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[IPk] RE: ip-uk-digest V2 #565 pregnancy, glargine, pumps & annual review

Hi I havent been able to send emails for a while but hopefully ok now.
Been keeping up with all the digest mails though.

 I need to have a moan, but dont really know whether it is justified.
After a lot of badgering about not having been seen this year for review
and having no one taking any interest in supporting me as I started on
pump therapy, I have at last had my consultants appointment.  I know
they think I can do everything myself DIY and he supported my desire to
start on a pump as I work in the NHS shift system in an intensive care
environment.  I had perfectly good HBA1cs but as so many here lots of
hypos especially at night when in retrospect I think I have spent many
years not properly sleeping but hypo.  I was lucky I suppose as
although I have not needed 3rd party assistance we persuaded the PCT of
my need.  Anyway Ive been on the paradigm pump now for over 4 months
and it is brilliant.  Latest HBA1c is 5.7% without feeling severely
hypo.  I also find that I actually feel slightly hypo in the low 4s now
so plenty of warning and dont need to do much to correct, tweak the
basal or 1 glucose tab.   

 Why moan!  Well my annual review seemed such a waste of time.  I wasnt
asked what I was doing with my insulin ie how much etc.  I sang the
praises of the pump and he accepted it is physiologically better as long
as the person using it can recognise and manage their individual needs,
which I accept is right.  I  said the first two months were really
trying to get to sort basals and I recognise that they change all the
time.  I suppose he recognises that I just get on with it but he didnt
seem concerned that Ive lost = stone  7stone down to 61/2.  Also no
one ever  looks at my feet etc and although I said Ive had shoulder
pain and really numb hands at night  gone now since on pump   I
rightly or wrongly attributed that to possibly having prolonged hypos at
night when on insulatard, got less on glargine  I didnt really get an
answer.  BP checked and see you in a year was the outcome.  The clinic
is a really depressing place to go to and I am wondering if I should
explore the possibility of trying to find an expert who preferably is
also interested in odd ball renal disease as well.  Anyone know of any
such consultant in the West of England? 

 There have been questions about pregnancy, glargine and pumps etc.
>From personal experience as someone normally very insulin sensitive, I
found insulatard awful when pregnant but that was in the days of
actrapid as well so probably a combintation caused me to have night fits
and wake up with honey all over my face and feeling as though I had done
a work out in the gym!  That was in the early 80s when no one seemed to
recognise severe hypos as a complication of pregnancy.  I had three
children all fine, I enjoyed pregnancy but not the hypos.  If I had my
time again I would definitely want to start on a pump but preferably two
or three months before trying to get pregnant so that one has had a
chance to learn about the fine tuning and prevent early problems with
cannula kinking etc. occurring in early pregnancy.  

 I found glargine awful.  I did take it in the morning which was better
for me but if I had a low enough dose to prevent night hypos I would go
high between meals particularly later in the day.  Also didnt give
enough basal cover if I was in a stress situation I would have to
correct highs with bolus injections.

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