[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]
[IPk] The Times article
You have to register with The Times to read this, and the system seems very
poor (I've been waiting nearly 2 hours for my new password to arrive). So
I've copied the text, but bear in mind this is copyright material so don't
A needle match
By Jane Feinmann
A pump that releases insulin has been dubbed the closest thing to a healthy
pancreas, yet diabetics are divided over it
MEDICAL ADVANCES are typically greeted with much fanfare so why has the
news that the NHS is to provide diabetics with a new tool to control this
difficult and potentially dangerous disorder been met instead with uneasy
Diabetes is characterised by swings in blood sugar caused by problems in
the production of insulin. Although the disorder is relatively rare three
in a hundred people in Britain are affected diabetes care accounts for up
to 10 per cent of the NHS budget, largely as a result of complications,
including stroke, heart disease, blindness and kidney failure, caused by
failure to control the condition. These complications can affect anyone
with diabetes. However, the impact is disproportionately high for those
with early-onset diabetes, whose daily lives are tested by having to match
insulin injections to food and activity levels.
But thanks to a recent decision by the National Institute for Clinical
Excellence (NICE), their lives could become more flexible and "normal".
NICE has just announced that an insulin "pump" is to be available on the
NHS for those with early-onset diabetes.
The pump delivers a continuous dose of fast-acting insulin, which means
that the user no longer has to self-administer insulin by injection several
times a day. It has been described by one advocate as "the closest we can
get to mimicking a healthy pancreas" in terms of insulin release, and is
already used widely in Europe and America (half of American doctors with
diabetes use the device).
Here, however, the uptake of the pump is expected to be low. NICE has
predicted that between 1 and 2 per cent of sufferers will use the pump.
This is partly for financial reasons: at around #2,000 a year, the pump
costs up to three times as much as the most expensive injectable insulin.
But money is not the only problem, as the experiences of two sisters, both
Kate Clapham, a graphic designer and mother of three, was first given the
pump four years ago, when she was six weeks pregnant with her third child.
"The first two pregnancies were horrendously difficult, with my diabetes
constantly seesawing out of control," she says. "I suffered nocturnal fits
with the first child and had to stop driving with the second, and both
babies started life in intensive care."
When Clapham became pregnant again her specialist suggested that she use a
pump to help to control her fluctuating hormone and blood sugar levels.
"The pump isn't something you put on and forget about," she says she has
to measure her carbohydrate intake for every meal and carry out frequent
blood tests. "But despite the extra work, the pump has been a liberation,
enabling me for the first time to eat only when I'm hungry and take
exercise without having to plan it beforehand. I feel physically healthier,
happier and more confident."
But Clapham's sister, Liz Moore, a GP and mother of two, has not been
persuaded to follow her example. "My control of my diabetes has always been
reasonable, and I'm now using an improved delivery system, with better
insulin, which means that it's getting better all the time," she says.
Moore is currently on a four-injection a day regime, and says that she can
easily adjust the amount of insulin according to how hectic her life is, or
what she is eating.
"I prefer injections to having a needle permanently inserted under my
skin," Moore says. "For a start, you have to hang the pump on something,
and that is difficult when you're swimming or going to the gym."
These differences in view echo divisions in the world of diabetes care.
Diabetes UK, a patient support group, for instance, has welcomed the NICE
ruling, but it is also concerned that provision will be patchy, depending
on the view taken by local clinicians many of whom see pump therapy as
complicated and potentially risky in untrained hands, and think that it
will mean extra work for staff. Specialists are also concerned about
working with unfamiliar technology.
"We should avoid being coerced into dabbling in pump therapy by patients or
pressure groups," Dr Graham Knight, a GP in Rotherham, South Yorkshire,
wrote recently in the British Medical Journal.
There are other developments that may make pumps less attractive, according
to Stephanie Amiel, a professor of diabetic medicine at King's College
Hospital in London. While pumps have their place, insulin glargine the
type that Liz Moore uses provides many of the same benefits.
"In the 20 years that other countries have started to increase their use of
pumps, we have continued to develop better drugs and systems of delivery,"
Amiel says. "Insulin glargine provides peakless, background insulin to
which short, sharp doses of insulin boosts can be added to cope with meals
It is likely that, in the short term at least, the fitting of pumps will be
concentrated at certain centres, such as Harrogate District Hospital, where
Clapham is one of more than a hundred people who have chosen this option.
"We are all pump evangelists here," admits Sandra Dudley, the hospital's
diabetes specialist nurse. "The first time you see someone's life being
changed when they get the pump, you think it's a fluke. When it happens
every time you realise that this is something special."
Dr Peter Hammond, a Harrogate diabetes specialist, believes that specialist
opinion will change as further evidence of the benefits of pump use emerges.
"There is no doubt that fewer blood sugar highs and lows mean fewer
complications and the pump makes that happen by delivering a constantly
varying amount of insulin instead of a flat-rate dose, which the patient
has to manipulate by eating and exercising to order," he says.
He adds that new evidence from a fivecountry study of pump use due to be
published later this year is set to confirm that pumps allow better
control of diabetes, with fewer complications and a better quality of life.
"Both Kate and I would love to forget about insulin intake for ever," says
Moore. "Until then however, we'll probably continue to disagree about the
best form of therapy though, of course, we're grateful that we have both
found ways of living virtually normal lives despite our diabetes."
How it works
THE pump, about the size of a pager, is attached to the body via tubing
with a needle at the end that is inserted into the skin. The usual site is
the stomach, though the hips, thighs or buttocks are also suitable. The
pump contains a reservoir of insulin, but instead of the normal combination
of long and fast-acting insulin, only the fast-acting is used (administered
at two rates to provide long-term background insulin cover, as well as
short bursts for mealtimes). The wearer has to measure carbohydrate intake
for every meal and do frequent blood tests, then adjust this constant flow
of insulin. The pump can be carried in a pocket or attached to a belt (and
can be used even when swimming or showering). Less insulin is needed to
achieve better control.
Copyright 2003 Times Newspapers Ltd.
* BursarVixen Enterprises * Web: http://www.bursarvixen.com/ *
* Email: email @ redacted * Tel/Fax: (+44)(0) 709 226 4571 *
* Order Discworld T-shirts, DVDs, posters, diaries & more online! *
for HELP or to subscribe/unsubscribe, contact: