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Re: [IPk] Forgetting injections



In message <email @ redacted>, Mary Moody 
<email @ redacted> writes
>Apparently there is a very fast growing groups of diabetics who miss
>injections regularly and generally don't manage their condition that well.
>The consultants apparently deal with this by exerting total control over
>dosages.

Is it just me, or is this not totally illogical?

It is obvious that if a patient prefers not to inject insulin rather 
than make a descision about how many units to inject, they will benefit 
from the doctor saying 'the answer is 42'.

But honestly, how many people are deciding not to inject because they 
are terminal ditherers?

The real reasons are varied (and doctors of the 'the answer is 42 
variety' don't like varied reasons, they like THE ANSWER).

As Melissa points out, some people have mental health issues.
Others have not-quite mental health issues: they have low self esteem, 
and may be struggling with life-circumstances that are quite horrifying 
- such as being a diabetic around (injecting) drug users, coping with 
relatives who are very ill, etc.
Others want to be thin.
Others are genuinely forgetful (we find the pump helpful as it chirrups 
at us if we go over a meal time without bolusing).
Others don't want to go hypo (it's not so much 'poor control' as 
'control at levels damaging to health').
Others may have literacy and numeracy problems.  Indeed, the 'I won't 
inject, because I might get the number wrong' patient is probably in 
this last group, or in the mental-health-issues group.  Many people are 
in more than one group.

I am doubtful that any of these groups are particularly 'fast growing' 
(?men who want to be thin, perhaps?)   I think the numbers may be 
'growing' as doctors are now being forced to admit that these patients 
are due a duty of care.  Or they may just be power mad.

Variety is best served by a patient-centred, multi-agency response. I 
went to a conference last month that suggested that diabetics might be 
given budget management responsibilities (great for the 'I won't inject 
because I can't decide how much' brigade, eh!) So if someone decided 
that getting a person in to get their mother up in the mornings was 
going to lead to better control than seeing a useless consultant who 
says 'inject 42 units, you silly woman", they can decide that.

Cheers,

Pat
dm a long time (I forget ....)
-- 
Pat Reynolds

It may look messy now ...
         ... but just you come back in 500 years time (T. Pratchett).
.
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