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Re: [IPk] iv correction bolus

>While I agree with John that properly trained patients ought to be able to
>give a couple of units intravenously, it is dangerous practice and one
>that I cannot see being approved by the UK medical profession.

At least not until UK doctors are given the authority, freedom and
resources to carefully tailor treatment strategies to the different needs
and abilities of each individual patient. The general aim of the NHS seems
to be to find a one-size-fits-all treatment plan, which is easiest and
cheapest to implement, but doesn't maximise the control and quality of life
for each individual patient.

This seems to contrast strongly with what I have seen in Germany, where a
great deal of resources are invested in helping each patient find their own
best treatment plan.

>If a
>mistake was made it could be fatal and where would the responsibility lie?

If what you suggest is true, the responsibility would lie with whoever had
agreed to take responsibility - possibly the patient - and that would be
established early on. But this sounds like an argument against people with
diabetes injecting themselves at all! - let alone testing their own bg and
adjusting their doses themselves... Imagine turning up at the clinic every
morning to join the queue of people waiting for their daily insulin
injection from the "expert" doctor! ;-)

>There has been a case where mother and father, both trained nurses, having
>read the insulin data sheets, discovered  that the only way to achieve
>'good' control in their child was to intravenously inject a small amount
>of short acting insulin at a certain time of day. It worked for months
>until the clinic staff accidentally discovered what they were doing. All
>hell let lose and social workers were called in. The result was
>catastrophic for the family concerned. While this was a child, it
>demonstrates the seriousness with which this was viewed.

I would take a different angle on this story - which I remember well. The
mother was not accused of doing something dangerous - in fact another
doctor used as an expert witness testified to this. The case revolved
around who was in charge of the child's treatment: the mother (who was
medically trained as a nurse) or the child's diabetes specialist. Under
English law, administering unauthorised invasive treatment amounts to child

The mother would test the child's bg, find it high, and respond in a
perfectly logical way, as she was professionally trained to do at the
hospital - give a couple of units of insulin iv. (This was before pumps and
Humalog - which is not licensed for children).

The crucial question here is how concerned parents should be over a child's
high bg - knowing as they do that it may ultimately cause complications.


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