# Pump funding update



## imtrying

ok, so I finally heard back from my DSN (well, she finally heard back from who she was waiting on!)....and this is what she said - 

_Hi Katie,
I have heard back from the lead nurse from Havering PCT. Basically, the GP needs to apply for special funding from the PCT but we need to assess suitability.
Obviously the main issue is regards to meeting the NICE criteria for funding, which is either HbA1c over 8.5%; or disabling hypos or fear of disabling hypos if Hba1c improved; or pregnancy.
I think if you are interested in a pump we should arrange to meet up and discuss the idea and explain what is involved. The most likely criteria for pump would be disabling hypos or pregnancy so we need to make sure you 'fit the bill'.
Let me know your thoughts on this.
Margaret_

Can anyone help me understand what this means?? Does this mean so long as I am deemed 'suitable' I will get one??

Sorry to ask such a stupid question, but I'm struggling to understand what the implications/meaning is of the email.

Thanks guys.


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## shiv

Hi Katie!

By the sounds of it, yes! Sorry if I have missed loads - why is your GP (as opposed to a hospital consultant) applying for you? It will be your GP/consultant who requests funding for you so ideally a meeting with them to get them to agree to request it is what is needed. Either way, I think you should get in to see your DSN asap to get the ball rolling.

Don't forget that as long as they agree you would be suitable for one, the PCT can't say no 

Siobhan


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## novorapidboi26

It is basically stating that you will be assessed to see if you meet the NICE criteria.........

So if you meet one of them, your in with a reasonable chance, I think......


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## imtrying

shiv said:


> Hi Katie!
> 
> By the sounds of it, yes! Sorry if I have missed loads - why is your GP (as opposed to a hospital consultant) applying for you? It will be your GP/consultant who requests funding for you so ideally a meeting with them to get them to agree to request it is what is needed. Either way, I think you should get in to see your DSN asap to get the ball rolling.
> 
> Don't forget that as long as they agree you would be suitable for one, the PCT can't say no
> 
> Siobhan




Thanks Shiv...it's because my diabetes team are not in the same PCT area (I kept my brilliant team when I moved as I didn't want to lose such a great team)....but I live in a different area so I think that its my GP who needs to say yes as the funding comes from a different PCT to my diabetes team...I think!! 

I'm seeing my GP on Friday anyway for my 'diabetic annual review' so am going to bombard them with why I should go on a pump...then I'm now off to my DSN at 4pm that afternoon to get things moving there. 

My diabetes team want me on one, my problem is I improved my HbA1C after going on their DAFNE course.... so may have shot myself in the foot. I can't claim disabling hypos as I'm a daily driver and I'd loose my license. Will see what they say Friday I suppose!


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## novorapidboi26

imtrying said:


> my problem is I improved my HbA1C after going on their DAFNE course.... so may have shot myself in the foot. I can't claim disabling hypos as I'm a daily driver and I'd loose my license. Will see what they say Friday I suppose!



Only one thing for it then...........BABIES......................

Only kidding, I hope it goes well.............you just dont know with the way things are across the country, some PCTs give them away, others claim to deny the existence of such a device..........


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## everydayupsanddowns

Hi Katie

Good luck with your application.

Here's a question - do you have a tendency to run your BGs a bit high 'just to be on the safe side' for driving? Have you ever had a nasty hypo and do you fear having another if you don't keep things nailed down? How many mini/low level dips (below 4) do you have a week? Do you absolutely *always* spot them? Do your team want you to reduce that number?

The NICE criteria allow for interpretation in terms of 'fear of disabling hypos'. I was quite honest with my DSN that I hadn't had anything like a severe episode or one that needed 3rd party assistance for years. I still qualified though, because I worried about having one. I was able to say that I spotted almost all my hypos in the 3's with good clear warning signs - but every-so-often I missed one and this made me nervous. I also said that I tended to avoid driving if possible - and when I did I made sure my levels were high 'just in case'. All of which meant the criteria were met despite an A1c that was well below 8.5%.

Sounds like your DSN wants to help you secure the funding - so good luck!


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## novorapidboi26

Whats to stop people lying about their fear of hypos then, is there any physiological test done.......?


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## everydayupsanddowns

novorapidboi26 said:


> Whats to stop people lying about their fear of hypos then, is there any physiological test done.......?



Just a consultation. How could you test it anyway? I AM scared of having nasty hypos! Isn't everyone?!


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## novorapidboi26

everydayupsanddowns said:


> Just a consultation. How could you test it anyway? I AM scared of having nasty hypos! Isn't everyone?!



I suppose, I have this picture in my head of them doing everything to prevent funding, however I have never been through the process so I dont really know...........

I know that I couldn't say I was scared of having hypos, when realistically if I was having one, I would be scared at the time..........


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## Phil65

everydayupsanddowns said:


> Hi Katie
> 
> Good luck with your application.
> 
> Here's a question - do you have a tendency to run your BGs a bit high 'just to be on the safe side' for driving? Have you ever had a nasty hypo and do you fear having another if you don't keep things nailed down? How many mini/low level dips (below 4) do you have a week? Do you absolutely *always* spot them? Do your team want you to reduce that number?
> 
> The NICE criteria allow for interpretation in terms of 'fear of disabling hypos'. I was quite honest with my DSN that I hadn't had anything like a severe episode or one that needed 3rd party assistance for years. I still qualified though, because I worried about having one. I was able to say that I spotted almost all my hypos in the 3's with good clear warning signs - but every-so-often I missed one and this made me nervous. I also said that I tended to avoid driving if possible - and when I did I made sure my levels were high 'just in case'. All of which meant the criteria were met despite an A1c that was well below 8.5%.
> 
> Sounds like your DSN wants to help you secure the funding - so good luck!



Totally agree with everything you have said Mike. The NICE guidelines for a pump are a semi-joke and a pump should be considered on a case by case application.  Understanding carb counting, ratios and adjustments are all important, as are being in control of your diabetes and diabetes education. My consultant agreed to my application even though I didn't really meet the NICE guidelines (apart from what Mike has already said above)....I basically said 'do you want me to have a higher Hba1C next time'......to meet NICE criteria! . Katie my DSN and consultant are also in a different county to my PCT (like yours) but because they recommended me for a pump....I got one, with no hassle from my GP or PCT. Good luck!


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## Ellie Jones

''The most likely criteria for pump would be disabling hypos or pregnancy so we need to make sure you 'fit the bill'.''

I like this part of the DSN e-mail, which translates into, we are fully behind you and will ensure what ever you'll will fit the bill...

The GP applying for funding is just part of the lovely protocol of paperwork source. As it's probably easier to go through the system via your GP in your area than a consultant from outside the PCT area..

Disabling hypo's can be fudged quite a bit, there's a little leeway in white lies here, 3rd party intervention did somebody pass you your hypo treat!  But also surrounding this, is to improve control you hit a problem with your sensitivity to insulin causing a hypo, and you really, really scared of having a hypo aren't you  Then you go along the line of impact of hypo's...  Not good when your job depends on meeting deadlines and you can't meet the deadline because of a hypo, even if it's just finishing off typing the letter before you go off to the loo!  Just don't mention what sort of deadline you'll talking about.

Good luck with your meeting, and by the sounds of it, your DSN is as keen for you to have a pump as you are...


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## imtrying

Thanks everyone.



everydayupsanddowns said:


> Here's a question - do you have a tendency to run your BGs a bit high 'just to be on the safe side' for driving? Have you ever had a nasty hypo and do you fear having another if you don't keep things nailed down? How many mini/low level dips (below 4) do you have a week? Do you absolutely *always* spot them? Do your team want you to reduce that number?



Mike, yesI do, but figured this was just 'normal'. I've had one very very bad hypo about 10 years ago and have run high ever since. I hated the feeling of having a hypo so I just ran high all the time. I've now bought it down and started the carb-counting in October, but I do urge on the side of caution. I also won't inject to eat if I know I'm going to be driving soon after. I'd say as well of living in fear of hypos, I also live in fear of losing my license...does that count too??! 



novorapidboi26 said:


> Only one thing for it then...........BABIES......................



hahahaha do you think my hubby will fall for it??!! could be a win-win situation there! but in all seriousness, it won't be too many years until we're wanting kids, so it is an option so I'm prepared for it.


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## everydayupsanddowns

Phil65 said:


> ..I basically said 'do you want me to have a higher Hba1C next time'...



Hahaha! That's pretty much exactly what I said too at one point, 'Would you like me to push my A1c into double figures? I can do that no problem...' My DSN said that would not be necessary


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## everydayupsanddowns

imtrying said:


> ...I'd say as well of living in fear of hypos, I also live in fear of losing my license... does that count too?!?



BABOOOOOM! She shoots... she scores!


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## imtrying

Ellie Jones said:


> ''The most likely criteria for pump would be disabling hypos or pregnancy so we need to make sure you 'fit the bill'.''
> 
> I like this part of the DSN e-mail, which translates into, we are fully behind you and will ensure what ever you'll will fit the bill...
> 
> The GP applying for funding is just part of the lovely protocol of paperwork source. As it's probably easier to go through the system via your GP in your area than a consultant from outside the PCT area..
> 
> Disabling hypo's can be fudged quite a bit, there's a little leeway in white lies here, 3rd party intervention did somebody pass you your hypo treat!  But also surrounding this, is to improve control you hit a problem with your sensitivity to insulin causing a hypo, and you really, really scared of having a hypo aren't you  Then you go along the line of impact of hypo's...  Not good when your job depends on meeting deadlines and you can't meet the deadline because of a hypo, even if it's just finishing off typing the letter before you go off to the loo!  Just don't mention what sort of deadline you'll talking about.
> 
> Good luck with your meeting, and by the sounds of it, your DSN is as keen for you to have a pump as you are...



Thanks Ellie. Yeah she's great and real advocate for pumping. The pump was her idea to start with! So glad I was off Friday anyway so I can get to see her asap to get the ball rolling...and already booked in to see my GP about my diabetes on Friday too...dare I say 'it was meant to be???' No, not tempting fate yet! 

Will let you know how it all goes... (there goes my day off resting, but hey! I know which I'd prefer!).


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## imtrying

everydayupsanddowns said:


> BABOOOOOM! She shoots... she scores!



GGGGOOOOOOAAAALLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL lol


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## Pumper_Sue

imtrying said:


> I can't claim disabling hypos as I'm a daily driver and I'd loose my license. Will see what they say Friday I suppose!



Quite right, but you  do have a fear of hypos........ Don't you? yes you do. Repeat after me.....


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## imtrying

Pumper_Sue said:


> Quite right, but you  do have a fear of hypos........ Don't you? yes you do. Repeat after me.....



I. have. a. fear. of. disabling. hypos.

How's that?! lol


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## novorapidboi26

But does no one feel bad twisting the truth and therefore stopping someone who actually is scared of dying from a hypo.........


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## imtrying

novorapidboi26 said:


> But does no one feel bad twisting the truth and therefore stopping someone who actually is scared of dying from a hypo.........



It's actually not twisting....I do fear hypos, and I fear losing my licence from having one, I just don't really talk about it as I thought that's just 'normal' so why mention it!!


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## novorapidboi26

imtrying said:


> It's actually not twisting....I do fear hypos, and I fear losing my licence from having one, I just don't really talk about it as I thought that's just 'normal' so why mention it!!




LOL, it is normal to diabetics.............................

If it works, great..........


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## trophywench

imtrying said:


> It's actually not twisting....I do fear hypos, and I fear losing my licence from having one, I just don't really talk about it as I thought that's just 'normal' so why mention it!!



Abso-flipping-lutely.

Job done!

And there was me I sent you a PM to say exactly what all the replies meanwhile have already said !

A nod's as good as a wink to a blind man .......

And if they only had 2.75 pumps a year to dispense, Diabetes teams would not even be saying the word 'pump' to most of us, just as they didn't in the not so dim and distant past.


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## everydayupsanddowns

novorapidboi26 said:


> LOL, it is normal to diabetics.............................
> 
> If it works, great..........



I don't think anyone here is suggesting 'twisting the truth'. Just realising that if the fear of hypos affects your quality of life (and I think that would be the case for many many T1s) then the NICE guidelines say you qualify for a pump if your consultant/team agrees and believe you have done as much as you can on MDI to solve your problems and come to a brick wall at the end.

I think you'd have a very good case yourself NRB (though I appreciate pumps North of the border are harder to come by). Your DP for example is all but impossible to deal with effectively without a pump. And your higher carb intake is easier to manage with a pumps advanced delivery patterns.


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## novorapidboi26

Your right, as you say, its all about the interpretation of the guidelines...........which varies from consultant to consultant..........


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## HOBIE

Good advice Mike !   I didnt have to "waffle" on to much to get mine but keep at them !    You have to say the right things (as u no not so much about hypos)       Good luck Katie.


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## Robster65

I'm in very much the same boat but within the 'non-patient-choice' system in Wales.

I've enquired on the basis of running out of viable injection sites. Slightly exagerrated but 5 a day plus corrections does take its toll after 30+ years with hopefully another 30+ ahead (I'm 46 with no complications).

I'm going to see the local consultant within the next 6 months or so (treated as new patient) to discuss and get his two pennerth. I'll mention the fear of hypos, the constant battle to keep BGs within range and the stress of finding a suitable injection site. But one criterion is DAFNE. Which is held 50 miles away. I refused to go that far to tick a box. So I'll go for demonstrating carb counting as NICE demands.

And then we'll see what comes of it. I don't particularly want a pump but then I'm pretty sick of injecting so it's about the next best thing available.

I really hope they play ball with you katie, and anyone else hoping for one.
We shouldn't have to beg for one and then live in fear of funding being withdrawn.

And they wonder why we become cynical! 

Rob


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## everydayupsanddowns

Robster65 said:


> But one criterion is DAFNE. Which is held 50 miles away. I refused to go that far to tick a box. So I'll go for demonstrating carb counting as NICE demands.



DAFNE was discussed with me but my DSN and I agreed that I was already carb counting/correcting/tweaking/coping in a sufficiently DAFNE-style way as to not require the course to meet the guidelines (though I could be referred to it if I wanted it).


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## Robster65

everydayupsanddowns said:


> DAFNE was discussed with me but my DSN and I agreed that I was already carb counting/correcting/tweaking/coping in a sufficiently DAFNE-style way as to not require the course to meet the guidelines (though I could be referred to it if I wanted it).


 
She said last visit that it was a hard and fast requirement but mentioned this time something about our area needing to do it if people couldn't travel the 50 miles.

I don't think she's clued up about the NICE requirements. She just knows what the PCT dictate. She'd never heard of INPUT either.

I think the PCT/clinic are pro-pump and don't have trouble giving them out but don't have enough bodies to process more than a few per year.

I'm not deserate and not even sure I want to go ahead but I'd like the option if I need it.

Rob


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## Pumper_Sue

> But one criterion is DAFNE. Which is held 50 miles away. I refused to go that far to tick a box. So I'll go for demonstrating carb counting as NICE demands.



Hi Rob,
please read the NICE guidelines very carefully. There is no mention of DAFNE in them at all.
The requirement is that you can demonstrate carb counting is A OK.
PCT's etc can not make the rules up as they go along just to please themselves. In many cases it's just a delaying tactic so as not to cough up for the pump. Doing this actually costs them more in the long run though.

I refused point blank to make a 100 mile round trip to do a DAFNE course. I have always carb counted so a complete waste of my time and very limited energy.


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## imtrying

Robster65 said:


> I'm in very much the same boat but within the 'non-patient-choice' system in Wales.
> 
> I've enquired on the basis of running out of viable injection sites. Slightly exagerrated but 5 a day plus corrections does take its toll after 30+ years with hopefully another 30+ ahead (I'm 46 with no complications).
> 
> I'm going to see the local consultant within the next 6 months or so (treated as new patient) to discuss and get his two pennerth. I'll mention the fear of hypos, the constant battle to keep BGs within range and the stress of finding a suitable injection site. But one criterion is DAFNE. Which is held 50 miles away. I refused to go that far to tick a box. So I'll go for demonstrating carb counting as NICE demands.
> 
> And then we'll see what comes of it. I don't particularly want a pump but then I'm pretty sick of injecting so it's about the next best thing available.
> 
> I really hope they play ball with you katie, and anyone else hoping for one.
> We shouldn't have to beg for one and then live in fear of funding being withdrawn.
> 
> And they wonder why we become cynical!
> 
> Rob



That's great Rob!! A pump was suggested for me for 2 reasons - 1 being my trouble with levels and exercise, and the 2nd was all my injections sites are screwed  they're concerned about the lumps on my arms, they've banned me from my stomach, and the cellulite I suffer as a result of injections in my legs is probably making the situation worse too. 

I hope, whatever you decide, that you at least get a choice, and that one is not made for you. 

We could be pumping newbies together!!


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## trophywench

I have a sneaky suspicion (nudge, nudge, wink, wink) that the BERTIE online course will be relaunched in an updated format, sometime ......


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## imtrying

Oh and did I mention I am meeting with my DSN this Friday, 4pm?? After seeing my GP at 9.30am?? 

And for some reason I craved my mum, and have asked her to come with me. I know it's not a big deal appointment, but I'd really like to have someone hear the same things as me so that I won't feel so alone with my diabetes management all the time (apart from you guys!!)


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## Robster65

imtrying said:


> That's great Rob!! A pump was suggested for me for 2 reasons - 1 being my trouble with levels and exercise, and the 2nd was all my injections sites are screwed  they're concerned about the lumps on my arms, they've banned me from my stomach, and the cellulite I suffer as a result of injections in my legs is probably making the situation worse too.
> 
> I hope, whatever you decide, that you at least get a choice, and that one is not made for you.
> 
> We could be pumping newbies together!!


 
I have no-go lumps at the tops of both arms and central area of stomach. Buttocks feel lumpy to me but not sure (didn't get DSN to feel this time. Maybe next visit - lucky lady! ). Thighs seem ok but need to be careful.

I tend to bruise easily in certain areas too which puts places out of action for couple of days or so.

I suspect you may be pumping before me but I'm sure I'll get there one day. My HbA1c was 6.3/6.2 but I'm due for another in next few days so will see how it goes. But certainly too low for me to claim difficulty with control or running high due to fear of hypos. Can only go on sites and 'normal' fear of hypos/complications.

Rob


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## imtrying

Robster65 said:


> I have no-go lumps at the tops of both arms and central area of stomach. Buttocks feel lumpy to me but not sure (didn't get DSN to feel this time. Maybe next visit - lucky lady! ). Thighs seem ok but need to be careful.
> 
> I tend to bruise easily in certain areas too which puts places out of action for couple of days or so.
> 
> I suspect you may be pumping before me but I'm sure I'll get there one day. My HbA1c was 6.3/6.2 but I'm due for another in next few days so will see how it goes. But certainly too low for me to claim difficulty with control or running high due to fear of hypos. Can only go on sites and 'normal' fear of hypos/complications.
> 
> Rob



Yeah but this is where I think the guidelines are flawed....a HbA1C of 6.2% does not necessarily mean good control (I'm sure it is in your case) but it can also mean fluctuating levels...which are still a problem, and don't mean that you don't suffer bad hypos!

As an aside...I also don't understand why the whole 'hypo' thing is solved with a pump??  

See what your


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## novorapidboi26

I think the fact pumps can deliver much smaller, more accurate doses are what stop the hypos........


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## Pumper_Sue

> I suspect you may be pumping before me but I'm sure I'll get there one day. My HbA1c was 6.3/6.2 but I'm due for another in next few days so will see how it goes. But certainly too low for me to claim difficulty with control or running high due to fear of hypos. Can only go on sites and 'normal' fear of hypos/complications.



You would be suprised how many haver lower A1c's but still have non ideal control as in swinging from high to low.

I have a friend on another forum who has a pump his A1c is 5.3% and has been for many years. Even pre pump. He qualified because he had a fear of having a hypo at 3.30 pm when picking the kids up from school  

My A1c was in the very low 6's when I had my pump. 
If you have lumpy injection sites then best to go for a pump sooner rather than later. This is due to scar tissue as you know, and you can not put cannulas in or near the lumps. Thus no point in a pump if no place to put the cannula.
So stop wasting time go for it.


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## trophywench

It isn't solved, 'just like that' - nothing is!

But because you have no long acting insulin in your body if you spot you are heading downwards, you can always turn your pump completely off for a bit, so you don't then necessarily, have to hit eg a 3.7 with MASSES of carbs - just a quick flash of short-acting, not necessarily any long-acting and if you can 'head em off at the pass' it potentially keeps your BG on the straight and narrow for far longer in every 24 hours than would ever be possible on MDI after a hypo.  Or most likely without any too.

You will presumably already know it gives the opportunity to make micro-adjustments to all insulin doses (bolus and basal) so you don't have to round up or down with meals or correction doses which has the same effect as described above.

Most of what I honestlly thought I already knew about my body's basal dose requirements during an average day, has been shot to pieces since going on my pump.  I didn't know what my body wanted - I only knew how to keep it relatively happy using Levemir and rounded up/down doses of Novorapid ......


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## Phil65

trophywench said:


> It isn't solved, 'just like that' - nothing is!
> 
> But because you have no long acting insulin in your body if you spot you are heading downwards, you can always turn your pump completely off for a bit, so you don't then necessarily, have to hit eg a 3.7 with MASSES of carbs - just a quick flash of short-acting, not necessarily any long-acting and if you can 'head em off at the pass' it potentially keeps your BG on the straight and narrow for far longer in every 24 hours than would ever be possible on MDI after a hypo.  Or most likely without any too.
> 
> You will presumably already know it gives the opportunity to make micro-adjustments to all insulin doses (bolus and basal) so you don't have to round up or down with meals or correction doses which has the same effect as described above.
> 
> Most of what I honestlly thought I already knew about my body's basal dose requirements during an average day, has been shot to pieces since going on my pump.  I didn't know what my body wanted - I only knew how to keep it relatively happy using Levemir and rounded up/down doses of Novorapid ......




long-acting ???.......there is no long acting insulin with a pump.


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## Phil65

Pumper_Sue said:


> Hi Rob,
> please read the NICE guidelines very carefully. There is no mention of DAFNE in them at all.
> The requirement is that you can demonstrate carb counting is A OK.
> PCT's etc can not make the rules up as they go along just to please themselves. In many cases it's just a delaying tactic so as not to cough up for the pump. Doing this actually costs them more in the long run though.
> 
> I refused point blank to make a 100 mile round trip to do a DAFNE course. I have always carb counted so a complete waste of my time and very limited energy.



Sue, I attended a SAILING (Self Adjustment Insulin Learning in Groups) course prior to my pump, it was a course ran by my DSN/dietician.....I poo-hooed the idea of attending such a course (x6 1 day/3 hour sessions spread over 6 weeks) for me I considered it to be a waste of time, I understood carb counting, had good control on MDI and "understood" Diabetes!.......I was wrong, I met 5 other Type 1s who were male and female, differing ages, who all managed their diabetes in different ways/regimes....I found the interaction with other Type 1s fascinating, enjoyable and in my way tried to offer advice and help to some of them who were obviously struggling with their D. I had never really known another Type 1, incidentally I was the only one that got a pump and indeed was the only one that wanted one. I didn't learn too much from the course itself but it made me realise that actually I know quite a bit about it and I enjoyed helping others that were not as confident.


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## Robster65

Pumper_Sue said:


> You would be suprised how many haver lower A1c's but still have non ideal control as in swinging from high to low.
> 
> I have a friend on another forum who has a pump his A1c is 5.3% and has been for many years. Even pre pump. He qualified because he had a fear of having a hypo at 3.30 pm when picking the kids up from school
> 
> My A1c was in the very low 6's when I had my pump.
> If you have lumpy injection sites then best to go for a pump sooner rather than later. This is due to scar tissue as you know, and you can not put cannulas in or near the lumps. Thus no point in a pump if no place to put the cannula.
> So stop wasting time go for it.


 
I'm on the waiting list for an appointment with the local consultant, so I can put all of this to him and gauge his reaction. If he's not going to listen, I'm not able to go elsewhere so I'll have to open a can of NICE woop-ass on him and see what effect it has. By nobody's standards am I an urgent case, so I would imagine my best hope would be a couple of years on the waiting list. But I don't intend to be shrugged off if I feel I'm elligible. The fear of hypos is a grey area because sometimes I just take them in my stride and others I feel petrified but I will happily emphasise the latter if that's what they're interested in.

I'll tell them aunty Sue is coming to get them if they don't play ball ! 

Rob


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## trophywench

Phil65 said:


> long-acting ???.......there is no long acting insulin with a pump.



Which is precisely what I said, Phil 'because there isn't any long acting, you can turn your basal completely off'  (and the caveat I didn't add was, 'but of course, fast acting still hangs round to some degree', but on the basis we all knew that already, I didn't say it LOL)


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## Phil65

trophywench said:


> Which is precisely what I said, Phil 'because there isn't any long acting, you can turn your basal completely off'  (and the caveat I didn't add was, 'but of course, fast acting still hangs round to some degree', but on the basis we all knew that already, I didn't say it LOL)



......I thought that was what you meant to say!  I just didn't want non-pumpers getting confused.


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## sofaraway

Looks good to me. Your team brought up the option of a pump to you, they wouldn't have done that if they didn't think you meet the criteria. 

Hope you can get more clarification from your DSN at your appointment. And ask about how the process works and timeframes. Ask if they have any waiting list, do they do group or individual starts.


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## Monica

imtrying said:


> As an aside...I also don't understand why the whole 'hypo' thing is solved with a pump??



Carol had a problem with Hypos - she didn't always realise she had them unless caught by her "normal" test. Also, they were usually in the mid to high 2s when she did.
Now - she recognises her hypos at a much higher number, if she has any at all.
Also, like trophy said, if you test and you're say 4.4 and you know you still have insulin in you, you can reduce the basal for a while. I had to do that last night, at midnight Caz still had .85u on board, so I reduced her basal by 30% for 2 hours and she was 4.5 this morning. Had I not been able to do that, I'd have had to wake her to have something to eat or let her go hypo and then wake her up to treat it.


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## imtrying

sofaraway said:


> Looks good to me. Your team brought up the option of a pump to you, they wouldn't have done that if they didn't think you meet the criteria.
> 
> Hope you can get more clarification from your DSN at your appointment. And ask about how the process works and timeframes. Ask if they have any waiting list, do they do group or individual starts.



Thanks Nikki. They were good, and my dr seems to be onside which is great. Her response when I mentioned it was just 'oh good, well I hope they just sign it straight off'! 

I'm probably looking at 3 or 4 months at least before getting anything. They did also give me the head up of another pump that's being promoted/tested by users at the moment, which is tiny in comparison to existing pumps, and said that was due to come out end of April/May time.


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## imtrying

Monica said:


> Carol had a problem with Hypos - she didn't always realise she had them unless caught by her "normal" test. Also, they were usually in the mid to high 2s when she did.
> Now - she recognises her hypos at a much higher number, if she has any at all.
> Also, like trophy said, if you test and you're say 4.4 and you know you still have insulin in you, you can reduce the basal for a while. I had to do that last night, at midnight Caz still had .85u on board, so I reduced her basal by 30% for 2 hours and she was 4.5 this morning. Had I not been able to do that, I'd have had to wake her to have something to eat or let her go hypo and then wake her up to treat it.



Thanks Monica...when you put it like that it makes total sense!!


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## sofaraway

imtrying said:


> They did also give me the head up of another pump that's being promoted/tested by users at the moment, which is tiny in comparison to existing pumps, and said that was due to come out end of April/May time.



That might be the cell novo pump- saw it last week and does look awesome. It's more expensive than the others apparently so I don't know if some PCT's will want to fund it. 

But whichever pump you get it will help solve the problems you are having. 
Like you I had awful problems with exercise for years. And although not 100% solved with the pump- yet! They are much much better. The rise during exercise is hard to combat.


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## imtrying

*New update*

Ok, latest update. 

I got an email update from my pump DSN yesterday which said - 

"I am having problems with sorting out funding for pump- spoke to Gp she says not her job to get funding- I need to work out who to speak to at the PCt but i am afraid this may not be a quick job. I will try my hardest but don't expect things to happen too quickly."

So it's not bad news as such, as I haven't been declined...just need to find out who is actually going to approve the funding, as obviously without that, I can't get one 

P.S She's only speaking about it taking a while as she's knows I'm impatient lol She's just trying to manage my expectations.


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## everydayupsanddowns

Have you spoken to INPUT Katie? They should be able to let you know the procedure etc.

As far as I know, your consultant needs to contact the PCT to say you need one, the PCT are then obliged to fund it.


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## novorapidboi26

Dies it have to be a consultant or someone on that level?

I thought I read it could be an HCP, so this would include the specialist nurses..........!


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## Pumper_Sue

imtrying said:


> I need to work out who to speak to at the PCt but i am afraid this may not be a quick job. I will try my hardest but don't expect things to happen too quickly."



If your funding has been applied for then the person you need to speak to is the Senior commissioning Manager.
From date of appliaction you should have the very latest 3 month later have a pump in your hands.
So ring up your PCT and ask to speak to the commissioning manager and ask if funding has been applied for. If it hasn't then go back to your DSN and say it can not be approved until funding has been requested. So why are you being mislead (lied to).
I suspect as it's nr to a new financial year you are getting the run around but make noises.

Now what is know as the Snr commissioning manager may be called something else in your PCT so ask to be put through to the right person. If still given the run around contact PALS or write to the Cheif Exc.


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## imtrying

everydayupsanddowns said:


> Have you spoken to INPUT Katie? They should be able to let you know the procedure etc.
> 
> As far as I know, your consultant needs to contact the PCT to say you need one, the PCT are then obliged to fund it.



Hi Mike, I've not spoken to INPUT. 

I think from what she's said that she's spoken t my GP to look for approval, but been told it's not her, so now the DSN needs to find *who* to speak to at Havering PCT which sounds like may take a bit of time....

that's what I took from it anyway!


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## imtrying

novorapidboi26 said:


> Dies it have to be a consultant or someone on that level?
> 
> I thought I read it could be an HCP, so this would include the specialist nurses..........!



my recommendation letter will come from my Consultant, but the pumping DSN is dealing with the paperwork and logistics before the letter gets sent.


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## imtrying

Pumper_Sue said:


> If your funding has been applied for then the person you need to speak to is the Senior commissioning Manager.
> From date of appliaction you should have the very latest 3 month later have a pump in your hands.
> So ring up your PCT and ask to speak to the commissioning manager and ask if funding has been applied for. If it hasn't then go back to your DSN and say it can not be approved until funding has been requested. So why are you being mislead (lied to).
> I suspect as it's nr to a new financial year you are getting the run around but make noises.
> 
> Now what is know as the Snr commissioning manager may be called something else in your PCT so ask to be put through to the right person. If still given the run around contact PALS or write to the Cheif Exc.



Hi Sue. We haven't got to that stage....my funding application has not been applied for yet - this is about who the funding application needs to go to. 

This is more complicated as my GP (and therefore funding PCT) are different to the PCT area my diabetes team falls under, so it is a bit more painful as it's across different PCTs!! 

I suspect she just won't get any answers very quickly...plus she doesn't work full time so she doesn't have as much time to chase. 

I was thinking of maybe trying calling my actual local diabetes centre, and asking them who funding applications get sent to from there, as I would guess it would be the same place my pumping DSN would have to send the application to...but I don't want to seem like I'm interfering....


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## Pumper_Sue

imtrying said:


> Hi Mike, I've not spoken to INPUT.
> 
> I think from what she's said that she's spoken t my GP to look for approval, but been told it's not her, so now the DSN needs to find *who* to speak to at Havering PCT which sounds like may take a bit of time....
> 
> that's what I took from it anyway!



Surely she has ordered pumps before?
It's normally the consultant that signs the forms.

Unless anyone else has managed it the last I heard I am the only one in the country to have funding via a GP. But yes a GP can ask for funding.


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## Pumper_Sue

imtrying said:


> Hi Sue. We haven't got to that stage....my funding application has not been applied for yet - this is about who the funding application needs to go to.
> 
> This is more complicated as my GP (and therefore funding PCT) are different to the PCT area my diabetes team falls under, so it is a bit more painful as it's across different PCTs!!
> 
> I suspect she just won't get any answers very quickly...plus she doesn't work full time so she doesn't have as much time to chase.
> 
> I was thinking of maybe trying calling my actual local diabetes centre, and asking them who funding applications get sent to from there, as I would guess it would be the same place my pumping DSN would have to send the application to...but I don't want to seem like I'm interfering....



It's simple Katie,
who ever it is who is paying for your consultation with the pump consultant and diabetes clinic is the one footing the bill.
I live on the border between 2 counties so can go to hospitals in which ever county offers the services I require. The bill gets sent to PCT that your GP is in.


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## imtrying

Pumper_Sue said:


> Surely she has ordered pumps before?
> It's normally the consultant that signs the forms.
> 
> Unless anyone else has managed it the last I heard I am the only one in the country to have funding via a GP. But yes a GP can ask for funding.



yeah but they've been within her own PCT, which I imagine is a more straight forward process!

My GP seemed all for me having one, but I suspect that she doesn't particularly get involved, or just happy to leave it to someone else to do.


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## imtrying

Pumper_Sue said:


> It's simple Katie,
> who ever it is who is paying for your consultation with the pump consultant and diabetes clinic is the one footing the bill.
> I live on the border between 2 counties so can go to hospitals in which ever county offers the services I require. The bill gets sent to PCT that your GP is in.



Yep, it will be my GP's PCT that needs to fund it. 

I just got the impression my DSN was just trying to find a name of someone to talk to before sending my application into the abyss for it never to be seen again! She wants to make sure I get approved. 

Unfortunately it might be easier if I lived on the border lol but I don't. I moved and didn't want to change my diabetes team as i really rate them and didn't want to risk ending up with a bad team.


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## Pumper_Sue

imtrying said:


> Yep, it will be my GP's PCT that needs to fund it.
> 
> I just got the impression my DSN was just trying to find a name of someone to talk to before sending my application into the abyss for it never to be seen again! She wants to make sure I get approved.
> 
> Unfortunately it might be easier if I lived on the border lol but I don't. I moved and didn't want to change my diabetes team as i really rate them and didn't want to risk ending up with a bad team.



Have a look on your GP's PCT's website and then stick in the search commissioning manager.
Or google CM xx PCT.
The gp's practice secatary will have the info anyway just ring and ask to speak to her. Or again if close by just go in and ask to speak to the practice secatary.


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## sofaraway

imtrying said:


> I just got the impression my DSN was just trying to find a name of someone to talk to before sending my application into the abyss for it never to be seen again! She wants to make sure I get approved.



This sounds a very reasonable explanation. It will differ between PCT's who is responsible for approving the pump funding. As Sue has said it's the commissioning manager in her PCT. In my PCT it's the medicines management team. So you DSN wouldn't want to send to the wrong people (confidentiality issues if nothing else). The best bet would be for her to ask whoever in the Havering diabetes team orders their pumps and ask them who the application gets sent to. 

I think it's really good that your DSN is keeping you updated with where things are in the process.


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## trophywench

So the invoice for hospital visits gets sent to the GP?

But who pays for them? - cos my PCT - ie the one that covers my home address - ie Warwickshire - funded my pump and funds all my supplies.  The invoices from Roche that I get copies of, are addressed to them.  My Hospital is in Warks, but is part of University Hospital Cov & Warwick. UHCW.  My GP is in Coventry and comes under Coventry PCT.

It was my understanding that all his funding for me came from Warwickshire PCT.

Lord knows what will happen when the consortia take over the world as we know it!


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## everydayupsanddowns

Lemonade (and Sue) I split your posts off to their own thread here: http://www.diabetessupport.co.uk/boards/showthread.php?t=27039


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