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Re: [IPk] Funding of Designated Specialist Centres for DiabeticInsulin Pump Users

I too agree with Ray's observation.

Pump initiation is certainly best performed at a clinic with a thorough
grounding in pump use. But the clinic would serve the community best if its
specialisation was not specifically in pump therapy, but rather in all
aspects of "intensified insulin therapy". You may choose to get your basal
rate by 3 or more smaller injections of long acting insulin, and meal
boluses, geared to what you are eating, by injecting Humalog. Or you may
choose to do the whole thing by pump. Frequent injections of long acting
insulin is a nice solution, since it smoothes out the potential peaks and
troughs of once or twice daily long acting insulin.

Edwin Gale, head of diabetes care in the Bristol area, talked to me a
couple a years ago about setting up a clinic for intensified insulin
therapy. I've no idea what has come of his plan. It would be both for
pumpers and people on flexible insulin therapy - where you match the
insulin to what you are eating.

Di was telling me - very revealingly - about a colleague of hers at work
who has Type 1 diabetes, and never tests "because it hurts and there's no
point". This guy is not stupid, and has several degrees behind him, and
works on an advanced research project. And if the late morning meeting
overruns, he gets rather shifty because he's late for his lunch, and at the
office barbeque he could only eat one sausage "because it was the wrong
time of the day". We have to respect his own choices. He's seen Di's pump,
and isn't interested. But I do wonder what prompts him to accept these
restrictions on his life. Is it ignorance? Is it that no one at his clinic
has empowered him to take control?


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