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Re: [IPk] NICE Appraisal

In a message dated 11/8/2002 6:16:11 PM GMT Standard Time, 
email @ redacted writes:

> I nearly lost it when I read 4.3.3. What a 
> >load of uh...I need not elaborate.
> Well, I generally agreed with what was said, although the emphasis is a
> little odd.  For example, on 4.3.3.:
> 4.3.3  The Committee heard evidence about the stringency of requirements
> necessary for people to use an insulin pump successfully, including
> scrupulous cleanliness, blood testing four times a day, estimating
> carbohydrate and calorie consumption throughout every day, moving the
> cannula site every 2 to 3 days, and programming the pump. The Committee
> believed that CSII therapy could be used only by those who were able to
> make a considerable commitment to the technology and who had the ability
> and determination to keep their blood sugar levels controlled.  

'Scuse me?  So you don't make any effort to place the site in a clean place, 
you don't test very often, you don't rely on carb counting (OK, cals not so 
important), you don't change the site regularly and you don't know how the 
pump works.  Or your parent doesn't.

All this means is that NICE considers that not EVERYONE is capable of using 
the pump (as opposed to not be being a candidate in the first place...but 
that's my bugbear and I'll keep out of that).  Most diabetics are (and NICE 
probably grossly underestimates our capacity to understand things which have 
been drummed into us from day 1 of diagnosis), but let's face it, not 
everybody is.

I do have some disagreement with the first section, which gives criteria for 
those diabetics who should be considered for pump usage.  I asked NICE how 
they would deal with pump users who, after months/years usage, would probably 
not have documented evidence of bgs showing the hypoglycaemic episodes 
required for inclusion - would the word of their diabetologist or GP suffice? 
 (I put in much more too, on other sections, but I guess that most of you did 
as well!)


IDDM 30+, 508 2 yrs
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