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Re: [IPk] Consultant appointment

Hi Melissa

I know your email was directed at Phil, but my daughter would like a pump 
and we have an appointment to have CGMS fitted on the 9th June.  So your 
email will also help me put together a strong case for a pump.  We have been 
told by the our DSN, we need to prove injections are not working to get 
funding from our PCT.

Many thanks
Julia Killengray
Ellie Age 11 -  99% pancreatectomy
Tate Age 8 - 95% pancreatectomy
Both on insulin and digestive enzymes
Hospital: St John's, Chelmsford UK

----- Original Message ----- 
From: "Melissa Ford" <email @ redacted>
To: <email @ redacted>
Sent: Wednesday, May 21, 2008 9:21 AM
Subject: Re: [IPk] Consultant appointment

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> Hi Phil
> Here's a general checklist for diabetes consultant appointments, which
> will make you look very well organized and competent :)
> 1) List of all current medications/supplements (prescription &
> non-prescription), with daily dosage amounts. In the case of your
> insulins: the times of day, the amounts you inject, any correction and
> carb factors you regularly use to figure rapid-acting doses
> 2) In addition to BG logs (printed out from your meter should be
> fine), knowledge how much/what types of exercise you've done in about
> the past 2 weeks. Do you make changes to your insulin or food/drink
> intake to accommodate exercise? If so, what do you do?
> 3) Although you are not meeting with a dietician, if you can
> generalize about the amounts and types of food you usually eat in a
> "regular" day (as opposed to a special occasion), that may be helpful.
> Write a list starting with breakfast. If you regularly must have a
> snack in order to prevent a hypo, put a note by it that you aren't
> hungry for that food but it's to prevent a hypo.
> 4) How many times a month or week do you have highs and lows in your
> bg level that cause problems or delays in terms of work or other
> responsibilities (family, social, driving etc.)?
> 5) Do you wake up hypo in the night? If so, how often has it happened
> in the past 6 months or so?
> 6) Do you need extra insulin to correct your bg when you first wake up
> (fasting)? How much, how often?
> 7) How many times in about the past 3 months have you done a 3 am
> blood glucose check? (This is not a question with a "right" or "wrong"
> answer - it just indicates whether you might *need* to do some in
> order for your consultant to help fine-tune your regimen or whether
> you are already doing them and there's not a very clear pattern in
> terms of overnight bg fluctuations...also a possibility.)
> 8) When you have a hypo, how do you treat it? Do you go up high
> afterwards on a regular basis? High enough that you have to inject
> more NovoRapid to fix the high bg? (This is important because you may
> have to gain discipline in treating hypos or change your hypo
> treatment - so many people overtreat a hypo and put themselves in a
> cycle of low-to-high-to-low bgs.)
> 9) If you are carrying around some extra weight, don't be offended if
> the consultant remarks on it. If the reason you're heavy is you are
> unable to exercise as much as you'd like, a pump may really help. If
> you are underweight, you might be able to keep more weight on with
> more physiologic insulin therapy. If you are normal weight, good for
> you!
> 10) What's your family life like? (If your family are supportive
> regarding your diabetes self-care, it can make a big difference in
> health compared to them not being at all concerned or being negative.
> If you live alone, it's not entirely clear what difference it makes
> but it's good if you have someone who would check on you if you were
> ill or seemed to be missing in action some day.)
> I know that sounds like a lot, but if you want to be prepared for
> anything at least it's comprehensive....
> Melissa
> Type 1 15+ years; MiniMed pumper 7.5 years; Animas pumper 4+ years
> .
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