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RE: [IPk] meeting NICE guidelines

Hi Louise,

Since moving the timing of your Lantus injection hasn't done the trick, I'd 
say yup, it ain't working for you. It means a lot that you've already tried 
moving it around so much and solving one problem has only caused at least 
one other problem. I remember being in your shoes with MDI (isophane + 
Regular) 8 years ago and I feel for you. If I could be an 'insulin pump 
fairy' and bestow pumps on people who clearly needed them, you'd be on my 
hit list!

I have to hand it to Aventis's marketing people: with slick advertising and 
rather vaguely presented data, they've given a lot of medics and nurses the 
idea that it's great for everyone and does exactly what it says on the tin. 
The number of 'professionals' I've heard say, 'But Lantus is just like a 
pump', makes me really sad (of course, after saying that in my hearing 
they've probably never said it again). I've never encountered anything or 
anyone from Aventis making that particular claim. The fact that many people 
have come to such a conclusion goes to show how little they know about 
pumps. Patients and pump companies must do more to educate both other 
patients and the people with prescribing privileges.

I have found it effective in conversations with other people who have 
diabetes and with professionals to start from the premise that an insulin 
pump relies on a different philosophy of treatment from MDI: rather than 
saying, 'Right, this seems to be the amount of insulin you need to have this 
sort of life, nevermind if you wind up having to make your life accommodate 
your insulin', pumping means, 'Right, you have a lifestyle, hormones, 
personal insulin sensitivities, favourite sports, Mum's Christmas pudding, 
and a job/course that keeps you on your toes...here's the insulin to make it 
all possible'.

What I've heard from medical professionals is that they wish they knew what 
to say to people with diabetes. The junior doc you saw most likely responded 
with what he thought was sympathy--in his eyes, you're bending over 
backwards and still frustrated, so there must be little more you can or 
should do and you shouldn't let yourself get so stressed. He's been trained 
in an acute-care model, to look at the situation right in front of him, 
think of a quick solution, and pack the patient off home. 
http://www.improvingchroniccare.org/change/model/components.html has a good 
graphic and description of an emerging model for chronic care. The fact that 
diabetes is chronic, but--unlike cancer of HIV/AIDS--one can muddle through 
with a mediocre quality of life and low health status for upteen years 
before things get critical REALLY throws the medics who think of a disease 
as a problem to be solved here and now.

No, it isn't fair,


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