Funding?

[bev]

I had reason to ring my sons DN today after school due to a couple of unexplained hypos. I explained that if we give alex a large meal (e.g. something over 100g his body seems to react badly against giving so much insulin - even though we are only giving him half of what he should be getting due to the honeymoon period) and she said he may be a good candidate for a pump. But she then explained that it would be 1 year or so as its difficult to get funding. Does anyone know why funding is so hard to get?Surely if a diabetic would benefit from a particular course of treatment, then it should just be available without having to fight for it? I realise i am probably being incredibly nieave (?) but i cant understand the reasoning for denying somebody a treatment that would help them long term! Bev

 

[Northerner]

Hi Bev, I believe it all comes down to money - pumps and their pariphenalia are more expensive than needles and pens. From what I can gather, pumps are a much better method as witnessed by the fact that so many Americans use them - over there they are usually funded by health insurance policies.

 

[Viki]

Hi Bev, i first asked for my pump in October and my appointment to start is Feb 10th. That includes all the fundng application etc. its takes time but i dont know why theyve said a year?? unless your PCT is particularly slow??

 

[aymes]

I had reason to ring my sons DN today after school due to a couple of unexplained hypos. I explained that if we give alex a large meal (e.g. something over 100g his body seems to react badly against giving so much insulin - even though we are only giving him half of what he should be getting due to the honeymoon period) and she said he may be a good candidate for a pump.

I remember being told by my DSN that injecting large amounts of insulin can affect absorption rates and so give odd results so was advised that if injecting more than 15 units (or there abouts) I should split it over two injections, one straight after the other, unless there are other reasons to split the timing, but in a different spot to ensure it is being correctly absorbed. It does mean another injection but may be worth a go if it keeps being a problem?

Regarding the funding, totally agree with your reasoning but it is usually just part of the whole NHS funding issues, limited funds so difficult decisions/waiting lists for various treatments, affects all conditions not just diabetes unfortunately and a lot of the time it is dictated by short term considerations rather than the long term benefits.

 

[diagonall]

I had reason to ring my sons DN today after school due to a couple of unexplained hypos. I explained that if we give alex a large meal (e.g. something over 100g his body seems to react badly against giving so much insulin - even though we are only giving him half of what he should be getting due to the honeymoon period) and she said he may be a good candidate for a pump. But she then explained that it would be 1 year or so as its difficult to get funding. Does anyone know why funding is so hard to get?Surely if a diabetic would benefit from a particular course of treatment, then it should just be available without having to fight for it? I realise i am probably being incredibly nieave (?) but i cant understand the reasoning for denying somebody a treatment that would help them long term! Bev

Bev there should be no wait for a pump or funding. It is an excuse used because the consultants DSN's haven't done the paper work.
Re your son being on only half what he is meant to be on..... I am very confused by this he needs the correct amount of insulin to keep his numbers in rang no half measures. You just adjust the insulin to he's needs depending on his blood sugars
100gms of carbs is one heck of a lot of carbs too in one go 😱. It's no wonder he is running into problems. Try some portion control and you will find a great improvement. The more carbs eaten in one go the bigger the dose of insulin the bigger the problem is when he runs into trouble. There are lots of lower carb things to fill him up it doesn't have to be carb overload.
Excessive carbs just cause his pancreas to work over time trying to shove out move insulin whilst it is dying off hence the hypos.

Here's INPUT's site have a read on pump funding etc.
http://www.input.me.uk/
Best wishes
Sue

 

[bev]

Hi Sue and all who have answered!
Surprised at your explanation of lazy paperwork? Normally a meal comes to about 60grams but if we gave him 6 units of insulin he would have a hypo 2 hours later as his pancreas is still producing some insulin. So we would jst give him 3 units (as long as his BS is under 10) if its over 10 we give him 1 extra, if its over 13 we give him 2 extra etc..
He has a pizza on a friday as a treat which mostly comes to 110grams - but it is a treat not something we do every day. I dont know what a 'normal' amount of carbs is that a 10 year should be having in a day? Is there a chart of suggested amounts? What is your view of changing to a pump versus injections? Thanks. Bev

 

[diagonall]

Bev the pizza, is very fatty so you need to split the insulin dose for it give 30 or 40% upfront then the rest 2 hrs later this will stop the hypo. Pasta and pizza are lethel on the blood sugars.
My view on pumps ....... I love my pump but you do have to know what you are doing with foods and insulin and know exactly how each food group effects the blood sugar.
Ask to see a dietition and discuss the carb amounts suitable for young Alex and ask about carb counting education too. DSN's do not have the food knowledge (even though they think they do)

Funding is available for pumps ring your PCT and ask to speak to the Snr commissioning manager and ask how long it takes for funding to come through 🙂 PCT's have to provide the funding as soon as a consultant or a GP makes the clinical desicion sp! that a pump will benefit Alex or anyone else.
My advice though is let Alex get used to injections and know whats what with them. As pumps can and do malfunction sometimes, he will then have to inject until a replacement is sent out.

Sue

 

[VBH]

but i cant understand the reasoning for denying somebody a treatment that would help them long term! Bev

I'm afraid its because PCT budgets have to be balanced for this year. 5 years down the line is probably going to be someone else's problem.

NHS budgets had a clampdown and a slashing last year which has probably made things worse. The fragmentation of the NHS into various overlapping trusts is probably also a factor.

So a lot of it appears to be simple short-term budgetting rather than long term goals, despite the NHS's role in prevention.

 

[diagonall]

I'm afraid its because PCT budgets have to be balanced for this year. 5 years down the line is probably going to be someone else's problem.

NHS budgets had a clampdown and a slashing last year which has probably made things worse. The fragmentation of the NHS into various overlapping trusts is probably also a factor.

So a lot of it appears to be simple short-term budgetting rather than long term goals, despite the NHS's role in prevention.

Please read this article
http://www.input.me.uk/index.php?page=how-do-you-obtain-a-pump
Funding hs to be provided.

 

[bev]

Bev the pizza, is very fatty so you need to split the insulin dose for it give 30 or 40% upfront then the rest 2 hrs later this will stop the hypo. Pasta and pizza are lethel on the blood sugars.
My view on pumps ....... I love my pump but you do have to know what you are doing with foods and insulin and know exactly how each food group effects the blood sugar.
Ask to see a dietition and discuss the carb amounts suitable for young Alex and ask about carb counting education too. DSN's do not have the food knowledge (even though they think they do)

Funding is available for pumps ring your PCT and ask to speak to the Snr commissioning manager and ask how long it takes for funding to come through 🙂 PCT's have to provide the funding as soon as a consultant or a GP makes the clinical desicion sp! that a pump will benefit Alex or anyone else.
My advice though is let Alex get used to injections and know whats what with them. As pumps can and do malfunction sometimes, he will then have to inject until a replacement is sent out.

Sue

Hi Sue thanks for that it makes sense. But as his DN hasnt told us to do it i think i may wait, also he normally has the hypo the next day, how long can insulin take effect on his levels? Also the dietician said to eat carbs as its a good thing for a diabetic - but some posts seem to be saying carbs are bad?

 

[aymes]

Hi Sue thanks for that it makes sense. But as his DN hasnt told us to do it i think i may wait, also he normally has the hypo the next day, how long can insulin take effect on his levels? Also the dietician said to eat carbs as its a good thing for a diabetic - but some posts seem to be saying carbs are bad?

the carb thing can be quite a controversial topic, a lot of people very passionately believe that low carb is the way to go to get good control. It's another case though of one size doesn't fit all, low carb works for a lot of people, personally so long as I have my carb counting right high or low carb makes very little difference to my control. A healthy balanced diet is always the way to go. Although I don't low carb I do try to stick with low gi as much as possible as I find slower release carb reduce the spike after meals.
Re how long insulin should last, they're all different but I think most if the fast acting ones peak at around one hour, most is used up after three but there may be some still working up to about five hours. Of course if there's any issue with absorption it may take longer.

 

[Northerner]

Hi Sue thanks for that it makes sense. But as his DN hasnt told us to do it i think i may wait, also he normally has the hypo the next day, how long can insulin take effect on his levels? Also the dietician said to eat carbs as its a good thing for a diabetic - but some posts seem to be saying carbs are bad?

Hi Bev,

Some people find that restricting carbs helps them with their control. On the other hand, I have lots of carbs as I am very active and need a lot of calories. I also am averse to placing too many restrictions on my diet as I prefer it to be balanced, and I would miss out on far too many of the foods I enjoy! I would think that a growing boy like Alex (no doubt to grow a great deal over the next two to three years - I grew 1 foot between ages 11 and 13!) needs a good, balanced diet too, and placing too many restrictions on him at the moment would be harder him than is necessary. I got my HBA1c today and it was 5.4, so it's not doing me any harm🙂

Of course, with this condition there are sometimes large variations in how people are able to eat and gain control. I think things are still at a very early stage with Alex and, whilst it's hard, you need to see how things develop over the next few months.

 

[VBH]

Funding hs to be provided.

And the PCT will resist it.
And the PCT are able to put pressure on GPs to reduce costs in both general and specific ways.

 

[bev]

Hi Bev,

Some people find that restricting carbs helps them with their control. On the other hand, I have lots of carbs as I am very active and need a lot of calories. I also am averse to placing too many restrictions on my diet as I prefer it to be balanced, and I would miss out on far too many of the foods I enjoy! I would think that a growing boy like Alex (no doubt to grow a great deal over the next two to three years - I grew 1 foot between ages 11 and 13!) needs a good, balanced diet too, and placing too many restrictions on him at the moment would be harder him than is necessary. I got my HBA1c today and it was 5.4, so it's not doing me any harm🙂

Of course, with this condition there are sometimes large variations in how people are able to eat and gain control. I think things are still at a very early stage with Alex and, whilst it's hard, you need to see how things develop over the next few months.

I probably am panicking too much - i am just keen to get it right and i am so impatient - but i am learning with diabetes that there are no hard and fast rules/answers! Excellent news about your HBA1c test! Alex is due to have one in 3 weeks time - but i know it will be rubbish as his levels are all over the place - still early days i suppose. How long do you wait for the results- is it immediate ? Thanks. Bev

 

[Northerner]

I probably am panicking too much - i am just keen to get it right and i am so impatient - but i am learning with diabetes that there are no hard and fast rules/answers! Excellent news about your HBA1c test! Alex is due to have one in 3 weeks time - but i know it will be rubbish as his levels are all over the place - still early days i suppose. How long do you wait for the results- is it immediate ? Thanks. Bev

It depends on how they do the test I believe. The Hba1c can be done on the spot, or as part of a series of other tests in which case the blood will go off to a lab for a few days. I went in a week before my appointment to provide the blood, and also received cholesterol and kidney results at the appointment.

 

[sofaraway]

I think pumps are great for kids, but as alex is only newly diagnosed he needs time to get used to injections. I think understanding the basic of diabetes, how food affects him, how insulin works, how to adjust etc. is vital before being put on a pump.

Instead of saying you are only giving him half the insulin he needed, could you not say his insulin:carb ratio is 1:20g. the 1:10 thing is just a starting point and each individual then works from there to fidn what works better.