Taking Action – By Helen May
I have previously written about my frustration about being declined the loan of a CGM. I have been dwelling on this ever since and, finally, decided to do something about it: I have written the following to my diabetes consultant.
I keep reading that 10% of the NHS budget is spent on diabetes care. Of this, 80% is spent on complications. Therefore, in line with yesterday’s announcement of the NHS five-year plan which aims to “curb the rise in hospital admissions”, I am very keen to reduce the probability of complication by improving control of my diabetes.
For just over ten years, I have been one of your patients with Type 1 Diabetes. We see very little of each other: at my annual review, I meet with a different registrar each year. In these ten years, my condition has been treated with a basal-bolus insulin regime and measured using a finger-prick meter. There has been no change to my treatment and, I make very little demands on your department.
In order to self-manage as best as I can, I try to keep myself informed of the latest research around diabetes through read. For example, I receive Diabetes UK Update magazine, I subscribe to Medical News Today, Glycosmedia and Diabetic Hypoglycemia and I completed the Open University Diabetes course.
Whilst my annual Hb1AC shows an “okay” control, there are some activities and situations where my blood sugar control seems difficult to predict and I feel impact on my lifestyle and long-term management. For example:
o When I lead or present at a high-profile meeting at work, my blood glucose is all over the place whilst preparing, presenting and after the meetings. I my find myself struggling to concentrate and, after taking a reading, I discover my blood glucose is very high. Or I may start to get shaking and realise my blood glucose level is very low. I cannot predict when it will go high or low.
o During my menstrual periods, I may feel okay during day. But at some point in the night, my blood glucose rises and it affects my sleep. I do not know when it rises and what I can do to control this.
o Despite having a desk job, I struggle to sit still and constantly feed this energy with food: I am a grazer. As I eat, I try to count my carbs and take bolus insulin appropriately. However, as there is rarely a couple of hours between eating, I do not know what my blood glucose level should be: if they are high, is this because the insulin has not reached the peak of its profile?
o One of my hobbies is walking. It is not unusual for me to go out for a day of four or more hours of walking through the countryside in the UK or overseas. Often, my holidays are spent walking for five or six consecutive days. During these long walks of prolonged exercise, my blood glucose levels may fall so I have to stop once an hour to prick my finger and take a reading. This distracts from the enjoyment of the walk.
I would like to understand my body better: how it is behaving between the finger-pricks. In this way, I hope I can better calculate my insulin timings and doses.
This is the reason why, at my last annual review, I requested the loan of a Continuous Glucose Meter for one month. As an engineer, I am used to adopting new tools and analysing data. Therefore, I would not foresee the need for extensive training. Over one month, I would expect to experience most of the scenarios I described above and make some conclusions about how to adjust my diabetes management before returning the meter.
However, my request was declined. I was told, the meters are expensive and there are others with worse diabetes control more in need of the NHS budget. Whilst I do not disagree with this, I feel the return on a very small investment to me would be beneficial to the NHS in the long term due to improving my diabetes control and reducing the probability of future complications.
I want to enhance my quality of life and, as a taxpayer, reduce the long-term cost I contribute to the NHS. By improving my diabetes control from “okay” to “very good”, I believe this is possible. Therefore, I request that you consider my proposal for a loan of a Continuous Glucose Monitor for just one month.
Let’s see if I get a response.