[Previous Months][Date Index][Thread Index][Join - Register][Login]   Help@Insulin-Pumpers.org
  [Message Prev][Message Next][Thread Prev][Thread Next]   for subscribe/unsubscribe assistance

[IPk] Justification for pump?

Our consultant has suggested that I email him with a 
request for a pump for our daughter, Emily (11), giving our 
reasons. He seems very pro-pump; he gave a talk on pumps to 
patients a few days ago and I believe the clinic is taking 
part in a trial for very young (3 and below) children using 
pumps soon.  

The problem is, Emily does not fit the NICE criteria. I'm 
hoping for advice on how to approach this and would 
particularly like to hear about any research into the 
negative effects of high and low BG's combining to produce 
an OK HbA1c. 

I am also concerned about the moral side of applying for 
NHS funding. Should we even be thinking of applying for 
funding in our situation or should we leave the money for 
those with worse control? It's difficult for me to judge 
because I don't really know how Emily's control compares to 

Emily is currently having 1 Glargine and 4 Novorapid 
injections per day. I carb count and adjust the dose 
according to Emily's BG and activity level. We take around 
8 blood tests per day, around half of these are taken 
during the night and early morning while Em is asleep. We 
have been having problems with variable BG's at night 
though the last few days had been more stable (touch 
wood!). Before this, Emily's BG was starting at around 7-8 
at bedtime and either dropping to hypo levels a few hours 
later or rising to the high teens before breakfast despite 
increasing the Glargine dose from 9 to 13. On the occasions 
when we discovered hypo's we have corrected with around 12g 
carbs which would normally raise Em's BG by around 4mmol, 
but again her BG have been in the high teens before 
breakfast. We have been quite successful at bringing her BG 
down by lunchtime recently by increasing her dose by up to 
30% to counteract insulin resistance if her BG has been 
high for a while. 

Emily's last HbA1c was 7.3; previous HbA1cs have been below 
7. The latest one was higher because we have been running 
Em's BG's higher over night in an attempt to reduce night 
time hypos after a really bad one with convulsions and 3 
hours of vomiting. We have managed to reduce the number of 
night time hypos but still get the odd one and feel unable 
to stop testing at night just in case. Over the last 30 
days there have been 2 readings below 3.3 but there have 
also been 8 other readings between 3.3 and 5 which I have 
also treated. 

I feel we were lucky last time Emily had her bad hypo 
because I was up late working. If it ever happens when we 
are all asleep we may well not realise as Emily didn't make 
much noise or wake up enough to get help even while 
vomiting. Very scary thought. It's so annoying really, if 
we didn't bother doing BG's over night, Em would probably 
have had several more bad hypos and we would qualify for a 
pump according to NICE. But because we tire ourselves out 
taking blood tests every night we don't qualify! (not that 
I begrudge the night waking but I'm not at my best during 
the day because of the lack of sleep and the whole family 
suffers as a result :-( ).

Anyway, enough waffle, here are some statistics, taken from 
our meter software, all covering the last 30 days:

Highest reading - 26.1mmol
Lowest reading  - 1.7mmol
Average - 9.5mmol
Hypos (=< 3.3mmol) - 15

Using targets of 4mmol - 8mmol:
31% of readings in range
56% above
13% below

Using targets of 4mmol - 10mmol:
49% of readings in range
38% above
13% below

A graph showing all BG's indicate peaks around 4-7, 9-11 
and 15-18mmol.

Well, thanks to anyone that's managed to plough down this 
far <g>. I would 
really appreciate any advice on either the practical or 
moral aspects of applying for NHS funding for a pump for Em 
and on the best 'angles' to use if we do.


Mum to Emily aged 11, dx Oct '99
Novorapid x 4, Glargine x 1, 
Robert aged 12 dx Mar '03 
Novomix 30 x 2 (+ Novorapid when hungry!), 
and Matthew aged 7.
for HELP or to subscribe/unsubscribe, contact: