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Interesting Diabetic Review :)

GrantGam

Well-Known Member
Messages
2,603
Location
Scotland
Type of diabetes
Type 1
Treatment type
Insulin
Morning all!

So had my six monthly review at the clinic yesterday and had an interesting/unexpected discussion with the Dr that ultimately resulted in leaving the clinic with a pump referral :)

When it came to discussing any issues, the only one I really had was my fairly recent battles with DP. I cite this as the only reason for my raised A1c (40 to 45 in four months). Although still within the "target range", it's a total nightmare and something which means I can't lie in. And when I do (accidentally): hello 12-15mmol/L...

Then came the discussion of my control, as pleased as the specialist was - she asked me how difficult it was to maintain. I replied with a modest response saying that "it wasn't so bad" once having worked out my split basal dosage, DP correction on waking, pre-bolus timings for poorer GI meals, correction factors for exercise/miscalculated mealtime carbs, I:C ratio/basal adjustments for less active days. All in all, between 6-10 injections per day...

Then came the surprise. The specialist asked me if I'd ever thought about pump therapy. I said I had given it good thought due to the flexibility, possible BG control improvements, etc. However, I had never seriously considered it due to not "ticking enough of the boxes". To this she basically said that just because my A1c is not high does not disqualify me from pump eligibility. I did not expect to hear that one bit! She then continued to outline that although my control is perceived as "good", it's coming at a price: multiple daily injections and DP issues. It was reassuring to hear from a Dr that trying hard and succeeding does not make you less eligible than trying and failing, or not trying and failing. It's a relief to hear that you don't have to relax on BG management to let your A1c rise enough to "meet criteria" outlined by a governing body.

To cut a long story short, my visit to the clinic was a good one. What I thought was going to be a 10 minute routine chat turned into an interesting, in-depth talk covering topics from islet cell transplant research to closed-loop artificial pancreas possibilities and pump therapy options! I think the specialist was most pleased with the interest I have in my condition and the firm grounding I have with regards to diabetes and its effects on my body. For the short period of time spent in the Dr's office, the engaging conversation and exchange of information almost made diabetes seem like fun...

Regarding pump funding, hopefully some of the aforementioned will work in my favour. Whether it does or not, I don't know. I'm just pleased that the possibility has been discussed without the need for a battle with those who are there to help. I guess I'm lucky and have a very friendly, kind and understanding care team. Although early days, I'm pretty happy and look forward to seeing how this all turns out.

The concept of a pump does appeal to me very much. I like the idea of having even greater control than MDI, without the need for excessive injections. Adjustable basal rates (or TBR's?) to help my DP would really help me greatly! However, I am concerned about having a "machine" attached to me 24/7. I've never experienced anything like that before so have no idea if it would suit me or not. Potential failures also concern me a bit, I guess without a true basal insulin on-board you're always that bit closer to soaring blood sugars, in the event that there is a delivery problem with the pump's QA insulin.

Even the option to trial a saline pump would be a great opportunity for me. I'd then get a great picture of what life with one would be like. Specifically whether it would be practical for me as a marine electrician. Anyway, we'll just see what happens at my next review in the Spring time :)

Cheers,
Grant
 
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Great appointment !!
it is reassuring to know those doctors do exist.
 
Morning all!

So had my six monthly review at the clinic yesterday and had an interesting/unexpected discussion with the Dr that ultimately resulted in leaving the clinic with a pump referral :)

When it came to discussing any issues, the only one I really had was my fairly recent battles with DP. I cite this as the only reason for my raised A1c (40 to 45 in four months). Although still within the "target range", it's a total nightmare and something which means I can't lie in. And when I do (accidentally): hello 12-15mmol/L...

Then came the discussion of my control, as pleased as the specialist was - she asked me how difficult it was to maintain. I replied with a modest response saying that "it wasn't so bad" once having worked out my split basal dosage, DP correction on waking, pre-bolus timings for poorer GI meals, correction factors for exercise/miscalculated mealtime carbs, I:C ratio/basal adjustments for less active days. All in all, between 6-10 injections per day...

Then came the surprise. The specialist asked me if I'd ever thought about pump therapy. I said I had given it good thought due to the flexibility, possible BG control improvements, etc. However, I had never seriously considered it due to not "ticking enough of the boxes". To this she basically said that just because my A1c is not high does not disqualify me from pump eligibility. I did not expect to hear that one bit! She then continued to outline that although my control is perceived as "good", it's coming at a price: multiple daily injections and DP issues. It was reassuring to hear from a Dr that trying hard and succeeding does not make you less eligible than trying and failing, or not trying and failing. It's a relief to hear that you don't have to relax on BG management to let your A1c rise enough to "meet criteria" outlined by a governing body.

To cut a long story short, my visit to the clinic was a good one. What I thought was going to be a 10 minute routine chat turned into an interesting, in-depth talk covering topics from islet cell transplant research to closed-loop artificial pancreas possibilities and pump therapy options! I think the specialist was most pleased with the interest I have in my condition and the firm grounding I have with regards to diabetes and its effects on my body. For the short period of time spent in the Dr's office, the engaging conversation and exchange of information almost made diabetes seem like fun...

Regarding pump funding, hopefully some of the aforementioned will work in my favour. Whether it does or not, I don't know. I'm just pleased that the possibility has been discussed without the need for a battle with those who are there to help. I guess I'm lucky and have a very friendly, kind and understanding care team. Although early days, I'm pretty happy and look forward to seeing how this all turns out.

The concept of a pump does appeal to me very much. I like the idea of having even greater control than MDI, without the need for excessive injections. Adjustable basal rates (or TBR's?) to help my DP would really help me greatly! However, I am concerned about having a "machine" attached to me 24/7. I've never experienced anything like that before so have no idea if it would suit me or not. Potential failures also concern me a bit, I guess without a true basal insulin on-board you're always that bit closer to soaring blood sugars, in the event that there is a delivery problem with the pump's QA insulin.

Even the option to trial a saline pump would be a great opportunity for me. I'd then get a great picture of what life with one would be like. Specifically whether it would be practical for me as a marine electrician. Anyway, we'll just see what happens at my next review in the Spring time :)

Cheers,
Grant

You wont have an opertunity to tril a pump Grant and to be honest ill be surprized if you havent got one full time within 6-9 months. Any chance of telling us where this lovely dr might be?
 
You wont have an opertunity to tril a pump Grant and to be honest ill be surprized if you havent got one full time within 6-9 months. Any chance of telling us where this lovely dr might be?
My clinic (apparently) allows patients to wear pumps administering saline if they feel that a pump may hinder their job or conflict with their way of life. It makes sense really. That's what I meant by "trial a saline pump".

I live in the North East of Scotland, not far from the commercially grown Haggis actually:) Joking aside, my clinic is in a place called Elgin.

Grant
 
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Nice one Grant hope your dreams come true, do purchase Pumping insulin as this will help you no end before and after you start on a pump.
 
I believe all new pump users are initiated on saline to get used to wearing/adjusting and becoming familiar with the pump before insulin is used, I was, so believe it's standard procedure.

Great news, having a good appointment is what we all strive towards, I think if you show a keen interest and are already doing as much as you can in managing your condition then you are in a better position when it comes to accessing a pump as your team know you will try your best in making it work for you, there's little point handing out a pump to someone who only shows limited interest as chances as it won't work for them. I got mine at the same time as a roofer who wasn't managing to keep his BG levels down during the day (due to being on the roof and not injecting) so was high all day and only in range later in the day, he tried the saline pump option and handed it back after a few days but he wasn't keen to start with as only felt comfortable being on a roof if his levels were elevated. If you really want it then it's going to work for you :)
 
That's great news grant about the possibility of going on a pump.
My clinic is also elgin it's a small world

Del
 
I believe all new pump users are initiated on saline to get used to wearing/adjusting and becoming familiar with the pump before insulin is used, I was, so believe it's standard procedure.

Great news, having a good appointment is what we all strive towards, I think if you show a keen interest and are already doing as much as you can in managing your condition then you are in a better position when it comes to accessing a pump as your team know you will try your best in making it work for you, there's little point handing out a pump to someone who only shows limited interest as chances as it won't work for them. I got mine at the same time as a roofer who wasn't managing to keep his BG levels down during the day (due to being on the roof and not injecting) so was high all day and only in range later in the day, he tried the saline pump option and handed it back after a few days but he wasn't keen to start with as only felt comfortable being on a roof if his levels were elevated. If you really want it then it's going to work for you :)


No I started straight on insulin, wasnt given the choice of anything else. (probably as they knew i wouldnt be giving it back!) I didnt even realise giving it back was an option tbh.
 
Fantastic, @GrantGam1337 - really heartening to hear!

And I'm sure once you're hooked up to that saline you'll find it much, much less of a 'thing' than you're imagining at the moment.

GO FOR IT!

:happy::happy::happy:

Edited to say I wasn't offered saline - it was straight away on the real thing - although I had been lent an old pump to wear for a week to see how it felt before I made the decision that I wanted to get one - I stuck a cannula on (but not IN) and went about my daily life of swimming and working and showering and sleeping with it on, and getting used to disconnecting and reconnecting for swimming etc. I found that very useful.
 
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Nice one Grant hope your dreams come true, do purchase Pumping insulin as this will help you no end before and after you start on a pump.
Many thanks, was looking for an ebook for the 6th edition last night but only paperback? May have to purchase the paperback and wait till I'm back home to read through.

Cheers,
Grant
 
I believe all new pump users are initiated on saline to get used to wearing/adjusting and becoming familiar with the pump before insulin is used, I was, so believe it's standard procedure.

Great news, having a good appointment is what we all strive towards, I think if you show a keen interest and are already doing as much as you can in managing your condition then you are in a better position when it comes to accessing a pump as your team know you will try your best in making it work for you, there's little point handing out a pump to someone who only shows limited interest as chances as it won't work for them. I got mine at the same time as a roofer who wasn't managing to keep his BG levels down during the day (due to being on the roof and not injecting) so was high all day and only in range later in the day, he tried the saline pump option and handed it back after a few days but he wasn't keen to start with as only felt comfortable being on a roof if his levels were elevated. If you really want it then it's going to work for you :)
Thanks very much!

At the end of the day, I guess a pump is a tool that will only deliver results relative to what the user puts in. So here's hoping my interest and knowledge (albeit rusty compared to some forum members) will help me on this journey to qualifying. Whether pump therapy is - or isn't - for me is something I'll only get to find out after having a go. It's very, very early days but I do hope we get to that stage sometime in 2017:)

Regards,
Grant
 
So had my six monthly review at the clinic yesterday and had an interesting/unexpected discussion with the Dr that ultimately resulted in leaving the clinic with a pump referral :)

That is excellent news, hopefully the referral will be approved and you'll soon be joining us :)

A pump will undoubtedly help with your DP problem and make managing your bg levels much easier, injecting multiple times over and above the norm could eventually lead to lipohypertrophy issues so now is a good time to change over to a pump. Good luck Grant.
 
That is excellent news, hopefully the referral will be approved and you'll soon be joining us :)

A pump will undoubtedly help with your DP problem and make managing your bg levels much easier, injecting multiple times over and above the norm could eventually lead to lipohypertrophy issues so now is a good time to change over to a pump. Good luck Grant.
I hope so too @noblehead, we'll just wait and see I suppose:)

The lipohypertrophy is one of my main concerns regarding loads of injections. Even though I have a good site rotation plan in place - I can imagine 30+ years of injecting would result in some fatty areas. I'm also limited to using the upper-buttocks area for basal as going into my thighs leaves lumps and bruises almost every time. I just think there isn't enough fat there...

A quick question for you, the "Pumping Insulin" book - is it worth forking out the extra £10 for the sixth edition?

Thanks!
Grant
 
A quick question for you, the "Pumping Insulin" book - is it worth forking out the extra £10 for the sixth edition?

Without a doubt Yes.

Long before I started pumping insulin I'd seen the book mentioned many times on the forum by members such as Azure and Carbsrok, I decided to buy it not long after I got approval and read it even though my actual start date was weeks away, tbh some of the book didn't make sense but it give me a good foundation which carried over when I did start on the pump.

It's a book you can keep referring back to time and time again, I often pick it up and have quick read if I'm experiencing some difficulties, that said mind Think like a Pancreas has some good information and advice too.
 
Without a doubt Yes.

Long before I started pumping insulin I'd seen the book mentioned many times on the forum by members such as Azure and Carbsrok, I decided to buy it not long after I got approval and read it even though my actual start date was weeks away, tbh some of the book didn't make sense but it give me a good foundation which carried over when I did start on the pump.

It's a book you can keep referring back to time and time again, I often pick it up and have quick read if I'm experiencing some difficulties, that said mind Think like a Pancreas has some good information and advice too.
Many thanks for getting back. I'll order up the sixth edition in that case and have it sent to my work. Wouldn't hurt to have the most up to date version of the book considering the way CGM has come on in the last couple of years.

Many thanks!
Grant
 
Many thanks for getting back. I'll order up the sixth edition in that case and have it sent to my work. Wouldn't hurt to have the most up to date version of the book considering the way CGM has come on in the last couple of years.

Many thanks!
Grant

Sorry Grant I may have misunderstood your previous post, do you already have a copy of Pumping Insulin but want the latest edition?
 
Sorry Grant I may have misunderstood your previous post, do you already have a copy of Pumping Insulin but want the latest edition?
No problem :) I thought you may have misread as the latest edition came out last month sometime.

The newest (sixth) edition is £23 or so with Amazon Prime, and the prior (fifth) edition is around £12 and available for digital download. This is what I was referring to when I was on about saving a tenner.

Any thoughts?

Cheers,
Grant
 
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