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Re: [IPk] Pump appointment at Treliske



Hi Hilly

I can understand your disappointment.

Maybe I can throw a bit of light on the situation as your healthcare
team may see it. One of the "rules of thumb" is when the A1C is above
9.0% it can be hard to tell whether a pump will really help. The first
thing to do is try to get your A1C down, steadily, perhaps targeting a
reduction of 1.0 by mid-Sept (3 months from now) and another 1.0
reduction by December (6 months from now). After you're down to 10,
maybe you can look at setting the next goal at 8%. Once you're at an
A1C of around 8.5% on MDI it may be clearer what times of day your
basal insulin needs are greater or less (one major reason why people
benefit from pumps is fine-tuning basal insulin) or whether you get
hypos according to a pattern that might be managed better if you had a
pump.

Your healthcare team owes it to you as a duty of care to work with you
if you want to set realistic goals and work to achieve them. Just
getting a pump doesn't change your A1C from 12 to 8 overnight:  a 4.0%
reduction in A1C takes up to a year, a lot of work, behaviour changes,
frequent glucose testing (probably 7-8 times a day, every day),
correcting high glucose levels sensibly (not "stacking" correction
doses or waiting until the next mealtime), and careful carbohydrate
counting/insulin adjustment.

Do you want to set that goal of getting to an A1C of 10 or less by
December? If so, I hope you'll contact your healthcare team and say
you are ready. If you don't think you can reduce your A1C at all using
the tools you have now - MDI, glucose monitoring, carb counting,
exercise - then I hope you will ask for more support and guidance in
using these tools to get to 10. Plenty of people with type 1 are
resigned to having high bgs and the suffering that comes as a result -
your healthcare team may be jaded from having seen a lot of them. If
you want to turn a corner, you can do it with the right support. But
you will have to ask for the support and put in a lot of hard work on
your own to make it happen. You may even need a referral to yet
another diabetes care team...see what your team says when you talk
about the goal of 10%.

When I got told in 2002 by a new 'diabetes nurse' at my GP's surgery
that she didn't have to tell my A1C because I wouldn't understand it
anyway, but it was "normal," I was livid. I knew because I had gotten
lazy it would have to be above 7% - definitely not "normal" if
non-diabetic is 4.5%-5.5%! After threatening to file a complaint I
heard it was 7.8%, which was high for me. As the nurse had said it was
"normal" I knew she was going to be no help in my efforts to get it
down. I was upset. I resolved to take on board all the sound advice
from better sources that I had been ignoring for a while. With the
support and insight of diabetes mentors and more helpful healthcare
professionals, plus a load of good-old fashioned discipline, I got my
A1C down to 6.9% within 3 months and lost a stone in the process.  I
haven't had an A1C above 6.5% for 6 years. In the past 6 months I've
kept my A1C at 5.7% and lost a further 10 lbs through modifying my
exercise to focus more on fat burning versus glucose utilization (this
has helped me really cut down on hypos at the gym too). For me,
exercise is key and after-meal glucose checks are essential.

Every day is a challenge - now the hard work is habit. Of course once
in a while it's necessary to chill out and relax a bit (just a bit!).

I think you can make it happen.

Melissa
Type 1 15+ years; MiniMed pumper 7.5 years; Animas pumper 4.5 years

On Fri, Jun 20, 2008 at 9:17 PM, Hilary Beattie
<email @ redacted> wrote:
[snip]
ot being stronger. I will now have to
> lose this consultant as he only does the pump clinics which is also upsetting
> as he's really good at his job.
> My blood sugar levels are still mostly 15 -25.0 (12%)and his point was if I
> went on the pump and had a target of even .
> 8% I would inevitably gain more weight. I really dont want this as it may
[snip]
.
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