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[IPk] re pumps

I cetainly agree with you re attitude of some medics re the pump. Yes, I think
there is an element of arrogance involved in some cases. Some give the wrong
info re cost or dangers of pumping ( still looking at the problems i the
1980s), or even make a hopless blunder like some ones consultant on this list
about the risk of malfunction causing massive insulin dose and hypo( yeas I'm
sure this can happen but the main risk...?). There's a great reluctance on our
part to admitt we don't know. This is very wrong when something has such a big
impact on the patients life such as diabetes

I agree that if good control/ minimal hypos in terms of frequency and severity
and duration, and lifestyle flexibility ( at least within reason so that
person can safely vary mealtimes, drive, choose when to do sport, have the
career of their choice), can be maintained on MDI , then excellent
Many people in the clinic I was attending have had great success with MDI
incorporating the favourites: glargine and novorapid: sometimes spectacular
improvements in control as measured by A1c
However, I sometimes wonder what cost. I think we often play down hypos
because we don't want to be seen as not managing, or we are too afraid of the
impact of avoiding them ( eg high BG)
I wonder that anyone couldn't get better control on a pump than MDI if they
were motivated and had the correct education and support intially until they
were empowered to take control on their own. Even if on noraml days they had a
flat profile they may have days of say: housework or gardening where it would
be very difficult to maintain BG without eating phenomenal amounts. Or they
may have a slightly "unflat profile" so they compromise by running a little
higher at some points rather than go hypo at others. These problems may in
some only casue a minor inconveniance or a few point increase in A1c ( 7.5
rather than 7.1) I think the real issue here is patient competence and
committment. Most peolpe wouldn't have these. And this is in part becasue the
medical profession do not empower them, and partly the fault of the system
becasue it is so under resourced, and also a cultural thing ( passive role in
own disease management)
With the recent developments re funding it would be within the short term
interests of the eastablishment to not educate re pumps. In those who a pump
would only make a difference of from 7.4 to 7.1 %, or not having to eat as
much when exerting themselves this would not be so important ( although if not
educated and competant re general diabetes management it could prove
with many people the improvement with pump therapy may be far more
significant, so they could be denied this. If, on the other hand the NHS
adopts a more enlightend stance or people avail themselves of the advantages
of pumps and stand up for their rights ( those who perhaps were struggling
with high A1cs or problmeatic hypos on MDI, that were blamed on their
lifestyle or that's just part of having diabetes or he doesn't have the
motivation/ knowledge to have a pump), the latter excsue for denying someone a
treatment will be lost, and I wonder if eventually there will be a huge
explosion in the use of pumps, or a gradual increase so insted of 1 to 2 % of
type 1s we have 5 or 10 %
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