From Cambridge, England:
My twelve year old son, diagnosed with type 1 diabetes two years ago and in good control, wants to go on the pump, but here in the UK, the National Health System does not support pump use. I located a private doctor who will manage my son on the pump, but his office is in London which is about a two hour trip, and our local doctor called to tell me he thought it was unwise to go on the pump with the managing doctor being so far away. I can't foresee any problem with my son on the pump that couldn't occur while he is taking shots. Should I reconsider?
I don't think that depending on a doctor in London, who is two hours away, is any contraindication to starting your son on an insulin pump. There are plenty of young people with diabetes who live even further away from the clinic here where I work.
However, a certain amount of preliminary homework I would l suggest:
- Learn as much as you can about pump therapy.
- Contact the local representative of the pump that you are planning on. I imagine that this might be the Swiss firm, Disetronic. I rather doubt though, in view of the NHS attitude to pumps that there will not be one just for the Cambridge area or even for East Anglia. You may have to contact the London office.
- Once you have done this, have him/her send you all the technical literature they have and use this to learn the mechanics of daily use.
- Perhaps you should also check with the doctor to be certain he is happy with this choice: it might be that he/she is more familiar with the MiniMed pump which is also very good and could supply advance instructions.
- Find out if the doctor has a nurse that you can contact after hours and on weekends in case you encounter a problem. In the U.S., these nurses are often trained as diabetes educators, and pump support for children is usually based on a team that includes a nutritionist, a nurse educator and a medical social worker. If your doctor is at Bart's or Kings or Great Ormond Street, this should not be a problem, but if not, you should inquire.
- Introduction to pump use usually takes several visits and may involve a trial period using saline solution instead of insulin (of course continuing with injections), so that it might be wise to see if you can spend a few days in London around the first visit.
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