# Do I have to be under a hospital for a pump?



## Tigermania (Feb 26, 2020)

Hi,

I am hoping some can answer my questions.  Is it possible to disengage with hospital/consultant care and be seen only by my GP? And if so, what would I still be able to keep my pump?

I am keen to do this as I am very unhappy with my hospital appointments but would rather not lose my pump.

thank you


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## Tee G (Feb 26, 2020)

hi @Tigermania.    As you have been referred to hospital, presumably by your doctor?  And therefore now under the care of a specialist, and you are asking to abandon that side of treatment, I cant imagine your Dr would be happy about that.  Simply because your doctor is a G.P.  A 'general' practitioner and will not necessarily have the knowledge or access to diagnostic tools a hospital would? I cant say about the pump..... But If you are not happy with that particular hospital, its a possibility you could ask your GP for a referral to another one?? Maybe this could be arranged?  I guess it would depend upon any other health issue you may have, I dont know. Worth asking I guess.


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## Thebearcametoo (Feb 26, 2020)

My understanding is that one of the conditions of having a pump is consultant care. I can’t see how a GP would have the specialist knowledge to deal with it.


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## Tigermania (Feb 26, 2020)

Thank you both.  That's what I fear.

However, I've been on a pump for 10 years and manage it independently and never need any help with it. Anything that goes wrong with it, I call the pump care line.


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## Thebearcametoo (Feb 26, 2020)

I would be inclined to go though PALS to sort your issues with clinic before giving up. There are all sorts of things to consider before refusing consultant care with diabetes including your contract with the pump provider (I’m presuming you self fund).


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## Pumper_Sue (Feb 26, 2020)

Tigermania said:


> Hi,
> 
> I am hoping some can answer my questions.  Is it possible to disengage with hospital/consultant care and be seen only by my GP? And if so, what would I still be able to keep my pump?
> 
> ...


As already said in your other post no you can not keep your pump if you are not under a consultant.
What good would it do you anyway? You really need to learn to use your pump to it's full potential and being under GP care wont achieve that.


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## grovesy (Feb 26, 2020)

I would think most GP's have not got the first idea about pumps, and you would need funding for it too.


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## Tigermania (Feb 26, 2020)

Sue, thanks for your help.  I really do know how to use my pump well, but I am on a huge dose of steroids at the moment at truly could pump a bucket load of insulin into me in the afternoons and it doesn't help.   When my steroid dose is lower, it is more manageable.
I have asked for my other post to be deleted as I can't handle a 'dressing down' today.    My blood sugars are good except from 3pm to 10pm when they rocket with the steroids.  My last (lovely) pump specialist said some people have a much harder time than others with steroids.  Hopefully my dose can be reduced again soon.

In terms of what good would it do. It'd mean that I can plod along with decent control normally and struggle with the steroids when I'm on them in the comfort of my own home.


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## Pumper_Sue (Feb 26, 2020)

@Tigermania,
I'm really sorry you thought it was a dressing down.  It certainly wasn't. I was trying to give you some practical advice so you could keep your pump.

The easiest way to deal with the steroids is to set up another basal profile which is double or even treble if needed. I always found that as I knew when the steroids hit the system then to make sure my basal was increased at least 2 hours before they hit home. As you know correction factors change the higher your numbers and steroid dose as does your carb ratio.

There's no point in worrying about the amount of insulin you need because what you need you need. I really do sympathise with you as yes it's hard whilst on steroids, a couple of times I have had over 500mg pumped into me over a 24 hour period and have been threatened with a 1000mg dose IV every day for 3 days  That would obviously be a case of IV insulin as well. But the 500 was managed via the pump and didn't go over 9 the wholetime. Consultant was impressed as was I at the time.


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## nonethewiser (Feb 26, 2020)

Told it was precondition to be under hospital clinic before going on pump. Perfectly honest, what your average gp surgery  know about pumps you could write on back of postage stamp.


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## Tigermania (Feb 26, 2020)

Thank you Sue, that's really helpful and very good to know about the insulin doses. I feel I have finally 'met' someone who can have as much insulin as me and still be standing!!!  I am going to be more confident with it and treble it 2 hours before tomorrow. The time they hit for me is at 3pm.  What about you? Steroids plus diabetes really is a miserable combination.  Thank you


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## Pumper_Sue (Feb 26, 2020)

You are more than welcome  make sure you have some of your fav hypo treatment just in case of hypo.
I find my numbers will go up from about mid day unless I ramp the basal up at 10 AM.

I'm assuming you take prednisolone? Do you take it 1st thing in the morning as that helps no end.
Are you able to scan your Libre every hour to see exactly when your bloods start to rise? If you can this will help you no end as well.
As I have Addison's disease I'm on steroids full time at a set dose unless unwell then I have to double my dose so had loads of practice in that dept.


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## SB2015 (Feb 26, 2020)

When I was on steroids I was amazed at how much higher my basal rates needed to be (on one occasion up to 350%!!!), I also realised that I had to increase my Bolus as well.  The steroids cause insulin resistance and that applies to both basal and Bolus.  It is only through testing that I worked out what % increase I needed each time, and there does not seem to be a consistent apporoach.

As yours seems to be one period in the day that is causing an issue, it does leave me questioning whether you have done a recent fasting test to check whether your basal rates are correct.  The steroids will just show any blips in these more.

I am pleased to be in the hands and would not want to be referred back to a GP to manage my pump needs.  If yo are unhappy with the consultant that you have at present I would ask to be referred to another.  I can’t imagine any GP being able to help, which is fine until you need help, it is clear that you already have a lot of experience with the pump but things change and who would do the transfer after your pump runs out?

I hope that you can get things sorted.


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