The pump speaks back

I’m Alison’s pump. She talks about me a lot so I’ve hi-jacked the blog to tell my side of the story. I don’t have long because we’re not apart often so I’ll get straight to it.

I’ve been with Alison for over 2 years now and overall I’d say we get on well. She’s a very enthusiastic owner, she makes me blush at times the way she raves about how fantastic I am. And so she should, I have integrated CGMS, I’m at the forefront of diabetes tech. Personally I don’t think she uses all of my capabilities – I’m sure she could spend more time downloading and analysing all the data I collect for her but apparently she has a life she wants to live.

Most of the time I get to sit in pride of place on her waistband, although don’t think I haven’t noticed that for parties that involve a posh frock I’m relegated to the bra, out of sight. That doesn’t do a lot for my ego.

This job has some good perks. She’s taken me white water rafting, sailing and on safari. I like it that she never leaves me behind although it was a little embarrassing when she spotted one of my friends in the middle of the Costa Rican jungle. Despite it’s owner speaking no English I had to endure the shame of her and Alison attempting to compare pumps via the medium of mime. I was willing my battery to run out so I didn’t have to witness the humiliating spectacle any longer.

I don’t want to sound ungrateful, Alison’s a good owner, but she can be a little hard to live with at times.

She has a tendency to shoot the messenger. I can’t predict how she’s going to react when I have to tell her that her blood sugar is too high, it’s like Russian roulette. If we’re in public I’m generally safe, she’ll acknowledge the high and put some more insulin in quickly and discretely. If we’re alone it’s a more hit and miss affair. Sometimes its fine, other times there’s furious muttering and occasional violence. Thankfully she’s only thrown me on the bed so far but she does talk about pitching me out of the window which I think is an unnecessary over-reaction. At times like this I fear for my safety.

There’s one thing though that hurts above all else. She thinks I don’t know, but I’ve seen her looking round at other pumps, seeing if there’s anything better on the market, eyeing up my replacement. I know I’ve got less than 2 years until I’m out of warranty and then what? I need to start planning for my future.

The things I know about Alison you wouldn’t believe. We’re rarely apart; I know everything about her, what I’ve told you so far is just a taster. If you want the more salubrious bits, please send money. I have to fund my retirement somehow.

Ten Tonne Tubby Timmy

After a summer diet consisting pretty much exclusively of whisky and protein I now resemble the character Greed in gory chucklefest Se7en. There are now two alternatives for me – I can either be tortured to death by a particularly inventive serial killer named John Doe, or I can cut out the whisky and do a bit more exercise.

After giving it some thought, and consulting with my wife, I’m going to go for the latter option.

The main problem with this is that I’m really not much into working out. The main flaws are that it’s boring, sweaty and time-consuming. Also in Scotland it’s not very nice outside after mid-September. And exercise hurts. Oh, and did I mention it’s as boring as hell?

I’m not a team player type of person and so the chances of me joining some sort of exercise or keep-fit club are next to zero. After all, if I wanted to spend a lot of time in a small room with a bunch of sweating, hairy men I would go to a Turkish prison.

So to try and combat these problems I’ve taken the effort to clean out our garage and turn it into a sort of pseudo-gymnasium. The effort of doing this left me puffed out and sweating like stalker focusing his night-vision goggles on an unsuspecting neighbour. Anyway, it’s given me more than enough room to put my bike up on its roller-wheel thing and I’ve set up an old set of speakers so I can connect up my MP3 player to provide phat choons (as I believe the young people of today call the Hit Parade).

So that takes care of the legs, but what about the top-half? After a considerable amount of research on the Intermaweb (about three minutes in reality) I came across “Shovelglove – the Sledgehammer Workout“.

Essentially the Shovelglove exercise regime consists of making “useful” movements with a bloody great sledgehammer. These useful movements consist of things like churning butter, chopping a tree down or driving in fence posts. As the author points out these movements are silly; but no sillier than, say, riding a non-moving bike or climbing a set of imaginary stairs in a gym.

I also quite like the concept of doing only 14 minutes of the regime at a time. The reason for this is that no calendar, such as Outlook, has an appointment period of less than 15 minutes – therefore at 14 minutes the session is the equivalent of no time at all.

The most important thing, however, seems to be the naming of your sledgehammer. After a quick look on and I had settled on “Magni the Mighty“. Rrrraaaagh! Prepare yourselves for the new slimline Timmy!

Why I'm a fan of the NHS

We Brits like to whinge about the NHS. It’s apparently inefficient with long waiting times and poor service. Yet despite its faults, I’m a fan. Why? Good or bad?

I’ve always been generally supportive of the concept of the NHS, but this support has grown over the last few years, partly driven by greater exposure to private healthcare systems through the internet. What really made me sit up and think was the realisation that in the current climate, I might be worried about my job security, but the issue of losing private healthcare coverage if I were to lose my job doesn’t feature on my agenda. Equally, I’ve never contemplated how I’m going to be able to afford my next bottle of insulin and I’ve never made healthcare choices based on what’s on special offer in the pharmacy.

In the UK we have the National Health Service. Free at the point of use, which is why I’ve never had the worries above. However, it is not, contrary to popular myth, free. In 2007 the NHS annual budget was £104 billion, which works out at a cost in tax of around £1,800 per person in the UK.

Many things infuriate me about the NHS. The fact that it takes over a week to type a letter and that healthcare for chronic conditions like diabetes is generally delivered 9-5, Mon-Fri (we still don’t seem to have worked out that patients have jobs too).

Another issue with a state run system is that it’s hard to find a clear motivator for overall improvement. Private providers drive for efficiency so that they can increase profits. The NHS doesn’t have profit, indeed if it doesn’t spend its allocated budget in a particular year it tends to be clawed back, meaning a huge drive to spend as the end of the financial year approaches. Good use of tax payers’ money? I think not.

So it has it’s faults (believe me, I could go on!), but as someone with a chronic condition I believe the concept of the NHS is a solid starting point from which we can improve.

I have the luxury of knowing that while I live in the UK, being able to afford basic life support like insulin will never be an issue for me. Most of the issues I have with the NHS I can fight to change. My own personal behaviour influences how people react to me, so I can manage their expectations . When I don’t feel I’m getting good care eg I want a pump and CGMS and can’t get one, I appeal. I work the system. I gather my facts and drive the organisation to consider my case, bringing in whoever I need to support my case, be that the Chief Exec, my MP or the press.

I admire the way a lot of American patients manage their healthcare providers like they’d manage any other supplier. In the UK, we don’t generally do this. There’s a perception that patients should be grateful for what care they get because it’s free (it’s not, its £1,800 a year, you’re paying for it!). Therefore many people don’t feel it’s appropriate to question or challenge the system. As customers, we’re not particularly demanding of the NHS.

I believe a change in the way patients act would help to improve the NHS. I treat my healthcare team like any other supplier I interact with – my bank, solicitor, electric company, car dealership etc. I try to build a good relationship whilst making my expectations clear. I provide constructive feedback – positive and negative so that they can improve. I’m conscious of my obligations – I turn up punctually to appointments armed with the relevant data. I act like an equal partner in the relationship but I have to admit, it takes a strong person to do it and it can be quite a battle to overcome a sometimes overpoweringly paternalistic approach!

But when it comes down to it, as someone with a chronic disease, I chose the cosy state owned option complete with all its faults. Why? Because I was gobsmacked when I read about people in one of the world’s richest countries, the good old US of A not knowing where their next bottle of insulin was coming from and having to balance the cost of diabetes medication against other essentials like food.

That, for me, is too great a price to pay. The NHS has many flaws but does react to pressure if push comes to shove and while we work to improve it, people are still receiving good basic healthcare. The NHS gets my vote.

Amputation rates show huge regional variation

According to the BBC: “Amputation rates for diabetes patients are 10 times higher in some parts of England than in others, according to a study. Researchers say the figures highlight the importance of ensuring the right specialist care. The findings coincide with an NHS report putting the annual cost of diabetes-related amputations at £120m.”

This dog agrees with Diabetes UK that this is a “national disgrace”. We’re used to there being a postcode-lottery for equipment including insulin pumps but for there to be such massive variation with something as important as amputations is appalling.

Source: Diabetes amputation rates show huge regional variation

Other coverage: Diabetes UK

Comatose and rotting toes – the lighter side of insulin dependency