Exactly. The NICE guidance states:
"It is recommended that CSII therapy be initiated only by a trained specialist team, which should normally comprise a physician with a specialist interest in insulin pump therapy, a diabetes specialist nurse and a dietitian. Specialist teams should provide structured education programmes and advice on diet, lifestyle and exercise appropriate for people using CSII."
As a result, you can end up with a lot of overheads involved. The pump discussions at Guy's include the following "guidance" (based on what I was told by the DSN):
- You must do a DAFNE course (My biggest bugbear - why do I need to relearn how to count carbs and do my ratios? Explain this one to me again please???)
- You must have an assessment with the clinical psychologist regarding pump use. (I think I probably need it more for the clinic to understand why this gets my goat)
- You must undergo pump training sessions (I can read a manual, pumping insulin and internet forums. Why are there multiple sessions to do this? I work in a technical environment and forgive me but these things are far from complex. With an hour to go over the idiosyncrasies of a pump, it's all pretty straightforward from what I can see.)
I know they have to be able to meet all the H&S pieces to make sure that people understand how to use a piece of technology, but I fail to understand why someone can be given two pens containing different insulins with little guidance and sent on their merry way, and yet you need to undergo tons of training to get hold of something that is simply a different mechanism to kill yourself by accident. The sole difference is the cost of doing so.
If you are going to misuse something expensive then it's considered much more of an issue.
I guess it varies hospital to hospital...
I had already done DAFNE, but all my consultant really needed to know was that I understood carb counting etc.
I've never seen a psychologist ever. I wouldn't object if I had to, but it has never come up.
The pump training was an hour with the pump nurse and involved her handing it over and showing me how it worked - it was in no way a big deal, but meant that I knew how it worked (including a few not-in-the-manual tips and tricks) and that they knew that O was ok with it.
Re getting the pump in the first place, again, I think it varies fairly significantly depending on your hospital.
I didn't meet hba1c criteria (though as I said to my consultant, I could easily have run things high for a few months to manipulate the results - it's a rather naive requirement), but I get a bit of dawn phenomenon (who doesn't?) and was ready to argue it re the lifestyle criteria (the reason I wanted it was to deal better with sport/activity etc).
In fact, all that happened was that I told the consultant at my clinic that I thought Is benefit from a pump, she agreed and taut was it - I was approved. That part took about 5 minutes.
There were a few delays with ordering etc, so I actually waited another month or two before it was in my hands, but the whole thing was pretty painless.
I am aware that I was lucky to have it so easy, but if anyone is interested or thinks that they might benefit from pumping, I'd definitely start out by just asking - it might be easier than you think!
We don't seek to replace, merely complement x
