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Re: [IPk] Paradigm in the UK, glargine etc.

No one has ever updated my
> education in diabetes here in the Uk.  Maybe it was asumed I knew as a
> professional.

I really emphasize with you. It's also hard to ask for help when you feel
you should be coping, especially if you fear that  people will say you
shouldn't be doing a responsible job or driving with that number of hypos,
or critiscize you for being hyper to avoid them ( th latter shouldn't occur
with your A1c!). I  never had the above comments but always feared them so I
kept things to myself. I heard about pumps and made the decision. Consultant
wasn't that postitive but ;let me try - already having had one patient on
pump after a big fight on her behalf...

I've always been plagued with hypos .
Unfortunately meany medics don't take them seriously enough unless it
creates extra work/ expense for the NHS

.  Trying glargine, but do not like
> it much, trying to persuade consultant that a pump is made for me but it
> hard work.  I have a HBA1c 5.8 pre glargine, due I think to spending much
> my sleep time hypo!
What's the A1c like now?. I expect it's the A1c thats stopping the
consultant being keen on a pump
or is he dead against pumps or seeing them as last resort only. This is
typical . Good A1c- end of story. I would love to pick up these guys by the
scruff of the neck and make them realise that patients are not an HbA1c or a
" good " or " bad" statistic

 Afternoons my blood sugar drops and then rises quite high
> pre evening meal, especially if we eat late as we often do due to ferrying
> family about, can counteract it by late afternood bolus

It sounds as if you may have a very similar basal pattern to me. I need a
much smaller rate through the afternoon and an increase in the evening
> Applying for this job made me really look into what was happening in
> care and to be honest, I don't feel the services are  anywhere near coping
> with the needs for education and ongoing education in a way that is
> for people with diabetes.  I may be a cynic, but I feel that maybe it is
> easier to leave people less informed of choices available, and certainly
> easier to teach them to have bd mixed insulin which in the 80's I believe
> done a lot without much account being taken of carbohydrate values of

I agreee whole heartedly. Patient empowerment is still not available in many
clinics. I have felt outraged by the ridiculous comments made by medics in
clinics and as a GP who reads clinic letters I have had a few laughs.
Qualified medics believe glargine is the same as the pump

> , so the basal is
> in for 24 hrs whatever comes my way!!

Yes, I would find this difficult

 The effect is supposed to be slightly
> stronger in the first 12 hrs. It is totally obvious that the glargine
level I
> need for when I'm asleep is totally inadequate when I'm working in a busy
> stressful environment.
At least you go high rather than low, during excercise as well, which may be
less of an immediate threat to your ability to do your job as usual, but I
can appreciate this must still be extremely difficult

> been putting up with what for me could be second best so am really keen to
> pump therapy and be able to vary my basal rate according to shifts and
> the fact that I do some running.

Does your consultant know you are having to give multiple extra boluses.
Would this make an argument for pump therapy in that MDI is unreasonable?
Although problems seem to be more hypers could risk of hypos at work be used
as an argument or would this lead to an " are you fit to do your job" >
situation without a solution being offered ie the pump
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