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From Buckinghamshire, England:

I'm a Type 1 diabetic, and have been for the last 27 of my 34 years. I have tried for the past 15 months to control my diabetes tightly: trying R+N, H+N, and finally, for the last eight months, H+U. I found that N was very unpredictable (could peak 2 hours early, or 2 hours late), but find that U is too strong in late afternoon. I've asked my GP for a pump, he asked the consultant, who says it won't be any good, but if I want one, I can go to a different consultant and get one.

Can you think of anything other than a pump that might help? Can you tell me what you would say an acceptable wait time for changing a regime (to a pump or something else)? I expect it will be about 2 to 12 months before I can get a referral on the National Health Service, so should I spend money getting one privately?

I'd ask these questions to a doctor, but as my GP doesn't know anything about pumps, and my specialist is anti-pump (he has no patients who use them), so I've no one to ask.


Yes, there's something besides using a pump that would work: follow the consultant's advice and find another consultant, one who works with a diabetes team approach. Somehow, I sense there's something quirky about your insulin program, but I'm not sure if that's really the case, or if your problem relates to other factors (such as those discussed below). I anticipate that your problems should be fixable with a caring endocrinologist who works with knowledgeable diabetes nurse educators and a Diabetes Team, who's willing to work with you in a team approach to get on top of your diabetes.

Some of the things I'd expect your new Diabetes Team to do:

  • Recheck your technique with blood sugar monitoring, and set up a program of very frequent testing, and daily or twice-weekly phone calls or faxes to watch what happens when the insulin is changed. And get a new bloog glucose meter if your present one is difficult for you to use.

  • Have you see a dietitian who understands carbohydrate counting, to be sure you understand these concepts of meal planning. Then get on the revised meal plan, and keep in touch with the dietitian if problems develop.

  • Review your exercise pattern, and advise you of changes in your insulin and food to compensate for any swings in blood sugar that result from exercise. Access to an exercise specialist would be very helpful.

  • Review the stressors in your life, and attempt to eliminate any unnecessary stress, and better control the inevitably necessary ones.

  • Then set up a new insulin program. If it is accompanied by the multifactorial approach I'm describing, it should be working smoothly within a few months.

An insulin pump is an option for you, not a cure. You can wait for the NHS to process the paperwork; I surely wouldn't advise you to go buy a pump without doing all of the above also.


Original posting 5 Jun 97


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