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Re: [IPk] RE: A big MOAN

Hi Ingrid,

The statisticians look for patterns, and suggest strategies for data
gathering which will reveal patterns.  Looking at a diabetics 'results'
by a consultant takes, I think, around 30 seconds.  We are talking about
sophisticated, iterative relationships between complex and shifting
variables here - not 'your morning bgs are on the high side, increase
the basal insulin by 2 units' advice that consultants are used to

There are some statistical tools that come with some bg monitors, but
given that most people don't understand percentages, a professional is
needed, I think - and not just for those who can't tell you what the
without-VAT price is when faced with the VAT-inclusive price, but

In the past, while such analysis was possible, there was no point in
doing it as it didn't matter that you knew the exact curve of insulin
needed, you were stuck with what you had available to inject (and
injecting committed you to behaviour).  Now, if we know that a high fat
meal needs a certain delivery of insulin, we can get fairly close to
delivering it (not exact, but fairly close).  So it's worth finding out.  

That is not to say that it's a simple matter of looking for patterns,
and then 'doing the right thing' and everything will work out perfectly
- indeed, one of the things the statisticians will be able to do is give
some measure of what, for each of us, is the variation we can expect.

With best wishes,

(dm 30+, 508 2+, not so much _delving_ into the thickness of the world,
as carrying out a scientific excavation) 

In message <email @ redacted>, Ingrid Morrow
<email @ redacted> writes
>Hi Pat,
>Can you clarify the role of the statisticians?
>I guess I see the consultant as the one who approves the use of the pump, 
>but the specialist nurse is the one I always approach on a day to day basis 
>if I have any issues regarding control....
>BTW I had a dream last night about scubadiving with a pump, I still don't 
>know if we have the go-ahead to scubadive, but what would I do with my pump 
>(ie minimed that isn't waterproof)?
>>From: Pat Reynolds <email @ redacted>
>>Reply-To: email @ redacted
>>To: email @ redacted
>>Subject: Re: [IPk] RE: A big MOAN
>>Date: Thu, 17 Jul 2003 20:10:45 +0100
>>Insulin Pumpers is made possible by your tax deductible contributions.
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>>I think I understand this attitude, but .... as professionals, I expect
>>them to keep up to the level where they can look at a patient and say
>>'A) their control isn't good (either in terms of hba1c or quality of
>>B) I've tried every trick in my book
>>C) I know sod all about pumps, but some folk are saying that they can
>>solve problems that other treatments can't
>>I'm not saying they then have to authorise a pump, or supervise its use
>>- just that they should know enough to say 'I don't know enough', and
>>refer the patient on.
>>I agree with the others who have commented that the pump consultant has
>>very little to do.  Indeed, I think that most pumpers do not need to see
>>their consultant on a regular basis.  Instead, the bloodwork and
>>circulatory tests should be done quarterly at the GP practice, which
>>should alert the hospital should anything be abnormal.
>>Specialist pump nurses should see a patient three or four times (to go
>>on saline, to go on insulin, and once or twice after) to induct a
>>patient, and 24/7 cover should be available from the pump nurse team,
>>for emergencies.  There should also be specialist dieticians and
>>statisticians who could be consulted (probably via email or phone,
>>rather than in person).  Both specialist nurses and a small number of
>>specialist consultants should, of course, be available for 'on demand'
>>appointments, phone calls and emails - which would mostly, I think, be
>>for advice on special circumstances such as pregnancy, etc.  They would
>>also be available to GPs and to other specialists treating the diabetic,
>>who want to know how the pump should be used during their treatments.
>>I am next due to see Dr. Pickup on 1st September, when I've just about
>>decided to be in Italy - perhaps I should suggest that he should simply
>>ask my GP for the blood work, and decide for himself, on the basis of
>>that, whether or not he can say anything of use to me?
>>Best wishes to all,
>>In message <email @ redacted>, Diana Maynard
>><email @ redacted> writes
>> >I think from the consultants' point of view, a lot of them are scared to
>> >look after people on pumps because they feel they don't have sufficient
>> >knowledge, which is understandable. They have to take time to learn
>> >about pumps, and many of them would rather not have to. Can you imagine
>> >if they gave you some bad advice about doses or something and something
>> >terrible happened? They don't want to take that risk. Of course, I don't
>> >  condone this attitude, but I think it helps if you can see where it's
>> >coming from. I think that's the reason a lot of consultants won't
>> >recommend pumps for people, because they themselves are worried they
>> >don't have the knowledge.  I know that doesn't help much though!
>> >Di
>> >----------------------------------------------------------
>> >for HELP or to subscribe/unsubscribe, contact:
>> >HELP@insulin-pumpers.org
>>Pat Reynolds
>>email @ redacted
>>    "It might look a bit messy now,
>>                     but just you come back in 500 years time"
>>    (T. Pratchett)
>>for HELP or to subscribe/unsubscribe, contact:
>Express yourself with cool emoticons - download MSN Messenger today! 
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Pat Reynolds
email @ redacted
   "It might look a bit messy now, 
                    but just you come back in 500 years time" 
   (T. Pratchett)
for HELP or to subscribe/unsubscribe, contact: