Group therapy at its finest.
It seems to be the month for group therapy. Following my local Diabetes UK meeting a couple of weeks ago I spent a happy few hours last night in our local hospital. They run a coffee evening a couple of times a year for all those who’ve mastered the dark art of carb counting and insulin adjustment through their training programme, or who have a pump.
Put 15 pancreatically challenged types in a room with a nurse consultant and a pump specialist nurse and you can have a great little chat and catch up on the local gossip…
The hypo/pump/driving tightrope. It was interesting to hear the pump team say that they’re starting to see patients have to tread a fine line – previously when they were applying for pump funding, pancreatically challenged types would major on any hypo issues they were experiencing to help them meet the NICE criteria for pumps. But now, people are more wary of doing that, because if you report more than two major hypos in a year, the DVLA can review your suitability to drive . So they’re stuck between a rock and a hard place – the easiest way to get a pump is to be honest about any hypo issues, but in reality that can also leave you exposed to potential DVLA issues. This was exactly Dave’s comment recently.
Someone sees sense on pump insurance. It seems our local diabetes network have decided that they no longer require people to insure their own pumps, following guidance from Diabetes UK “People with diabetes have reported being asked to insure their insulin pump themselves, despite the insulin pump being the property of the NHS. Diabetes UK believes this is an unfair burden that should not fall to the individual with diabetes and/or their carers. The NHS and pump suppliers should work towards resolution of this issue.” That’s nice for me because that was the approach I’d taken anyway. It’ll be interesting to see if teams across the country do the same.
Exercise. It’s always interesting to hear how other people deal with exercise because I find it can be a bit of a black art. The general consensus seems to be to reduce basal a few hours before, and reduce the bolus for any meal eaten up to an hour before exercise – for me, for an hour’s fast swimming I’d reduce my basal to 25%, 90mins before swimming, eat a light meal about an hour for and only bolus for about 40% of it.
For those with any serious interest in sport, www.runsweet.com has some useful tips. My favourite from last night, which had never crossed my mind, was to do a short sharp burst of intense exercise at the start of a session to force the body to produce the exercise hormones that naturally raise blood sugar. This should help stop you dropping during the session. And consider doing the same at the end, to delay any post exercise blood sugar slump. It’s certainly worth a try.
Patients can be powerful. It was good to hear the pump team talking about how genuinely valuable patient feedback is to them – it gives them ideas for what they need to be doing next and helps them to improve. But it also gives them ammunition – often when trying to improve services a well-informed patient voice can carry a great deal of weight in getting issues addressed – so far that’s proving to be the case with my eye clinic situation.
Quote of the night…“Can someone tell Medtronic to speak English – my pump told me to check for an occlusion the other night and I had to look it up in the dictionary to find out what it was.” Now I come to think of it, it’s not a word that had ever entered my world before I started pumping. Surely calling it a blockage would be simpler.
That sounds like quite a useful get together – I find I learn a tonne of useful things when I meet up with my fellow pancranaughts.
I’ve had to use occlusion on a daily basis at all of my jobs, maybe engineers are natural born pumpers!
Paying for my own insurance doesn’t bother me, I figure its the least I can do if the NHS are paying for the pump, supplies & insulin but then I rarely agree with any of DUK’s comments.
I’ve had to use occlusion on a daily basis at all of my jobs, maybe engineers are natural born pumpers!
Paying for my own insurance doesn’t bother me, I figure its the least I can do if the NHS are paying for the pump, supplies & insulin but then I rarely agree with any of DUK’s comments.
Great post Alison. I recently met with my local pump group and found it a very enlightening meeting of minds.
I would agree with @furrypaul on the insurance thing though. Theft isn’t going to happen without a little bit of physical violence so it largely comes down to loss or accidental damage. If I’m clumsy enough to break something by dropping it or throwing it at the cat then why should my health authority / PCT have to pay for it’s replacement? And by that I mean why should they pay for it upfront or through insurance? Without signing up to be a member of the Taxpayers Alliance, resources are limited and I’d rather the cost of insurance is carried by me than restricting provision elsewhere – I understand healthcare finance wastes are a separate issue but I hope you get my point.
I feel the ownership detail is interesting but not that important. I’m using a fairly fantastic bit of kit worth £3000. I feel there is an obligation on me to look after this and if I choose to be reckless with it, then I should be paying to insure it.
Insurance is about risk so if you feel you don’t need the insurance don’t get it; but accept that if you drop it out of a window you should pay to replace.
Rant over.
Did you get biscuits? The funniest part of my meeting was the DSN handing round some very nice biscuits which most people took and then went to read the nutritional info bit on the packet before bolussing away!
I haven’t actually been to one of these evening sessions since the mid-nineties when I was the youngest person there & being told stories about having to kill cattle & grind up their bones, when they were young to get at the insulin, etc.
Ok, that may be an exaggeration but it wasn’t particularly useful or constructive for me back then.
My new hospital is good & pro-pump so I may have a look & see what they do & DUK is on my way home so its possible their meetings may be more interesting.
@seasiderdave I agree with you that insurance is about risk, so if you feel you don’t need the insrance, don’t get it but accept the risk – the problem is in some cases PCTs have been demanding people sign contracts to say they’ll insure the pump before they’re allowed to have one – which is very different.
My main problem with this though is that the ability to benefit from having an insulin pump shouldn’t come down to someone’s ability to pay to insure it. I know people on pumps for whom the additional £83 a year I’ve just been quoted for pump insurance after a quick look online is money they don’t have.
Thirdly, this is a completely inconsistent policy approach. To my knowledge we don’t ask patients to insure other expensive kit they get from the NHS eg portable oxygen tanks, portable dialysis machines, wheelchairs etc. All of which are vulnerable to loss, damage and theft. They need to sort the system, not simply bodge together policy in easy to exploit areas.
@furrypaul I find the pump meetings really uplifting – you tend to get a bunch of really motivated people who can have an informed discussion. Great mix of ages too – I think every decade from 20 through to 70 was represented (although I may have just upset someone in their late 60’s by promoting them to their 70’s!). I think it does depend on who’s running the session too – my pump team are really proactive and realistic about life – which helps avoid the “you’re all going to go blind unless you stop eating cakes” approach.
@alison I take your points and maybe I’m viewing this from an oversimplistic viewpoint that gadgets cost a lot of money and I’m partially choosing to treat my diabetes this way. I do understand though for others pump treatment is less of a choice and that they might not be able to add it to their home insurance for nothing.
The only way forward is for hospitals to be consistent and demand insurance for all crutches, specimen bottles and plaster casts taken from the hospital. Is that what you mean? 😉
I think that’s where we differ Dave, I don’t see it as a gadget that was my choice, like a nice new phone – I see it as a NICE approved treatment that I meet the criteria for, and like I wouldn’t expect a cancer patient to have their best treatment given to them only if they could afford to co-pay for insurance, I feel the same for people who would benefit from pumps.
Insurance for everything is obviously the answer. Can’t stop to debate this any further, I’m off to buy shares in major insurance companies, I sense a boom coming 😉