Nhs-funded Pump Without Meeting Nice Criteria?

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There are different ways to interpret the NICE guidelines.
For example, my hB1AC has always been consider "good".
However, I exercise a lot and found this led to hypos.
Therefore, the justification for me was exercise and hypos.
 

paulliljeros

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If you can show records that prove you are having to do a ridiculous amount of work to keep your levels that good, you may get one. Log every dose, and everything you can think of. If you can show that managing your diabetes using MDI in impinging on normal life, it’ll certainly help.
A very good point! I forgot to say that, part of my justification was that with the benefit of CGM, I had learnt how I could micro-bolus to maintain excellent control throughout the day, but this regime resulted in 10-12 injections per day,which is obviously unmanageable - hence direct proof I understood exactly how a pump would work and was required due to impact on my life.
 

LooperCat

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A very good point! I forgot to say that, part of my justification was that with the benefit of CGM, I had learnt how I could micro-bolus to maintain excellent control throughout the day, but this regime resulted in 10-12 injections per day,which is obviously unmanageable - hence direct proof I understood exactly how a pump would work and was required due to impact on my life.
That was key in my case. They looked at the Diasend uploads from my phone, and said my control was great, I was doing well etc - but none of my dose data was on there. Then I asked them to look at the Librelink uploads from my scanner, where I’d logged every single shot and they were horrified that i was having to do that - basically mimicking a pump by dribbling in tiny amounts every hour or so. The real bonus of all that record keeping was that we had great data to set up my pump right from the start, so transitioning was really quite easy. Just a different delivery system. I’m only seven weeks in, but haven’t had the horrendous time of switching that many people do.
 
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LooperCat

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Seriously 7 weeks! I thought it was about 2.........Just wondering what deadlines I may have missed in those 5 missing weeks! :dead:
No, I meant I’ve only had it seven weeks. It was nine days from me asking for it and actually getting it!
 

tim2000s

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The association of British Clinical Diabetologists also highlights the following factors when looking at pumps:

  • Excessive number of injections for optimised control
  • Unacceptable number of sick days
  • Pathological fear of hypoglycaemia
  • Marked glycaemic excursions/dawn phenomenon
  • Impaired exercise capacity
  • Abnormal eating behaviour
  • Shift work
  • Frequent travel across time zones
  • Suboptimal school performance
  • Exclusion from aspects of a full school life
  • Behavioural problems eg meal times
  • Adverse impact on family dynamics
While these are not part of the NICE Guidance, many pump clinics will use these criteria to get a pump start underway.
 

kitedoc

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The association of British Clinical Diabetologists also highlights the following factors when looking at pumps:

  • Excessive number of injections for optimised control
  • Unacceptable number of sick days
  • Pathological fear of hypoglycaemia
  • Marked glycaemic excursions/dawn phenomenon
  • Impaired exercise capacity
  • Abnormal eating behaviour
  • Shift work
  • Frequent travel across time zones
  • Suboptimal school performance
  • Exclusion from aspects of a full school life
  • Behavioural problems eg meal times
  • Adverse impact on family dynamics
While these are not part of the NICE Guidance, many pump clinics will use these criteria to get a pump start underway.
Thank you for that extensive list: I assume that severe hypos comes under 'excessive glycaemic excursions'.
 

tim2000s

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Thank you for that extensive list: I assume that severe hypos comes under 'excessive glycaemic excursions'.
If you look at what it's hooked up with, it's really about Basal insulin not matching background glucose output and resulting in unwanted highs.

Hypoglycaemia and impaired awareness of hypoglycaemia are already covered in the NICE technology assessment:

Continuous subcutaneous insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that:
  • attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life
 

kitedoc

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If you look at what it's hooked up with, it's really about Basal insulin not matching background glucose output and resulting in unwanted highs.

Hypoglycaemia and impaired awareness of hypoglycaemia are already covered in the NICE technology assessment:

Continuous subcutaneous insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that:
  • attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life
Thank you for that clarification.