different methods, after which the most suitable
or most preferred can be chosen. When at university I was forced to adopt a
change in regime, which has affected my career and life ever after. The
pump while being relatively new and an advance is not suitable for all
diabetics. I have tried to advance the construction of an implantable pump
which would work as a pancreas, with methods that overcome all the known
problems. Please realise that I am very much pro the pump and have been
since the early eighties.
Nevertheless I think caution should be used regarding children, as I state
above there are situations in which a pump "must" be used but until there
is solid evidence of the pump's long term use overzealous promotion should
be restrained. Remember also that children are minors and can make
decisions or have them imposed which they soon regret.
I did not suggest that pumps should be withheld from people because of
their age, I suggested great caution.
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