Insulin Pump & Complications

Hi Cyrran

I have moved your post to the Insulin Pump part of the Forum so that some of out pumpers will be able to support you. By the way, which country do you live in?

Regards

Doug

Cyrran said:

I am a diabetic type 1 since 1986. I am anxious to go on the pump as my bm's go from high to low but mostly highs! My last HBA1C was 9.3. I just recently learned from my eye doctor that there is some disease at back of my eye. All this worries me and am very anxious to improve my health situation. Added to my concerns is the prospect of getting a pump. I am waiting to complete a DAFNE course since 2008. I don't live in the U.K . I spoke with my G.P recently and asked to be referred to another diabetes consultant as the present one is not 'pump friendly'. My problem is getting a consultant to recommend me for pump therapy. I have learned also that a G.P. can't do this, it has to be a hospital consultant. I feel the health professionals are ignoring my requests for pump therapy and hence I go on to suffer. I have tried everthing possible to be recommended and at this juncture, in my life, I find hope is fading for me. I want to be at least given the opportunity to go on the pump!
I would be grateful of any advise on my current predicament.

cyrryan

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Hi,
must admit to being confused by your post. Are you saying you don't live in the UK, but expect the British tax payer/NHS to pay for a pump for you? If that's the case I don't think so. :thumbdown:
If in the UK then
GP's can authorise pumps, I know this because mine did and does.

Hi Cyrran

Insulin pumps dont work magic in controlling bg levels so please dont think that by getting one everything will be ok for you. It can take a lot of bg testing throughout the day/night and adjusting the settings on the pump to get the device to control bg levels within some sort of target.

I think that if you find out online about how you can use an insulin to carb ratio correctly to control how high or low your bg levels go with the food that you eat.... your well being will get much better. Google BDEC for starters and register. You will then be able to learn all about DAFNE straight away without attending a course. I'm sure lots of diabetics reading this forum have done that although some have attended courses. If you look at the recommended bg targets that diabetics should be able to achieve with insulin and keep to eating the same quantities of carbohydrate (to start with) and test your bg levels every 2.5hrs, you should be able to make use of an insulin to carb ratio. Most diabetics start with using 1u for 10g carb and then learn through bg testing and looking at the recommended targets, how to adjust the ratio to achieve the levels. So BDEC and DAFNE first, then look towards using a pump.

A GP in the UK might only be ok with applying for funding for a pump if they are certain that you know about carb ratios and can adjust insulin all ok and of course do frequent bg tests in order to help themselves...

In the interim period, just out of interst.. How often do you test each day and night?
Would you whilst still on injections have enough strips to test perhaps on times that lead up to lows, and test 2 hrs after eating? This is what pumpers have to do for setting up their rates, and you will have to do the same when on a pump. What testing do you currently do, and when do you get your highs and lo's... Are there any patterns.

The reason I ask is that consultants have to see that you have really tried and cant get the balance right..
More so in adults, i believe as I think they see children as persons who need pumps mode to give them better control.
Have you actually asked your consultant why he/she isn't wanting you to have a pump? What was the answer.
Many people have probs getting them, but I do believe that it is possible to get one if you can prove fully that you have tried to do everything you can... Including why you believe a pump would work for you, and that you research everything about what is invokved in managing diabetes with a pump... Because it isnt the answer for everybodies lifestyles, habits, and how they care about monitoring, eating, exercising, changing rates, programmes etc.

Hello. Well this is my 4th day on a pump and find it so much easier. Like yourself I was having highs and lows but have been type 1 diabetic for 50 years. I was attending hospital to see a consultant every 6 months and although in principle on paper everything looked perfect in reality things were far from perfect. It is my opinion that it all depends on amount of funding available and I have been so lucky. I think if you can demonstrate that you are doing everything to keep your diabetes under control you have a good case, but like I said I believe it's a matter of funding available.

When I spoke to one of the reps for Southern Ireland around 5 years ago, from what he said they had very good access to insulin pump therapy a lot better than we had in the UK...

If you are having problems with control, you are very unlikely to resolve it with 4 or 5 blood tests a day...

I suggest that you get yourself, plenty of test trips, pen and note pad for some extensive testing and diary keeping..

Google the Bdec on line carb counting course, and also buy yourself a diabetic control book, John Walsh's Using Insulin is a good one.. This will tell you how to do fasting tests, how to work out the various formula's for corrections, carb/insulin ration's etc...

You need to do fasting tests to ensure that your basal insulin is correctly set, Once you've done this then

You keep an extensive dairy and in the dairy you include all this

Your Bg's, before/after meals, snacks, before/during and after exercise (Housework is exercise)
You also note down not just the amount of carbs you eaten, but also what type, was it pastry, pasta, fruit etc..
Note down, Stress levels, illness, was it a day off work or a work day...
Note down your injections sites.. Even if the noting down, whether it's warm, cold etc can help

As you can see very intensive, requires a lot of testing but well worth the effort..

As you will be able to see how different carbs adsorb in your system compared to your insulin.
Whether you have any lagging involved, i.e that exercise you've done actually impacts later dropping your blood glucose levels.
Whether Dawn P, is playing apart in problems.

Collecting this information seems taunting, but well worth the effort, as you either be able to improve your control with injections or identify the problems that can only be resolved by a pump.... If the latter not only will you have more of a case for pump, you will also find you have a better start with pump therapy, as you will know exactly what problems you need your pump to over come.
..

My GP did not request my pump but the primary care trust did through a consultant at the hospital. It was not an easy road to follow but I was keen to be on a pump, I was authorised for a pump but after research I had set my heart on a patch pump which I was Lucky enough to trial. I was turned down 3 times for funding and it took over a year of letters and nice rulings but finally i got the pump I wanted in Jan this year and have to say it was worth the wait. I feel that more emphasis should be placed on patient preference and Not just their clinical condition. After all if you are happy with your treatment and it makes managing bg's easier it should be made readily available as your long term health prospects will improve.

Cyrran said:

I have been advised by my diabetes nurse specialist to resist doing bm's after meals. Basically what jopar is suggesting is a forensic analysis of diabetes treatment. This sounds daunting but I agree that it can give a clearer picture and better prospects. However having said this, I feel the pump is designed for this process and hence why do it on injections? We can only take our treatment plan step by step and day by day as lifestyles are so unpredictable. There is also the question of predicting carbs before bolusing and so on.. but in the long term is this of benefit to the pumper?

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I thought what jopar suggested was fairly normal for all type 1's :?

If you don't count your carbs you won't know if your bolus is right and if you don't test often enough you won't know if your basal or ratios are right which is the same for injections as a pump surely.