[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IPk] Re: ip-uk-digest V1 #348




----- Original Message -----
From: ip-uk-digest <email @ redacted>
To: <email @ redacted>
Sent: Saturday, October 14, 2000 9:19 PM
Subject: ip-uk-digest V1 #348


>
> ip-uk-digest        Saturday, October 14 2000        Volume 01 : Number
348
>
>
>
> PLEASE edit the subject line of your reply messages.
> ####################################################
> This issue of the digest contains:
> RE: [IPk] no delivery and knots
> RE: [IPk] no delivery and knots
> Re: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pum p Users
> [IPk] Injection Swabs
> Re: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pump Users
> Re: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pump Users
> RE: [IPk] Funding of Designated Specialist Centres for Diabetic I nsulin
Pump Users
> RE: [IPk] Funding of Designated Specialist Centres for Diabetic I nsulin
Pump Users
> Re: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pump Users
> Re: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pump Users
> RE: [IPk] Funding of Designated Specialist Centres for Diabetic Insulin
Pump Users
>
> ----------------------------------------------------------------------
>
> Date: Fri, 13 Oct 2000 21:08:57 +1300
> From: "Anne Lindale  & Alexander Lange" <email @ redacted>
> Subject: RE: [IPk] no delivery and knots
>
> > >I always try to remember to refill when I'm down to the
> > >> last cm. rather than waiting till the very end.
> > >
> > >Tell me you mean mm and not cm!
> >
> > OK, having looked at a ruler and my pump, I should have said 0.5cm.
> > That's mainly because of the bubbles, and also because I have to tell by
> > feel how much insulin I've got left, and I can't be that precise, so I
try
> > to do it sooner rather than later!
> > Di
>
> Oh, another of those "duh" moments.  Now I understand and it all makes
> sense.  But that begs the question, how can you pick up that you've got ai
r
> bubbles?  I would have thought that they were devilishly hard for you to
> see.
>
> Annie
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 11:34:02 +0100
> From: Diana Maynard <email @ redacted>
> Subject: RE: [IPk] no delivery and knots
>
> >
> >Oh, another of those "duh" moments.  Now I understand and it all makes
> >sense.  But that begs the question, how can you pick up that you've got
air
> >bubbles?  I would have thought that they were devilishly hard for you to
> >see.
> >
> >Annie
>
> That is exactly my problem. I can only really tell when they come out of
> the tubing - or rather, when *no insulin* comes out of the tubing when I
> test it (having disconnected it first). By which time it's too late!
> So, I try to avoid getting them there in the first place, and I refill
> before I get to the end, since I know from experience that's where they
> tend to lurk.
> I also clip my pump on *upside down* when possible, which means if there
> are any air bubbles they go to the plunger end rather than the tubing end
> of the reservoir.
>   Di
> -
>
> I agree completely, Ray!
>
> I met with a woman Wednesday night who is being recommended for pump
> therapy. I met her thorugh a different list, and we agreed to meet so I
> could show her a pump and talk about what you need to do on a pump.  One
of
> my big concerns was to introduce carb counting, because what they teach in
> Rep of Ireland is 'healthy eating' and 'the food pyramid'.
>
> This woman is, technically, on MDI, because she takes three shots of
> actrapid a day, and two of Insulatard. We met in the evening in a quiet
> pub, where we had a meal.  She had ten units of Actrapid, and then ordered
> what turned out to be chicken breast on a bed of iceberg lettuce - for  a
> total carb count of 2.5g! She thought she was being healthy, when what she
> actually did was set herself up for hypoglycaemia.  And this is her
> clinic's fault, because they have everyone taking the same dose of insulin
> at the same time of day regardless of what they eat.
>
> I won't even bother having the rant.
>
> elizabeth
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 15:09:54 +0100
> From: Cork Phillip <email @ redacted>
> Subject: [IPk] Injection Swabs
>
> I'm having problems getting hold of pre-injection swabs (70% isopropanol)
> from my GP on the NHS (UK); can anyone help?
>
> Philip
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 16:14:06 +0200
> From: John Neale <email @ redacted>
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
Insulin 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?
>
> John
>
>
>
> - --
> mailto:email @ redacted
> http://www.webshowcase.net/johnneale
>
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 15:25:54 BST
> From: "Ingrid Morrow" <email @ redacted>
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
Insulin Pump Users
>
> You have to feel a bit sorry for the guy. I wonder what is holding him
back?
>
>
> Ingrid
>
>
> >From: John Neale <email @ redacted>
> >Reply-To: email @ redacted
> >To: email @ redacted
> >Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
> >Insulin Pump Users
> >Date: Fri, 13 Oct 2000 16:14:06 +0200
> >
> >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?
> >
> >John
> >
> >
> >
> >--
> >mailto:email @ redacted
> >http://www.webshowcase.net/johnneale
> >
> >
> >----------------------------------------------------------
> >for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> >help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> _________________________________________________________________________
> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com.
>
> Share information about yourself, create your own public profile at
> http://profiles.msn.com.
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 15:50:20 +0100
> From: Cork Phillip <email @ redacted>
> Subject: RE: [IPk] Funding of Designated Specialist Centres for Diabetic I
nsulin Pump Users
>
> Just what I was thinking! When I was first diagnosed I worked at Beecham
> Pharmaceuticals and a chap there was just the same but worse! If his blood
> sugar dropped he would slow down until he was next timetabled to eat! This
> may be sad but the impact on me was not good. Work colleagues (even at a
> drug research centre!) expected me to behave like that (i.e. strictly
> controlled) or fall apart and die. Mind you I did give a good display of
> rapid weight loss before I was diagnosed. The point I'm making is that
such
> people do influence the expectations of others around them. I would not
> accept that nor would I accept the advice of a GP, consultant or indeed
> anyone unless I understood it and agreed. This is why I was surprised that
> some members of this forum actually listen to their GPs about staying away
> from pumps - I never asked mine (ps I'm not advising anyone else to do the
> same as me!).
>
>
> Philip
>
>
>
> - -----Original Message-----
> From: Ingrid Morrow [mailto:email @ redacted]
> Sent: Friday, October 13, 2000 4:26 PM
> To: email @ redacted
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
> Insulin Pump Users
>
>
> You have to feel a bit sorry for the guy. I wonder what is holding him
back?
>
>
> Ingrid
>
>
> >From: John Neale <email @ redacted>
> >Reply-To: email @ redacted
> >To: email @ redacted
> >Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
> >Insulin Pump Users
> >Date: Fri, 13 Oct 2000 16:14:06 +0200
> >
> >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?
> >
> >John
> >
> >
> >
> >--
> >mailto:email @ redacted
> >http://www.webshowcase.net/johnneale
> >
> >
> >----------------------------------------------------------
> >for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> >help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> _________________________________________________________________________
> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com.
>
> Share information about yourself, create your own public profile at
> http://profiles.msn.com.
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 16:06:49 +0100
> From: Cork Phillip <email @ redacted>
> Subject: RE: [IPk] Funding of Designated Specialist Centres for Diabetic I
nsulin Pump Users
>
>                                  [this is the second attempt at typing out
> this message!]
>
> John,
>
> The funding of work carried-out at Hospital Trusts is undergoing change at
> the moment. It is likely that PCGs/PGTs will take over a large element of
> the commissioning of contracts with Trusts. They are established to take a
> more local view of the world and may well be under pressure to justify
> themselves by cutting expenditure in certain areas. I have no way of
> predicting the outcome but it may well be that some PCTs will support
their
> local GPs simply because GPs will form part of their main boards, and
favour
> GP based diabetic care.
>
> Some Trusts appear to be building up support for IP users. I believe when
we
> met at Milton-Keynes that you mentioned Bournmouth, Harrogate and I think
> Birmingham as examples. As I say, my interest is to help these recieve
> funding by putting them in touch with the team drafting the proposals. Can
> you help me by providing a list of contacts, say the consultant at each
> centre? I would prefer to use e-mail because it is quicker.
>
> Philip
>
>
> - -----Original Message-----
> From: John Davis [mailto:email @ redacted]
> Sent: Thursday, October 12, 2000 5:38 PM
> To: Insulin Pumpers
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
> Insulin Pump Users
>
>
> This is not a new idea, both Disetronic and MiniMed have for some time
been
> trying to set up "Centres of Exellence" in regional hospitals across the
UK.
> The problem is to convince the medical professionals that pump therapy
works
> and to be prepared to set aside enough time to be trained in it.
>
> In the real world, what happens is that the hospital say they want to
> participate
> in the training of new pump patients, but when it comes to the actual
event,
> the
> DSN, in most cases, just "pops in and out," leaving the supplier's Nurse
> Educator,
> to get on with the initial training. As for the consultants!! They very
> rarely show.
> I am sure that Disetronic and MiniMed will confirm this. In addition both
> Disetronic
> and MiniMed send reams of information and literature to consultants, which
> just
> ends up being filed in the "Bin." At the recent INPUT Open Day in Milton
> Keynes,
> we sent out invitations to all the consultants and nurses in the area,
from
> Bedford,
> to High Wycombe,  to Northampton and Hillingdon, not one of them made an
> appearance.
>
> In an ideal world, suppliers should be involved with the hospitals in the
> initial training and support. Then the hospitals should take over
continuing
> support, after all pump patients are diabetics, and most of the problems
> will be diabetes related. This would leave Disetronic, MiniMed and any
> others who may decide to enter the UK market, to find and train new
"Centres
> of Excellence."
>
> As far as the funding of these centres is concerned, we at INPUT believe
> this should be done by central goverment through Local Health Authorities
> and Primary Care Groups, a policy which is gaining ground rapidly. There
are
> many LHA's and PCG's already funding pump patients. Unfortunately, it is
> very
> much a case of "Post Code" prescribing. At present you have to put forward
a
> good case, but we can help with this.
>
> We have also been involved with Diabetes UK in writing to the NICE
> Secretariat,
> part of that letter reads;
>
> "Diabetes UK would therefore like to recommend that insulin pump therapy
is
> appraised by the National Institute for Clinical Excellence (NICE). NICE
> guidance would be welcomed by people with diabetes and health
professionals
> alike."
>
> Some Members of Parliament are also behind us and they are very interested
> in individual cases, and are prepared to fight for their constituents
> rights.
>
> Pump Therapy in the UK is on the way, the number of users has DOUBLED in
the
> past 9 months, (there are over 500 of us now), but there is still much to
be
> done. The number of diabetologists and DSN's who are convinced that pumps
> work, grows daily, but the main area of concern is to convince the rest of
> the
> medical professionals that pumps do work and they do not "kill people."
They
> are
> the way forward for motivated diabetics. Only then will we see a growing
> number of
> regional "Centres of Excellence."
>
> John Davis
> INPUT
>
>
>
>
>
>
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 15:38:11 +0100
> From: email @ redacted
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
Insulin Pump Users
>
> I don't really like discussing other people behind their backs, but I'm
> going to anyway :-)
> It's not for lack of info - I collared this guy at the  barbeque in
> question, demonstrated my pump, got talking about testing, etc.
> Ostentatiously ate and drank and bolused accordingly.
> Sent him all the info about IP-UK, pumps, etc. on email.
> And he's a big fan of the Internet.
> Offered him a free BG meter.
> My office is only a few yards away from his if he wants to talk.
> At the time, he seemed really interested. Since then, he's shown
absolutely
> no interest.
>
> I think it's more a case of feeling that you're OK as you are and not
> realising that things could be a lot better. Like my dad who's stuck to
his
> twice daily mix of short and long-acting. He's seen how much more
> flexibility I had on MDI and now the pump, but he doesn't have a problem
> with what he does because he's done it for 50 years and survived.
> Despite having to eat lunch at precisely 1pm or he goes hypo. And he has
> to eat a fixed amount of carbs at each meal, because he won't adjust his
> insulin to match the carbs, although he knows how much carb he needs to
> eat. If someone else cooks the meal, he eats what he's given, and takes
the
> same insulin as usual, despite the fact that it might have more or less
> carbs than is appropriate for the insulin. And then goes high or later
> accordingly.  The fact hat he could have a better life on MDI is something
> that he can't grasp. There's no real reason for him not to try it, and he
> has the info - even his doctor has asked him repeatedly if he wants to try
> it -  but he won't because he doesn't see the need.
> I've given up trying to persuade him.
> Di
>
> On Fri, 13 Oct 2000, you wrote:
> >You have to feel a bit sorry for the guy. I wonder what is holding him
back
> >
> >Ingrid
>
> >>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?
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Fri, 13 Oct 2000 19:45:28 +0100
> From: "John Davis" <email @ redacted>
> Subject: Re: [IPk] Funding of Designated Specialist Centres for Diabetic
Insulin Pump Users
>
> I believe when we
> met at Milton-Keynes that you mentioned Bournmouth, Harrogate and I think
> Birmingham as examples. As I say, my interest is to help these recieve
> funding by putting them in touch with the team drafting the proposals. Can
> you help me by providing a list of contacts, say the consultant at each
> centre? I would prefer to use e-mail because it is quicker.
>
> Hi Philip,
>
> Yes, I have a list of every consultant in the UK but it would not be
> feasible to e-mail them all. If you let me know the areas you are
interested
> in, I will e-mail those.
>
> I suggest we do this off list.
>
> Regards,
>
> John Davis.
>
>
>
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> Date: Sun, 15 Oct 2000 09:18:53 +1300
> From: "Anne Lindale  & Alexander Lange" <email @ redacted>
> Subject: RE: [IPk] Funding of Designated Specialist Centres for Diabetic
Insulin Pump Users
>
> It would seem there are quite a few who do not alter their regime.  So if
> your father eats what he's given and goes high, then he has the same
doseage
> for the next meal and eats his normal meal, that suggests to me he's still
> going to be high after the meal - in fact ad infinitum.  How does he, or
> anyone else in the same circumstances, get back on an even keel if he
> doesn't correct?  It baffles me.
> Annie
>
>  Like my dad who's
> > stuck to his
> > twice daily mix of short and long-acting. He's seen how much more
> > flexibility I had on MDI and now the pump, but he doesn't have a problem
> > with what he does because he's done it for 50 years and survived.
> > Despite having to eat lunch at precisely 1pm or he goes hypo. And he has
> > to eat a fixed amount of carbs at each meal, because he won't adjust his
> > insulin to match the carbs, although he knows how much carb he needs to
> > eat. If someone else cooks the meal, he eats what he's given, and
> > takes the
> > same insulin as usual, despite the fact that it might have more or less
> > carbs than is appropriate for the insulin. And then goes high or later
> > accordingly.
>
> - ----------------------------------------------------------
> for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
> help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml
>
> ------------------------------
>
> End of ip-uk-digest V1 #348
> ***************************
>
>

----------------------------------------------------------
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml