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Re: [IPk] looking for your input


You need to be a sensitive to your docs concerns.  The readily available
published evidence indicates that there is an increased potential risk of
DKA with pumps.  Wredling et al Practical Diabetes 1997 vol 14 (1) p5-8 is a
useful reveiw plus update on modern pump therapy-if you want a copy let
Estelle know and she will put a copy in the post to you.  The three key
sources that are rolled out are  1). the ADA position statement 1991 -see
the latest one from 1999 available from the insulin pumpers.org website

2). Wang et al Lancet 1993:341 p1306-1309

3)  Haakens et al 1995 practical Diabetes 12:178-181

The Haakens pubn was a 4 year follow up which showed that hospitalisation
occurred exclusively in the CSII group

While understanding the historical basis for the drs concern it is fair to
point out thaty these papers were based on pump technology that no longer
exists-with infusion sets that I hope are no longer produced-many problems
in the early days were due to using PVC in the construction of the sets with
poor gluing of the needle to the tube etc. Also in the early days the
frequency of Bg tests was too low to be effective and some inappropriate
patient selection also caused problems.

No one should now get a pump without a comprehensive training programme
which trains the patient how to use the pump effectively, overcome potential
problems, recognise the devt of ketones etc.  Sending pumps through the post
or simply training people how to push the buttons is not acceptable.

So you can empaphise with the doctors concerns, accept that it is a
potential risk but that with the right training, frequent Bg monitoring,
regular changing of the infusion set and site (no Di I am not simply trying
to flog a few more sets!) this problem remains theoretical-particularly now
that pumps are comprehensively alarmed.

Best of luck

Best wishes

John H
-----Original Message-----
From: email @ redacted <email @ redacted>
To: email @ redacted <email @ redacted>
Date: 29 November 1999 14:55
Subject: Re: [IPk] looking for your input

>Thanks Di.  I'm printing that off for my doctor, as it's a very good
>summary of what I think.  No harm in having supporting documentation!
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml

for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml