# Insulin pump should be used with caution, care



## Northerner (Dec 1, 2011)

"Shoot first, ask questions later,"often is used to characterize the act of making brash choices. Acting impulsively, then sorting out the consequences later can be very costly when it comes to diabetes self care. One example of this is the rush to prescribe the insulin pump to some diabetics who are poorly prepared and trained in their use.

A pump is a fantastic device and can be extremely helpful, but its best prescribed to an empowered and knowledgeable patient. In reality, an insulin pump is more of a choice than an essential management tool. Although they may seem to make things easier, pumps require their users to make dozens of daily self-care decisions and actions which impact their overall effectiveness. Patients often are lured to a pump by myths and misconceptions about them.

http://www.caller.com/news/2011/dec/01/insulin-pump-should-be-used-with-caution-care/


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## Pumper_Sue (Dec 1, 2011)

That endo has it 100% correct.


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## trophywench (Dec 1, 2011)

Hear Hear.

And I'm sorry, I think hospitals who are not prepared or financed or adequately manned to give proper carb counting and pump training or support to their patients, should not be allowed to prescribe pumps.

OTOH they shouldn't be allowed to opt out either!  LOL


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## Jennywren (Dec 2, 2011)

Not even considered for a pump at my hospital until , you have completed a DAFNE course


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## FM001 (Dec 2, 2011)

Pumper_Sue said:


> That endo has it 100% correct.




I agree and one of the reasons I wouldn't be suitable for a pump


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## Pumper_Sue (Dec 2, 2011)

Jennywren said:


> Not even considered for a pump at my hospital until , you have completed a DAFNE course



That is not part of the NICE guidelines.
As my GP pointed out I could count carbs backwards he considered it a complete waste of resouces and took a place away from someone else.

Everyone diagnosed with diabetes should be shown how to carb count from day one.


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## HelenM (Dec 2, 2011)

> Everyone diagnosed with diabetes should be shown how to carb count from day one


absolutely agree (and I was, though the aim was to have a very fixed carb regime)

 It's probably easier to get a pump here than the UK but training is taken very seriously.
There were several 1 to 1 sessions with pump nurse, (bit like the US pump trainers but she's not employed by an individual pump company, her company sells all makes of pumps)
  Pump start with  5 others, as part of a  4 day quite intensive course in hospital. (no fears the first night on the pump, you had nurses to to the night time checks and supply you with hypo treatments if necessary)
 A follow up day course  a year later. That reunion was supposed to happen yearly but seems to have stopped. 
 Pump nurse sees (visits) me indivually  every 6 months.


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## Copepod (Dec 2, 2011)

Agree about need to teach carb counting from day one. I wasn't taught, and wasn't even told about MDI, until a friend's mother, a pharmacist in Tasmania posted me an article about the regime (1996, before widespread use of internet), and as soon as I read the article, I realised that it would suit me so much better than bimodal insulin, and taught myself how to find carbohydrate content of food, which has got easier since then with improved nutritional information on food packets, while carb contents of things like bread and potatoes haven't changed much, so once I've learned it, I just have to remember.

Good quote in article: "An insulin pump is a device which is no better or worse than the human being operating it."


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## novorapidboi26 (Dec 2, 2011)

Does anyone know any pumpers that are/were not prepared for it............?

The criteria is quite strict is it not........


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## Copepod (Dec 2, 2011)

The article was written by an endocrinologist working in USA, not NHS - not sure how their insurance companies arrange training etc, but probably each combination of insurance company / pump company / health care provider is different.


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## novorapidboi26 (Dec 2, 2011)

Copepod said:


> The article was written by an endocrinologist working in USA, not NHS - not sure how their insurance companies arrange training etc, but probably each combination of insurance company / pump company / health care provider is different.




that explains it.............


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## Robster65 (Dec 2, 2011)

This is what concerns me about the NHS criteria.

The worse the control, the more likely to be considered for a pump. It seems that they will try a few things on MDI, then rather than give the patient an intensive course in MDI, including carb counting, techniques, etc, they put them up for a pump, and THEN give them further training.

So it may not be the pump that has improved control, but the more intensive training.

The person operating the pump may have done a whole lot better if they'd had the proper attention from the outset. 

Rob


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## trophywench (Dec 2, 2011)

Well that's how 'my' clinic approach it Rob - education first, then see what happens.

I think that's right.  However if you have continued to educate yourself and know where the gaps are that a pump can answer, they don't mess you about.


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## Robster65 (Dec 2, 2011)

trophywench said:


> Well that's how 'my' clinic approach it Rob - education first, then see what happens.
> 
> I think that's right. However if you have continued to educate yourself and know where the gaps are that a pump can answer, they don't mess you about.


 
Sadly, in this region, they now insist on DAFNE which they don't run here so would mean a trek to Timbuktu and back. 

The daft thing is that 2 years ago I could have fitted the criteria since I thought I'd tried everything to get control. And nothing was offered that I hadn't tried, so I thought. I thought I was carb counting and so answered yes to the question, when in fact I wasn't. And it was never queried. My concern is that they take the patient's word for it too often rather than working through step by step on a 1 to 1 basis. It's easier just to rush them through for a pump because the support is in place for that.

Rob


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## Pumper_Sue (Dec 2, 2011)

Copepod said:


> Good quote in article: "An insulin pump is a device which is no better or worse than the human being operating it."


In plain English, the pump is only as good as the user. It's not plug and play.


novorapidboi26 said:


> Does anyone know any pumpers that are/were not prepared for it............?
> 
> The criteria is quite strict is it not........



Depending on how you interprit the guidelines no it's not. Anyone and everyone can qualify for a pump.

Oh yes there are are many pumpers who are not prepared for all the hard work involved. There's 1 person in particular (who I wont name) should never have been given a pump in the 1st place. Let alone still have it. As completely clueless and no intention of listening to anyone who tries to help. Infact abuse is the usual response.

The biggest whine on the forums is how much hard work is involved and they want to smash the pump to pieces when things go wrong. Many go a running to the nurse instead of problem solving themselves. (nanny state)


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## trophywench (Dec 2, 2011)

Well Sue I appreciate you don't have an expert DSN at the end of her mobile phone night, day and weekend.  And of course we all want to solve the problems we have by ourselves to prove to ourselves that we are capable, if nothing else.  But I also always want to keep my DSN in the loop as well as taking advice - from you and others! - she does after all, exist to help the likes of me and I don't abuse the help she gives but when I am completely stumped that phone mumber is a Godsend.

I mean - sometimes she can't help if eg it's a hardware prob (which some of em have been) but she needs to know that too, doesn't she?  I mean if I just turn up every few months and say NP in the interim, I think she'd faint. EVERYBODY has problems from time to time, even when we know it's User Error - and I'm very truthful so I never disappoint LOL  

I think it's important to be open with our HCP's and if they are any good, they appreciate it.  But they can't solve all our probalems.  OTOH if they are daft enough to send someone utterly clueless away whether with a pump or on any other course of treatment - then they should damnwell solve all that person's problems IMHO.


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## Pumper_Sue (Dec 3, 2011)

trophywench said:


> Well Sue I appreciate you don't have an expert DSN at the end of her mobile phone night, day and weekend.  And of course we all want to solve the problems we have by ourselves to prove to ourselves that we are capable, if nothing else.  But I also always want to keep my DSN in the loop as well as taking advice - from you and others! - she does after all, exist to help the likes of me and I don't abuse the help she gives but when I am completely stumped that phone mumber is a Godsend.
> What I was getting at was far to many abuse the DSN's time instead of thinking for themselves.
> I mean - sometimes she can't help if eg it's a hardware prob (which some of em have been) but she needs to know that too, doesn't she?  I mean if I just turn up every few months and say NP in the interim, I think she'd faint. EVERYBODY has problems from time to time, even when we know it's User Error - and I'm very truthful so I never disappoint LOL
> Yep if stumped a fresh set of ears is always welcome. But again many do not problem solve to start with. Pump is always blamed it's never the users fault.
> I think it's important to be open with our HCP's and if they are any good, they appreciate it.  But they can't solve all our probalems.  OTOH if they are daft enough to send someone utterly clueless away whether with a pump or on any other course of treatment - then they should damnwell solve all that person's problems IMHO.



Agree 100% with last statement.


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## Robster65 (Dec 3, 2011)

Pumper_Sue said:


> Agree 100% with last statement.


 
Would you also agree though that some people are sent away with very little knowledge to do their own problem solving and probably a larger % may not have the confidence to do a much of it.

Some people are self-assured and will see it as their own responsibility (prob don't want any interference either!) but many see the technology or the processes as confusing and potentially dangerous, therefore not to be tinkered with without 'expert' approval.

The question is, should those people be sent away with a pump assuming they can do the work or should they be better assessed to see if they can walk the walk ? And only be given a pump if they meet the criteria, or be given confidence training.

Rob


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## Pumper_Sue (Dec 3, 2011)

Robster65 said:


> Would you also agree though that some people are sent away with very little knowledge to do their own problem solving and probably a larger % may not have the confidence to do a much of it.
> Yes but then why were they sent away with no knowledge in the 1st place. Problem solving is the same for MDI. Many who go on a pump expecting a cure all can not even understand mdi. So why give them a pump?
> Some people are self-assured and will see it as their own responsibility (prob don't want any interference either!) but many see the technology or the processes as confusing and potentially dangerous, therefore not to be tinkered with without 'expert' approval.
> Then again why are people not given an intensive course like DAFNE in the use of pump usage before they are let loose.
> ...



Well in all honesty if they have no confidence in using the pump why give them one? Close monitoring for first 3 mths is fair enough. But after that!


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## trophywench (Dec 3, 2011)

Robster65 said:


> Would you also agree though that some people are sent away with very little knowledge to do their own problem solving and probably a larger % may not have the confidence to do a much of it.
> 
> - Yes, definitely
> 
> ...



Yes I do agree; I think it's wrong.  Nobody wants to feel patronised but it is possible to deliver info in a simple way (you know, KISS principle) without taking a superior attitude.

I keep hammering on about this - I'd never really taken ownership of my diabetes treatment *because in 35+ years, no HCP had ever hinted that I should, let alone that it would be acceptable to them.*  Yes - I knew very well that I had the intelligence to understand it all - I had a very technical insurance job battling with matters of law and liability, and I was bloody good at it!  No two days were the same, it was a continual steep learning curve and meant getting my head round lots of things I hadn't a clue about to begin with.  Cutting through the legalese and technical jargon to discover the meaning .... I loved it.

But in January 2008 during a break in my carb counting course, one of the DSNs running it who I'd met for the first time that very day asked me a question.  She said, 'Who treats your diabetes, Jen?' and I said 'Dr Consultant and Dr GP; nurse at GPs though she's pretty much less than useless, so I usually have to ignore her to save myself bashing her -  and now - you do - and so far seem far better informed!' and she laughed and answered, *'Wrong *answer!  And if Dr GP thinks he does, then he just better have another think.  Because *YOU* do!'  And added that the most any HCP - be they topmost Consultant or surgery nurse - could do for a diabetic was try and *assist *them in their lifelong project.  Oh - if only someone had said that in 1972 .......  or at any time in the previous 35 years .......  I responded to that by saying thank you and that it would give me the very greatest of pleasure to inform my GP of that - and perhaps she'd like me to video it for her later enjoyment?

Some people never grasp that, let alone embrace it.


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## Ellie Jones (Dec 4, 2011)

Robster65 said:


> Would you also agree though that some people are sent away with very little knowledge to do their own problem solving and probably a larger % may not have the confidence to do a much of it.
> 
> Some people are self-assured and will see it as their own responsibility (prob don't want any interference either!) but many see the technology or the processes as confusing and potentially dangerous, therefore not to be tinkered with without 'expert' approval.
> 
> ...



(I've used Rob's quote rather than add all replies to this quote)

I've been around pump therapy for almost 10 years now, but as pump funding/access has become easier the easier it becomes to see the foibles of it and how the 'user' impacts on out come.. MDI more often or not fails for either/and lack of knowledge or lack of commitment and a pump isn't going to resolve this at all...  

If you asked my team they would tell you, that I took to pumping like a duck to water, I'm a star pupil with fantastic results and I am what pumping is all about... Oh apart from 2 days of training they've not had any input since  Apart from doing blood tests and my consultant over view bits..  

When I started on my pump, not only could I tell you why MDI failed and why I couldn't deliver insulin via injections to get it to work, I also understood pump therapy so could explain how I could use the various features to deliver my insulin to over-come the issues...  So all I had to do when I got my pump is put theory into practice...  And yes it did take me about an hour to change my first cartridge as I to, do lack some confidence around using new technology..

To many people now see pumps as a plug and play item, negating the need to fully understand how to manage their diabetes for them and then when the pump fails to perform they want a CGM funding, which is yet another very useful piece of kit when in the right hands..

I can actually suss out which diabetics will benefit from insulin pump therapy and those who are very unlikely to achieve anything...  Rarely am I'm wrong..

So yes a lot more needs to go into training on MDI and that of confidence building with MDI before some are let lose and a lot of money wasted on insulin pump therapy


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