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Re: [IPk] RE Nice

In message <email @ redacted>, Julian Woodley
<email @ redacted> writes
>Sorry if I seem argumentative over this.  it is not my intention.  My opinion
>is this:
>A non diabetic human has insulin pumped into their system 24 hours per day in
>a predicatable manner.  The pump simulates this whereas large doses of insuln
>by injection are rarely predictably absorbed. 

Rarely?  Many people do seem able to get a fairly stable basal rate from
injected insulins.  Certainly, NICE didn't come up with any evidence to
suggest that most people are having problems with basals.

> Surely then, the pump must be
>the closest to normality that there is.  
If you are right, and it's rare, they you are right, most people need
the pump.  If you are wrong, and it's common, most people don't need the
pump.  That's where our ourgument lies, not in the value of the pump as
a method, per se.
>ok I realise some people prefer not
>to use this sort of therapy.  I also see a lot of snobbery before common sense
>in the medical profession regarding the pump. It isn't "only" about funding
>there is also an element of "I know better and I aren't willing to look at
>alternatives" in some corners of the profession.

Here we have no disagreement whatsoever.  But it's not just the pump -
it's also carbohydrate assessment, altering insulin dosage, and general
education - stuff which is not 'free' in that it costs the NHS
_something_ to employ an educator - but is far, far cheaper, and has
commensurate cost savings within the financial year.

And isn't it best to fight to change this attitude, which is, I agree
100%, a barrier to pump usage, rather than to argue, spuriously, that
'pumps are for all' - something where they _do_ have arguments against
us - indeed, I have arguments!
>Maybe this sounds unreasonable but it is what I see.
Not at all unreasonable, but, I think, good reasoning from an error.

Best wishes,

dm 30+, 508 1+
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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