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[IPk] UK doctores/ pump vs MDI

Just been to a talk given by a consultant from Cardiff re modern insulin
mainly about the advantages of glargine vs NPH
CSII only mentioned briefly " ideally all our patients would be on this but
the cost is phenomenal"
later when asked about this again he backed down and  mentioned that 3 of his
patients had tried CSII but the pump had " broken down" on all 3 and only one
patient was a " success"
makes you wonder about patient selection and support
I spoke out and mentioned that I had not encountered much in the way of
mechanical problems and that if a person is capable of driving a car safely
surely they should be capable of using a pump safely (was this Pat's argument
re NICE?)
It was the old story about motivation again but it seems that checking BG 3 or
4 times daily and reading an instruction manual, is more of a hassle to many
than having severe hypos and developing complications from poor BG control. It
must be cultural. I am sure that in the UK a patients willingness to defer to
the medical opinion and not take any responsibilty for themselves must be
fuelled by low expectations from the medical profession, so it becomes self

The other issue is that he failed to mention varying insulin sensitivities at
different times of day so there was little explanation of why CSII is
superior, and I have doubts myself as to whether MDI with glargine could not
produce equivalent control in many people, so he failed to expalin the real
advantage of a pump and why it may be a necessity to some but a lifestyle
choice for others
( I do hope I do not cause offence by this statement, but if I had very
similar basal requirements throughout 24 hours I would consider converting to
MDI with glargine and humalog or novorapid)
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