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Re: [IPk] disappointing meeting with Sasha's consultant

In a message dated 11/29/2002 7:52:46 PM GMT Standard Time, 
email @ redacted writes:

> I have reservations about Glargine at the moment, for reasons that I don't
> want to go into.There are children in the UK using it now though.    Maybe
> another longer lasting insulin may be better than NPH.  But I don't
> understand my consultant he is saying that he would only be happy if we were
> at a hospital that had lots of experience with children but then said he
> wouldn't be happy to take over Sasha's other care like doing the HbA1cs
> even.

Hi Jackie,

As I said before, many diabetic specialists (including consultant 
diabetologists) - and note that I've taken the "I think" out of it, because 
I'm 100% certain now - have little knowledge of CSII and are only aware of 
the old studies carried out when the technique was far less reliable.  Even 
recent reviews, published in major medical journals which most medics would 
read, have focused on the early studies.  So they are scared of pumps.

Or, as Abi rightly says, they (or the PCTs) just don't have enough money to 
fund them.  

If your consultant can't see beyond the "wonderful" HbA1c result, then 
perhaps you need to give him some evidence of what lies beneath the average 
result, ie the awful peaks and troughs - and I believe that graphs are great 
for a visual impact.  Maybe you've done this already, but if not, read on!  
I've held many clinics myself where numbers are crucial, including diabetic 
clinics, and a book full of numbers is unlikely to be appreciated by most 
docs who are running behind with the clinic whereas a couple of colourful 
sheets demonstrating ups and downs can be shown quickly with effect.

You've tried MDI and it doesn't work.  If Sasha's basal rate is steady, then 
that would explain why she's had trouble with MDI.  It would also mean that 
glargine would be the next logical step, so you'd be likely to have problems 
obtaining a pump. If her basals are not stable, then you have the reason for 
a pump.

Hope this is of some use,

IDDM 30+ yrs, 508 2 yrs, medic 20 yrs
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