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HBA1c over 100 what criteria do I need for a pump

  • Thread starter Thread starter Deleted member 45091
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Hi anyone know the criteria to access a pump, been type one for 31 years been on nova rapid and levimir the last 6 months or so from humilin M3 twice a day, sugars seem to be worse now, sugars nearly always above 20, just had another eye op last week again to save whatever sight I have left in right eye, I've been on Dafne course years ago carb count, have around 8 injections a day now, seems the insulin Iam on works as it should some times. And then not, it's pure hit and miss. Been told there's possibly a two year or so waiting list for a pump. Just not sure what to do now, it's a shame only 41 and felt with the right help and support I could of turned a corner instead of feeling more health problems are round the corner, what a sad life, just seems like a constant struggle to get the right support.
 
A pump is not the solution. A pump is just another mechanism to give insulin.
If you want a pump, you need to work with your team to understand why your insulin does not always seem to work. Is it that you are insulin resistant at certain times of day? Does your insulin stop w or king when your levels are high? These are things that can be addressed by understanding your body and how insulin works.
You mention that you attended DAFNE years ago. Maybe you need a refresher. Especially as you were not on basal bolus last time you attended. It now covers much much more than carb counting.
My advice is to ask for assistance from your diabetes team. A pump maybe the answer but you need to know how to use it and I don’t mean what the functions do - I mean how and when to use them. If you have only been following the basal/bolus regime for 6 months, you probably have a lot to learn. I don’t mean that as an insult. I mean that it is far more complex than a fixed basal dose and a fixed insulin to carb ratio. With the flexibility it brings, you need to know when and how to use that flexibility.
 
i don't know how forceful you are in communicating with your care team .... if it were me i would be constantly ringing and chasing ......clearly your control is not where you want it to be and your team will be aware of this ...if you are in the UK i would tell them that the latest NICE guidelines are saying every type 1 should have libre or full blown CGM ...,,,,keep pushing and dont accept being back of the queue.

how many times per day do you currently test / or do you have freestyle libre ??
 
One more reply yep in UK, got libre scan about 100 times a day and blood test around 15 times a day, I've tried getting extra help but struggling now, it's a shame more than sadness, not worked in over 15 years and health declining, and i try and get help it's slow, you need to meet criteria, or this technology is not for everyone and just be pushed aside, not saying I'm the world's smartest bloke but could of made a good impact on society if I had just had the proper help and support. Instead going to bed at 7pm every night and living a pittyful existence, sorry mate thanks for your reply I know you mean well, sorry won't put any more posts up
 
If you can't get your sugars headed the right way on mdi, then giving you a pump may make your condition worse, and may increase your risk of severe hypos and hypers. Your diabetes team will need convincing a pump will help and not endanger you. You know that with bg above 20 you are suffering permanent, irreversible damage, particularly your eyes right now.

In your place I would request a libre. Set out a plan for your diabetes team where you show them you plan to document every insulin dose, every bg reading, all meals with carb (+ fat) content, exercise and heart rate. Then book an appointment, probably with a nurse, sit down and go through the data, work out how your insulin sensitivity varies and ask "What do I need to change?"

Even if this doesn't get your sugars to where you need them, just seeing that you will put in the effort and work is more likely to convince your team that a pump might help, or at least, not put you in unnecessary danger.
 
Please keep talking to us. If we can help we will.

Have you been shown how to get your basal insulin levels right? This should have been your first step when being taught about the basal/bolus regime. To have sugar levels always above 20 suggests your background/basal insulin needs adjusting. Also, levemir does not last 24hr for some people, so many people split it into two injections 12hr apart.
 
Hi @DannyH and I'm sorry you haven't been able to get more help for your T1. I'm not personally a pump user (I middle along with MDI and a dexcom and when my numbers aren't where I want them one day, I try to improve them the next, with varying degrees of success) so not going to comment on the pros and cons of your team giving you one.

But as @Seacrow says, the first thing to address on a basal/bolus regime is the basal, levemir on your case. Once that is right you should be able to calculate correction dose ratios and carb ratios. Have your team been helping you with this? With levels of 20 I imagine that you are feeling pretty ill all the time aside from any diabetic issues such as eyesight.

I sympathise with you on the fact that insulin doesn't always seem to act the same way. An issue for me is that some of my injection sites are better than others (probably wasn't as careful as I should have been in my youth) so if I inject in a less good spot... It's incredibly easy (for me anyway) to overuse a spot.

Please don't give up. As seacrow already said, we'll help you if we can, and if we can't we can at least listen and attempt to provide some moral support. I work on the principle that it's never too late to improve your diabetic levels. (I've certainly had some sky high ones in my 52 years of T1.)
 

Hi,

I’m on MDI, had trouble with both eyes.. (When I say had… I had.) However, there can be a way forward using what you are currently prescribed.

Good news is, you have a Libre which is a great tool at spotting what’s not right for you & your current regime?

By all means come back & question where you are now? & what you wish for the future..

Best wishes in hoping soon you can mean well to yourself.
 
Hi @DannyH sorry to hear of your struggles. It’s not good to feel you’re battling an insoluble problem. If it were me I’d also be worried, especially about my sight.
A Dafne refresher course might be a good idea, and a first step on the road to getting a pump. It’s very useful to review what we know and how we apply it. It might help you get more consistent results with the way your insulin regime works, especially in the best way to adjust doses.
Have you been shown how to do a basal test? The general idea is that if you get basal doses right then it’s easier to go on the seeing if your bolus doses are right. It all requires lots of timing, keeping notes, weighing and measuring, and periods of fasting for the basal test.
 
Basal test. https://www.mysugr.com/en/blog/basal-rate-testing/
Do you have twice daily injections of Levemir? Twelve hours apart? I do mine at 9.00 am and 9.00 pm (21.00). Some people need different doses for the daytime and the nighttime.
When you’ve done the basal tests then you’ll have something solid to show your health team.
I think you could be really firm with them now, though, and ask for more help.
 
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