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Oct 31, 2010
novorapidboi26 1,819 posts

Topic: General Discussion / Insulin Pumps

I would of thought that if your HbA1c is as good as that, without the hypos then you dont need a pump, you could benefit from one obviously, but at what price........
 
Oct 30, 2010
Stew B 125 posts

Topic: Site Development / Online BG Diaries

Thanks Garry. That's a good point, but I'd also like to see the records "collected" together so that, for example, all my hbA1c's can be seen in date order.

Stew
 
Oct 30, 2010
Garry 328 posts

Topic: Site Development / Online BG Diaries

Just checked and field appears to be 200 characters...so should be plenty for most text entries.
Garry
 
Oct 30, 2010
Garry 328 posts

Topic: Site Development / Online BG Diaries

Like you Stew I prefer to keep as much as I can in the same place.
Quick fix though if you wish...
Have just been to see our DAFNE diabetic nurse and got latest HbA1c and weight figures and I enter them on the day in the Comments field - both in my DAFNE diary and in the Online diary too.
Not sure what the field character limit is on the Comments field...but I have not been limited yet.
Best Wishes Garry
 
Oct 30, 2010
Stew B 125 posts

Topic: Site Development / Online BG Diaries

Hi Simon,
I've been enjoying the "Diabetes Results to You" thread on the general discussion forum, and wonder whether in addition to having the on-line diary facility for storing our BG results etc. we could have somewhere on the site where we could enter and store things like hbA1c, cholesterol, blood pressure results etc. for easy access and retrieval, and perhaps comparison over time? I know that I've got stuff like this on various letters, cards etc. but it would be nice to be able to store it together on-line. Something like that would enable me to bring together results from various sources (GP vs Hospital Clinic for example - it seems that everytime I go anywhere near my GP surgery someone takes my blood pressure!).

Stew
 
Oct 30, 2010
Stew B 125 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

Good thread! I think that it would be really useful to have some rather more extensive guidelines/advice re. injecting than seem to be available at present, although I know that one of the difficulties is that we're all different and one size won't fit all. It wasn't until I did my DAFNE course that anyone inspected my injection sites, and I discovered what "lipos" are (I had them on my thighs from night-time Lantus injections). What I learned from DAFNE also pursuaded me to only use a needle once. Like others responding to this thread, although I like to think that I rotate my injection sites, I don't do it in any way systematically - what would a good "system" look like? I now have a new consultant, and she actually asks to see my injection sites at my annual review - a bit of a surprise, since I switched my Lantus injections to my buttocks...

Stew
 
Oct 30, 2010
Jennypenny 34 posts

Topic: General Discussion / Insulin Pumps

Hi Adrian and Simon , i always think its worth asking you diabetes health team im not sure if different Health care trusts have different criterias ~ jenny
 
Oct 29, 2010
SimonC 78 posts

Topic: General Discussion / Insulin Pumps

I also would like to try the pump route - have been told that as my Hba1C have always been good - currently at 6.2, been down to 5.9, then there is no chance. I have been type 1 for 20 years now and seek that holy grail of normal blood sugars, and whilst I don't do too bad, I feel the pump would help me get that bit closer. I work shifts, in a fairly responsible role, but have been told no way.
 
Oct 29, 2010
Adrian_Hill 8 posts

Topic: General Discussion / Insulin Pumps

I also suffer hypos in the night but highs at random times during the day possibility caused by the dawn thing but as my HbA1c is running at 6.7 I thought it would be impossible to get a pump. Has anyone managed to get one with ok HbA1C?
 
Oct 29, 2010
PNThompson 57 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

I used to be one who only used a couple of injection sites as it was only two injections a day, and it was easier.
I later discovered the problems when I had a lot of difficulty in controlling my blood sugars.
Even prior to DAFNE, I learnt to rotate the sites, and didn't reuse the same needle, though I had felt one needle a day wasn't over using the same needle.

I have never left the needle on the pen, unless I needed to take the pen on its own at lunchtime, etc.

I still disagree with the professionals at the hospital on injection sites, and i'll admit that I don't always keep the needle in my arm, leg, etc long enough.

Any topic which generates different views is good news and should be covered somewhere within the forum as it may provide somebody with another view that benefits them!
 
Oct 29, 2010
marke 681 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

I would just like to add, thank you for rasing these issues and please feel free to do so on our site. I think challenging people to change is a good thing and is one of the key things for DAFNE i.e change the the perception that Diabetics cannot eat certain things, do certain things.
I agree we can all get set in our ways and find it hard to kick habits but with encouragement we can.
I am pleased that someone from the HCP side is again being so pro-active, it helps dispell the idea that some have that the medical profession are all people that don't understand diabetics. I'm not referring to people on this site, before people get upset by my comments !
Brum_taffy are you involved in the DAFNE programme ? I only ask because it would help to have you 'labelled' on the site as a HCP, however I guess I can only do that if you are invovled in DAFNE, unless of course I get permission from the DAFNE programme people to make you a HCP. The reason for needing permission is the access to some of the parts of the site that only DAFNE HCP's have.
The more HCP's we have contributing the better, especially in the 'Questions for HCPs' forum where people often ask Diabetes related questions and having a Diabetes expert rather than other Diabetics answer is often more re-assuring.
 
Oct 29, 2010
JayBee 587 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

Are these fair subjects for discussion in a consultation?

Hell yes. You're there to help the patient and educate them to a certain degree.

Do your diabetes teams discuss these issues with you?

Yes, and on that note, I'm thankful. I change my pen needle every time now!

Do people with diabetes find these questions sensitive? If so, why is that?

Yes because diabetics take pride in their control. If someone - even another diabetic in a very similar boat - can easily offend a diabetic by suggesting they change something.

For example, I've suggested that a diabetic try adopting the DAFNE regime in the past and what sort of response did it lead to? Her saying to others that I was accusing her of not looking after herself properly without a mention of the term DAFNE in her explaination.

Wow, thanks for listening to me properly. T_T

How should us docs approach a person who is not using their pen device well, and try to persuade them to make some changes?

I'm sure you do it fine, but be prepared for some diabetics to be more awkward or bull headed than others. Sad
 
Oct 29, 2010
JayBee 587 posts

Topic: General Discussion / "Diabetes results to you" Your help requested

I prefer the coloured ruler design because I I feel it puts things into perspective better than the traffic light system does - but I've been a diabetic for a long time. Experience allows me to appreciate the wider range.

I mean, there's many levels to the control of diabetes, not just one point here and one point there like the traffic lights are like. Saying that, the traffic light system may be better for newly diagnosed, to get them off the ground with what to aim for.

Just my 2 pence.
 
Oct 28, 2010
charlotte77 11 posts

Topic: General Discussion / "Diabetes results to you" Your help requested

I've posted my preferences on the Sandwell website. I also think this is a fantastic idea - there's a much stronger possibility of remembering my results between one clinic appointment and the next. I only tend to remember the anticipation of the appointment which is never helpful.
 
Oct 28, 2010
LauraH 6 posts

Topic: General Discussion / "Diabetes results to you" Your help requested

I prefer the traffic lights.

I would LOVE to have my HbA1c sent to me by letter. At the clinic I'm usually stressed and nervous, and although I hear them tell me my HbA1c, I don't have enough time to think about why it's risen / dropped and what I need to do. If I received that letter when I'm in my own home, relaxed and ready to really think about what I need to do I can see huge benefits.

I would also like to be able to keep track of my results over time, I feel like when I ask the clinic for this I'm getting in their way or wasting my time.

Fantastic idea.
Laura.
 
Oct 28, 2010
novorapidboi26 1,819 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

I only change the needle once the insulin is depleted or if it gets sore, its bad I know, but its habit (cost effectvie)...lol

I have had no problems with lumps, or at least any that I have noticed as i do rotate, randomly, on my legs, arms, stomach and bum...

And commenting on the point Helen brought up, I do prime every injection, this is a habit I picked up from DAFNE, more often than not, before the priming, I always used to get a misfire with the injection.......but then you dont want to re inject as you cant be sure if you got the dose or not...
 
Oct 28, 2010
JayBee 587 posts

Topic: Carbohydrate Counting / Carb free soups

Thanks for the reply. It certain is looking that way so I'll probably do the salad deal instead!
 
Oct 28, 2010
HelenP 218 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

Have you asked about "priming"? You may get some surprises there also!
 
Oct 28, 2010
DavidMansfield 3 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

"a rubbery lump under your skin at injection sites, which stops insulin getting in reliably. "

cheers for the reply - so is this part of injecting the same spot too often?
 
Oct 28, 2010
Brum_Taffy 13 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

"what's a lipo? lol"- so sorry to go all jargonistic on you David- a rubbery lump under your skin at injection sites, which stops insulin getting in reliably.

One of the telling stats from a large international patient survey was that 75% of those not rotating got them, but 25% of those doing it all perfectly still got them... clearly we still don't know enough about why they happen, despite many theories.

I certainly understand and empathise with the comments re habit, ease, familiarity, "laziness"! Plus I can see the "if it ain't broken" approach is appealing.

What I don't know is how much of a difference these factors can make in the average person, but from my experiences I believe it can be dramatic in some.

I imagine many docs feel uncomfortable discussing these 'nitty-gritty' components of care, after all, you guys know much more about this than we do... !!! LOL
 
Oct 27, 2010
HelenP 218 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

Hi,
I think they are fair questions but it is difficult to change a practice when you know you have no problems doing it the old way. I used to change syringes every time (in the olden days) and it was a "burden" to take stuff with me (where do you dispose of the syringe etc). Then the pens came in and I only change needles when the pen is empty! (lantus up to 9-10 injections) and the novorapid when the pen gets blunt or when I think of it...whenever). For me it is not a question of cost...it is convenience...so much easier to just throw the pen into the handbag sidepocket without all the other diabetes stuff. Similarly with the meter just throw it in. Use the lancet multiple times also. I have never had a problem. I would need to be persuaded that there was some advantage to me to change. Lantus tends to go in the abdomen (more because of the clothing I am wearing at the time) and novorapid in the stomach. Hey, but no hard and fast rules. I have no lipos and I hold the pen in for longer if I am out...probably because i don't want a blob of blood on clothing!

I only know one diabetic who is changing needles etc, using alco wipes etc all the time the rest fall somewhere between me and him. It is a topic we discuss. A few admit to lying because we know what you want to hear! Another topic is where do you carry all the gear. The best I have seen is a zippered carryall about 20x15x3 cm but that does not fit in a pocket and takes up a fair amount of space in a handbag. Good for travelling though. Pragmatics!
Good luck.

Sunny side up!

Helen
 
Oct 27, 2010
SimonC 78 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

I am afraid I am one of those that only change the needle bit when I change the vial - suspect that this goes back to the time when the insulin was free but the needles you had to pay for. I know and understand and accept all the arguments for changing them after every injection but it is a habit (and I am lazy) that I just can't stop.

I do change my sites but I must admit in a random fashion - I used to only use the side of my leg, as there was no fat what so ever on my stomach (this started 20 years ago) and the syringes hurt a lot in the stomach, obviously with the passage of time there is now fat on my stomach and I can use it and so I do vary now between the stomach and leg, and also move around these sites - but not in a systematic way.

I think these subjects are for discussion and should be discussed, they are with me, but as my HBA1c results have always been very good (have been down to 5.9, currently 6.2, and never higher than 7), the team have never pushed too hard to make me change as clearly what I am doing is working.

I don't know why people are sensitive about it though.
 
Oct 27, 2010
DavidMansfield 3 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

hey I'm getting into this. 2 posts in as many days after a weak or more of just reading Razz

I think it'd be great if my consultant bothered to talk to me about these things. For 12 years I've been scared to ask about rotating injection sites because when I've tried I've been looked at like an idiot or given a book for 3 year olds which mentions its important but gives no actual tips/guides. I've even been told (while laying in hospital with DKA) that I'm over-doing my stomach injections and that the skin is "obviously" too hard & lumpy when it felt normal to me before & after said advice but the Dr rushed off before I could ask for more information.

I did used to re-use needles but mostly out of being disorganised & not having the new needles readily available whereas now I've read a leaflet (while waiting to see the Doc at a check-up) that explained how important it is & sorted out a place with ready access to the needles as soon as I got home - though actually when I go out I might still use a needle twice or maybe three times because of the hassle of finding somewhere to put a used needle. storing a replacement is easy enough but finding somewhere safe to put the original just isn't particularly easy in my experience. I do like the finger prick needles i use now which come in a set of 6 somewhat like a gun barrell so I only need one & it'll last for a day or more. Not sure if an injection needle could work in this way though.

Needle on the pen - pretty much links to above answer I guess.

Rotate - already mentioned

what's a lipo? lol

and 2-3 seconds max?! I was specifically told to hold it in at least 6 seconds & that's what I've been doing for years. Scared now.

I also imagine many people find it tough to get their GP to allow them enough needles for the amount of injections we (probably) each do these days. Everything on a prescription seems to come with an "as little as possible" idea in my experience (though my GP's actually brilliant with everything - just a shame she doesn't deal with my repeat prescription orders & is often baffled when I mention that others have cocked it up)

I just noticed you also asked "Do people with diabetes find these questions sensitive? If so, why is that?"

I'd say no-one wants to hear that they're doing it wrong when for the most part diabetics I've met have been told "here's some needles, you have to do injections with your meals" and that's it. By this I mean that several diabetics seem to have been left to work it all out for themselves so it could appear to be a more personal than intended dig when you tell them they're wrong. You've probably noticed from my earlier answers that I'm seeing things (eg lipos) for the first time here so there's definitely a lack of information being handed out.

"How should us docs approach a person who is not using their pen device well, and try to persuade them to make some changes?"

I can only answer this for how I would like to be taught & that would be to not rush to "omg! if you carry on like this you'll be dead by the end of the month" and more of a sensible explanation of what exactly I'm doing wrong & why its wrong & what to do about it. Again I find that the consultants I see just rush to get me out again & would more often go for an answer of "ask the Diabetes Nurses" than doing anything themselves.

Hope this has helped & I aplogogise if its lengthy & rambly

edit: forgot the whole true point of the topic for a second there...Scrambled!! & with ham & cheese or not at all!
 
Oct 27, 2010
Brum_Taffy 13 posts

Topic: General Discussion / Please sing to the tune of "How do you like your eggs in the Morning?"

Question- "What do you do with your pen device in the morning?"

I presented on new injection device guidelines at a medical meeting last week. Us docs love to give people the 'third degree' about doses, carb counting, exercise etc., but in my view we have been slow to think about the 'mundane' issues of needle re-use, needle length, proper rotation of sites [i.e. not just randomly moving], injection technique, how long you hold it in, lipos at injection sites and so on. After discussing this with some diabetes nurse colleagues, I thought I would begin to explore these issues with the people with diabetes I meet in consultations.

One week on, to my surprise the great majority of people I have met and asked very honestly tell me that they regularly
-reuse needles, sometimes for 5+ injections
-leave the needle on the pen (insulin was dripping from the needle and bubbles had got into the insulin chamber) between injections
-do not rotate injection sites (but do pick a new random site each injection)
-continue to use lipos, even when they know what they are and acknowledge that the lipo may stop insulin getting in well
-hold the pen in for 2-3 seconds max

I seem to have 'kicked a hornet's nest', since even though people are very open about what they do with their pen device, I have found it very hard to persuade people to change. One patient accused me of being in the pocket of the pharmaceutical industry by suggesting he change needles each injection! A handful of these folk are DAFNE grads who acknowledge these issues were discussed on the course.

I had the feeling I was straying into sensitive territory, and I couldn't understand why that is.

So I need your help!

Are these fair subjects for discussion in a consultation?
Do your diabetes teams discuss these issues with you?
Do people with diabetes find these questions sensitive? If so, why is that?
How should us docs approach a person who is not using their pen device well, and try to persuade them to make some changes?

When I understand the issue better, I'd like to have a go at making some educational material, written, video etc. in case it may help. Anyone know of anything out there 'off-the-shelf'?

To answer my original question- "I like mine with a kiss!" Smile
 
Oct 27, 2010
Brum_Taffy 13 posts

Topic: General Discussion / "Diabetes results to you" Your help requested

Your replies have been thoughtful and most generous- everything I'd expect from DAFNE graduates, thank you all so much!

This is a final call for using the link to register a preference- it looks like one design is well ahead, so we plan to make a decision tomorrow am so we can order the artwork to be mocked-up and then our pilot can begin.

I'm always amazed how few diabetes teams communicate directly with people with diabetes. I have been writing all my clinic letters to people with diabetes for several years, hopefully in terms people can understand (copied to their GP) with a full meds list, latest test results with interpretations and agreed action plan. It is the only way to travel!

This idea came from hearing Douglas Smallwood (DUK) giving a speech at a conference and recounting a contact with a doc who was reticent to share DS's blood test result with him. It made me ask myself why can't we get results to people BEFORE the consultation, rather than 'breaking the news' within it. So now my patients who want it can have A1c within 5 days of having blood taken (AND if the Trust/PCT agree its worth the ~50p or so per paper result, sms is free).

Whether we can do that for more than just A1c.... maybe the next project! So few of the people I see understand A1c at present. It makes me very sad and needs much work and focus to turn it around.

I'll keep you updated on progress Smile