Is going on to a pump over-mystified by the HCP population and to some extent, users?

[tim2000s]

There are lots of new topics posted about going on to a pump and the excitement and anxiety that this drives, and it set me wondering. Does the difficulty of getting pumps in the UK, and the HCP mechanism and reaction to hand over drive a mystification of pump use?

The reality of it is that it is just another insulin delivery device, all be it one that allows us to better match background insulin levels to what our body does, and yet for some reason, pump change overs are built up almost to a frenzy.

Now I admit I like my pump, and I wouldn't want to go back to MDI, but neither should it be this way! If they were common devices that every T1 was given on diagnosis, there wouldn't be the hoohar associated with changing over to something that makes life easier, but also requires a bit of work.

Do you think I'm barking up the wrong tree, or does the healthcare profession drive a level of over-mystification of pumps and as a result what they are capable of as a result of our UK prescribing model?

 

[AndyS]

Read this on your blog on the way to work. All excellent points and I found myself nodding in agreement.

I think you have kind of hit the nail on the head there in that pumps do seem to be put out there as this magical device that will solve all. Restricting it to people who (and I hate to use this next term to please forgive me) "failing in their control" are pretty much shunted to the head of the queue.

Pumps really should be treated as just another management technique though I do think that due to the nature of how they work they should NOT be considered in isolation but as part of a larger solution that includes CGM and much more fine grained monitoring working much closer with the medical team, at least in the early days.

Certainly with the way that most things cam be synced to the cloud I see little reason why HCP's could not simply monitor things remotely. Tie in some analytics and you could essentially give them a high level view so that they only actually get their attention called if things are outside of where they should be.

But as with most things in the NHS it seems to come down more to cost than to outcome or patient quality of life.

Either way, a very interesting read there sir!

/A

 

[azure]

Yes, I largely agree with that @tim2000s

From my own experience, I'd say that the hoohah has increased over the years, which is kind of the opposite way you'd think it would happen. When I got my pump 12 years ago, there was no major build up, no real delay, no fuss. I was connected up to it, with insulin, about an hour into my training session. My local hospital isn't as bad as some I've read about on here, so there's a lesser level of hoohah, but still they do make more of a song and dance about it.

My personal belief is that the reason for this is the fact that more people, of varying abilities and knowledge, are getting pumps now, so education has to cover all people and thus has to be more thorough than many people might need.

In addition, the newer, more complicated pumps might necessitate extra input from a training team whereas the older ones were simple but just as effective (in my opinion).

 

[tim2000s]

In addition, the newer, more complicated pumps might necessitate extra input from a training team whereas the older ones were simple but just as effective (in my opinion).

And you know what? Even with the modern pumps, the basics are exactly the same...

 

[azure]

And you know what? Even with the modern pumps, the basics are exactly the same...

Precisely. But I think the various options/screens/software etc can worry HCPs (and pump users) so they feel they need extra time to go through everything and answer questions.

Was it you who started that thread about the perfect pump? I think I said I'd get pumps back to basics there too : D

 

[tim2000s]

Was it you who started that thread about the perfect pump? I think I said I'd get pumps back to basics there too : D

Yes, that was me! That is something that the Combo did. You had a Basic mode so that if you didn't want whistles and bells they could just be turned off.

 

[BeccyB]

I agree. I think HCPs and us lot need to remember that just because something has bells and whistles we don't have to use them. Some people will be able to exploit all the features such as temporary basal rates and that's great for them, but this shouldn't stop people who just want one basal rate (and correct as they bolus) from benefiting from a pump.
I think there's a real risk that people are scared that pumps are going to be too complicated/difficult for them to manage, when in reality they don't need to be.

 

[noblehead]

Do you think I'm barking up the wrong tree, or does the healthcare profession drive a level of over-mystification of pumps and as a result what they are capable of as a result of our UK prescribing model?

Barking up the wrong tree, I don't see that HCP's over-mystify pumps, it's a fact that some people adapt to them more than others.

 

[tim2000s]

Barking up the wrong tree, I don't see that HCP's over-mystify pumps, it's a fact that some people adapt to them more than others.

Whilst the title refers to HCPs, the real point is that the system we have in the UK results in this aspect, and as a result the profession adds to it by the hoops that must be jumped through in order to obtain one.

Yes, I'd agree that some adapt better than others, but the lack of penetration of pump therapy in the UK goes a long way to driving a belief system around what pumps will do for the individual, and I don't think this is as well addressed.

 

[noblehead]

Whilst the title refers to HCPs, the real point is that the system we have in the UK results in this aspect, and as a result the profession adds to it by the hoops that must be jumped through in order to obtain one.

As we know pumps and consumable are a expensive piece of kit compared to injections, therefore there has to be a clinical need and HCP's have to state this (and make a case) when applying for funding, it's the same for other health conditions when applying for drugs that are expensive to prescribe.

 

[AndyS]

While I am not on a pump I still believe that the pump will only be as good as the person operating it.
Since diagnosis I have managed to keep my A1c around 42 (43 last week) and that's with MDI though I do work at it. I think that there is very much an attitude in some circles that the pump will solve all your problems but as far as I can tell all you are doing is taking away one set of complications and replacing them with another.

From the comments of some pumpers on here it seems that to get the best out of a pump you in fact need to put in MORE effort than you would with MDI but then the tools are kind of there to give you finer grained control.

Have to agree with Tim really that you need to get the basics right and go from there.

/A

 

[catapillar]

I don't have a pump. I am desperate for one. Not because I think it will be a magical cure but because I want to be able to use all tools possible to try to manage my diabetes, including more delicate & pre timed adjustments that simply aren't possible on MDI. I don't feel that a pump has ever been presented as either some mythical cure or over complex beast - the impression I have had from HCPs and pump users has always been that a pump can only be as good as the user.

Undeniably, there are an awful lot of hoops to jump through to get one. But that is unfortunately part of the rationing process.

@tim2000s you seem to be suggesting that using a pump ain't rocket science, but at that same time, you frequently comment that the DOC is more engaged, more informed and more proactive than the general diabetic population. Maybe part of the mystification is in fact useful for those who are less informed?

 

[tim2000s]

@tim2000s you seem to be suggesting that using a pump ain't rocket science, but at that same time, you frequently comment that the DOC is more engaged, more informed and more proactive than the general diabetic population. Maybe part of the mystification is in fact useful for those who are less informed?

An interesting viewpoint!

 

[catapillar]

An interesting viewpoint!

What the DAFNE course taught me was a new appreciation for the phrase lowest common denominator - if you have been diagnosed type 1 and on insulin for 12 months, but ask on three separate occasions if insulin will lower your bood sugar, you might be a person who would require some fairly significant preparation that having a pump isn't just a case of pressing a few buttons & it will manage your blood sugar for you.

I appreciate its not a view point of a terribly nice person, just a pragmatic one.

 

[tim2000s]

What the DAFNE course taught me was a new appreciation for the phrase lowest common denominator - if you have been diagnosed type 1 and on insulin for 12 months, but ask on three separate occasions if insulin will lower your bood sugar, you might be a person who would require some fairly significant preparation that having a pump isn't just a case of pressing a few buttons & it will manage your blood sugar for you.

I appreciate its not a view point of a terribly nice person, just a pragmatic one.

I fully understand that. I've had plenty of interaction in a similar vein, and much of what the NHS does has to be targeted at those who struggle with comprehension.

A discussion I've had in the past is that it must be a struggle living with T1 if you struggle with numeracy. Given that the skills for life survey (2011) reckoned that 17mn adults in the UK had the numeracy skills of a primary school child (that's 1 in 3), extrapolating that to the UK diabetic population you end up with a diabetic population with numeracy issues that is some 88,000 people. How do you get them going on MDI and carb counting effectively, let alone using a pump, which while not complex, does require certain numeracy skills?

 

[iHs]

Tbh......This is just my opinion, but if most people have a basic routine in their lives, then there is probably no need to prescribe highly expensive analogue basal and bolus to control bg levels when bg control could be easier with twice daily injections . Most would comply and apart from bg testing 6 times per day initially to work out the carb qty ok, the majority would most likely be ok just testing 4 times as the insulins action is more stable than MDI

 

[tim2000s]

Tbh......This is just my opinion, but if most people have a basic routine in their lives, then there is probably no need to prescribe highly expensive analogue basal and bolus to control bg levels when bg control could be easier with twice daily injections . Most would comply and apart from bg testing 6 times per day initially to work out the carb qty ok, the majority would most likely be ok just testing 4 times as the insulins action is more stable than MDI

I tend to agree, and the move to MDI coincides with an increased incidence of higher Hba1Cs and a greater occurrence of complications amongst T1s. That can't be just down to coincidence...