What do I ask?

[DonnaC-T]

Ok so I'm seeing my new consultant again in two weeks, last time I saw him, four weeks ago I forgot to ask about the pump. That was the reason I originally was supposed to see him! Doh! But due to possible complications there was no actual discussion of my control etc just symptoms.
So how do I ask? What do I say? How do I convince him. I'm having lots of hypos, carb counting everything, but my hba1c is 5.7 so not in the high 'you need one' category. I would like to be able to give smaller doses which is why I first thought about a pump. Two dsn's have said it might be better for me than MDI. How did you convince yours? Thanks x

 

[noblehead]

I would have thought that your frequent hypo's was reason enough to get funding for a pump, push them on this as by all accounts insulin pumps do reduce the frequency of hypo's once a person adapts to using one.

 

[MushyPeaBrain]

Yes especially if you are having hypo unawareness as this is very dangerous so a pump would be worthwhile.

 

[DonnaC-T]

Just counted for another thread and it's been 10 a week for the last two weeks. No wonder I'm tired! X

 

[Flowerpot]

I would start by saying that I was having serious, ongoing problems with hypos despite my best efforts to avoid them and show the blood glucose results to back this up. A pump is considered as a suitable method of treatment if your HbA1c result has been reached with a lot hypos which affect your quality of life. An HbA1c of 5.7 combined with a lot of hypos to my mind does put you in the high 'you need one' category if you are unable to stop them happening on MDI, 10 hypos a week is quite a high frequency. It is the frequency and danger from hypos and the impact they are having on your life that would qualify you to be considered for pump funding.

Since using a pump, my hypos have been less severe and less long lasting, the ability to adjust basal rates by 0.025 gives much more flexibility for accurate insulin delivery. Good luck getting your pump request started.

 

[iHs]

An a1c of 5.7% is way too low for a type 1 even eating low carb meals. Dont be surprised if yr consultant wants you to relax a bit on your tightness first and then see about a pump.

 

[donnellysdogs]

Totally agree with iHs.

 

[Spiker]

An a1c of 5.7% is way too low for a type 1 even eating low carb meals. Dont be surprised if yr consultant wants you to relax a bit on your tightness first and then see about a pump.

Yes the NHS view would be that such a low Hba1c would statistically predict a high frequency of hypos. In the OPs case, they would be right.

 

[DonnaC-T]

Consultant said no. Thanks for your advice guys x

 

[Spiker]

Consultant said no. Thanks for your advice guys x

Sorry to hear that Donna but it may be for the best.

 

[donnellysdogs]

Donna..
Are you hypo aware. Did the consultant ask how often hypo's are? Whether you have needed assistance etc?

Mainly, did the consultant give you any advice on reducing hypo's?
And raising your hba1c?

 

[DonnaC-T]

Possibly. He said I'm very insulin sensitive. He also mentioned Levemir instead of Lantus but said not yet. No answers on what else is wrong with me yet. Gastro appointment in November. I just want some answers. X

 

[DonnaC-T]

Sorry crossed messages. I've got to reduce Lantus by 1 unit at night. He said ratios may need tweaking. And go to bed at higher levels. He saw my diet and asked where the carbs were. Quite frustrated at the mo x

 

[donnellysdogs]

Are your pens full units or can they deliver 1/2 units? To fine tweak you may need 1/2 unit deliverys of insulin.

It sounds as if your consultant wants to try every step of reducing hypo's by mdi prior to consideration of a pump, which is NICE guidelines when you have a hba1c that is within target levels.. Unless you have lost awareness permanently or having to have constant 3rd party help.

Lowering your basal one unit.. Make sure you check your morning levels..as it will may raise these too much if you suffer DP.

When do you next see your diabetic consultant? Is your hospital actually pump friendly?

 

[DonnaC-T]

The hospital, I'm not sure of but the diabetes clinic I go to is. I have half unit pens for both as I take quite small amounts.
I've got to see the dsn in six weeks and he said to stick with them and if they felt I needed to see him again they'd arrange it.
I'm not sure who I see about the possibility of gastoparesis/ autonomic neuropathy. GP I suppose? X

 

[donnellysdogs]

Initially you will have to see the GP and ask for a referral to a gastroenteritis consultant ref gastroparesis.

Again on seeing consultant, they will ask if anything has changed inyour diet. (I had initially said no,-and then thought jelly babies!!). Have you eliminated sources of food causing you problems?

Don't think the worst with your stomach. It us a hugely complicated organ in us. (As I found out by not eating enough fat!!)

Personally, as a pump delivers such small qtys I would have thought it could have helped your control improve longterm. However, the hospital may have different factors to consider that I'm not aware of.