Coronavirus letter from hospital diabetes clinic

[AJLang]

This letter was addressed specifically to insulin pump users

“important re: Covid 19
I am sure you are aware of Coronavirus and having Type 1 Diabetes puts you in a higher risk category and you are at higher risk of Diabetic Ketoacidosis using an insulin pump.
The purpose of the letter is to ensure that you are kept safe during the pandemic and to try to avoid admission to hospital due to Diabetic Ketoacidosis relating to raised blood glucose levels.
please follow NHS advice re: Coronavirus if necessary.”


i will try to scan the rest of the letter and add it as an attachment. It’s basically about having the right diabetes equipment and following sick day rules if necessary.

 

[AJLang]

Copies of the rest of the letter

 

[Pumper_Sue]

It’s basically about having the right diabetes equipment and following sick day rules if necessary.

Now that's what I call a waste of money as surely all patients with pumps or any form of insulin delivery device have sick day rules and keep adequate supplies of emergency kit?

That's as daft as the hospital ringing me to cancel my endo appointment and then sending me a letter.
Answers on a postcard as to why the NHS is broke

 

[trophywench]

When your GP surgery think you are completely bonkers/deliberately being awkward when you ask for Levemir and Novorapid but then clearly don't use it cos you never want it again until just before the original lot goes out of date, have not yet agreed to assist you in getting strips for your ketone meter which the other hospital trust kindly donated to you when you 'did' your knee and your glycogen kit has dropped off your repeats YET again - some of us may give up asking, Sue.

 

[Flutterby]

Thanks for sharing Amanda.

 

[JohnWhi]

Sorry for the innocent question. Could someone point me towards the evidence indicating that using a pump makes us more liable to ketoacidosis? I can think of a number of reasons why that ought not to be the case.

 

[Icebat]

I'm not on a pump, but I got more or less the same letter on Wednesday (sent via a text message from my GP - at least they didn't waste paper I guess). Basically saying make sure I have enough of everything I need, then pages of sick day rules. I assumed it must be a local initiative since I hadn't seen anyone else post about it, but it must be more widespread after all.

Not really sure what to make of that, if anything.

 

[stephknits]

Sorry for the innocent question. Could someone point me towards the evidence indicating that using a pump makes us more liable to ketoacidosis? I can think of a number of reasons why that ought not to be the case.

One reason is that we have only small amounts of background insulin working at any one time, so if anything goes wrong (eg pump failure) there is a lot less room for manouvere than someone on MDI

 

[grovesy]

I'm not on a pump, but I got more or less the same letter on Wednesday (sent via a text message from my GP - at least they didn't waste paper I guess). Basically saying make sure I have enough of everything I need, then pages of sick day rules. I assumed it must be a local initiative since I hadn't seen anyone else post about it, but it must be more widespread after all.

Not really sure what to make of that, if anything.

Welcome I see you are new. Everything varies from area to area .

 

[JohnWhi]

One reason is that we have only small amounts of background insulin working at any one time, so if anything goes wrong (eg pump failure) there is a lot less room for manouvere than someone on MDI

Many thanks for the answer. Never heard that from the consultant at the pump clinic, nor in the letter that in my case came from the DAFNE pump group attached to the pump clinic. Given that we have a sick-day basal rate set up, that we can easily give an extra dose every hour (as instructed) if suffering a high blood sugar, and that we have the possibility of additional injections, I would have thought the pump a good bet. In any case, to have ketones, you need to be somewhere above the normal blood sugar range. The suggestion in the letter that you inevitably have a higher blood sugar range and are less capable of managing it if using a pump is where I have the problem. Looking in the medical literature for recent research on this.

 

[Northerner]

Many thanks for the answer. Never heard that from the consultant at the pump clinic, nor in the letter that in my case came from the DAFNE pump group attached to the pump clinic. Given that we have a sick-day basal rate set up, that we can easily give an extra dose every hour (as instructed) if suffering a high blood sugar, and that we have the possibility of additional injections, I would have thought the pump a good bet. In any case, to have ketones, you need to be somewhere above the normal blood sugar range. The suggestion in the letter that you inevitably have a higher blood sugar range and are less capable of managing it if using a pump is where I have the problem. Looking in the medical literature for recent research on this.

Pump failures may lead to DKA I suppose, something that doesn't happen on injections.

 

[JohnWhi]

Pump failures may lead to DKA I suppose, something that doesn't happen on injections.

Pump failures tend to lead to injections, pretty sharpish! Either the pump gives an alert or the blood test/monitoring shows a high. I would argue that DKA follows high blood sugar over a fair time, resulting in the generation of ketones. I am not sure that injections eliminate that possibility. I would say that DKA results from high blood sugar and ketones, resulting from an insulin management problem, rather than the manner of delivery.

 

[trophywench]

Many people can entangle themselves in bed fairly easily and physically FOLD tubing over at 90 degrees sometimes John - if they're asleep at the time they don't know they have cos if their spouse happens to have all their body weight on the pump and happen to have enough flesh to bury it ….. or themselves have lack of feeling somewhere or another for whatever reason so don't get woken by the vibration …… many of us don't wear nightclothes or even if we do usually, if we share a bed with a partner ……. !

I fell over a couple of years ago and badly injured a knee and for the first time ever (to my knowledge) in my life Kazoom!!! Ketones in the high 2s!

As you know, any time we get anything involving a temperature, we get ketones. As a higher temp than normal is a feature of COVID 19 whether we subsequently die of it or not - it's a VERY timely reminder since comparatively very few of us are instantly aware of 'normal sick day rules'. Most of us normally don't get ill. I had flu once, 20+ years ago and that was that, ever since I'd had chicken pox when I was c.7 years old. I have NEVER in my life had any discussion with a medic about sick day rules! (Except the Ward Staff Nurse after they'd operated when I did my knee) (cue to start drinking even more water and ringing for ruddy bedpans …… as my kidneys were working fine LOL, TMI)

 

[everydayupsanddowns]

Sorry for the innocent question. Could someone point me towards the evidence indicating that using a pump makes us more liable to ketoacidosis? I can think of a number of reasons why that ought not to be the case.

It is to do with only having short acting insulin I think.

If the pump fails for any reason... it would usually take a short while for the person wearing it to notice, and after approximately 4-5 hours from the point of failure or delivery interruption (even if just an infusion site failure that would not cause an alert on the pump) there would be absolutely no ‘insulin on board’ and BG would rise steeply.

With MDI your long acting lasts 12-48 hours giving you at least a small amount of protection.

 

[JohnWhi]

Thanks for those answers. Pump clinics ought to tell us that pumps are more dangerous than injections. Presumably we ought to stop using if we are ill. I will ask the consultant about this when I see her next.

 

[Inka]

Thanks for those answers. Pump clinics ought to tell us that pumps are more dangerous than injections. Presumably we ought to stop using if we are ill. I will ask the consultant about this when I see her next.

My clinic stressed the increased risk of DKA (because pump users have no long-acting insulin on board). You’re right this should have been mentioned to you.

You don’t have to stop using your pump if you become ill. It’s more about awareness. Did your clinic tell you you shouldn’t disconnect your pump for more than X amount of hours? That’s for the same reason - blood sugar potentially rising due to a lack of long-acting basal insulin. The longest I take my pump off for is around 2 hours. I can see the effect from the lack of basal when I do that.

If you’re interested, there’s a regime called Untethered, where you have some of your basal as an injection of long-acting insulin and the rest through your pump. This is to give more flexibility as you then have a little bit of long-acting insulin working away at all times.

 

[JohnWhi]

If you’re interested, there’s a regime called Untethered, where you have some of your basal as an injection of long-acting insulin and the rest through your pump. This is to give more flexibility as you then have a little bit of long-acting insulin working away at all times.

Many thanks for the advice. My total per diem basal is 17.4u and for most of the night it is down to 0.05u/h. Over 36+ years of using long-acting, I always had a problem with its inability to respond to the variations, and this was the main reason why I was advised to use a pump. During the day, if one is awake and watching the Freestyle Libre or whatever (I am told the new version will come with an alarm if high or low) I would find short-acting more helpful to achieve a swift result. I can see the benefit of a small dose of long-acting in addition to the sick-day basal profile.