And now the end is near – by Andy Broomhead




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Andy BDecember will see the REPOSE study I’m taking part in come to a conclusion, and with it, I’ll be handing back my insulin pump to the team at the hospital, although I hope that will only be temporary.

In some ways, it feels like I’ve had the pump forever, yet in others it seems like it was only a few weeks ago that I was going through DAFNE and going back to basics with my own diabetes care.

If you’ve read these blogs fairly regularly, you may know that the purpose of the study is to understand whether or not people with type 1 diabetes can improve their HbA1c with just structured education(like DAFNE) or whether education and an insulin pump will give people better long term control.

I’ve been asked a few times what I think about pumps and whether or not I think it’s made my control better.  It’s a surprisingly difficult question to answer properly.  There’s no doubt my HbA1c has improved since I started on the pump (63 to 55) but that’s also been in conjunction with a significantly improved diet and by implementing the techniques from DAFNE into daily life. Some people perceive that insulin pumps are a silver bullet to treating diabetes.

I think there’s a belief amongst that having a machine doing the thinking for you means your control has to get much better.  Personally I don’t think it’s that straightforward and that, like having insulin pens, if you don’t know how to use it properly, it will only get you so far.

Speaking about my own experiences, I think the pump definitely allows for more freedom and flexibility around my lifestyle and it’s helped me understand more how my own personal experience of diabetes.  For example, I do quite a bit of running and so having the ability to lower my basal insulin rates by pressing a few buttons means I can be a lot more flexible about when I exercise and for how long.  It’s also shown me that I can refine my insulin doses to take into account things like the Dawn Phenomenon (where my BG rises after I wake up).  I think it’s a lot harder to cater for these sorts of things with multiple daily injections (MDI).

That’s not to say that the pump necessarily means I have completely flat, stable blood glucose levels, because that’s definitely not always the case.  I have periods when my BG is higher than I’d like and stubbornly refuses to come down.  Then there’s the occasional period of unrelenting lows where it feels like a battle to maintain anything about 5 mmol.

I think the difference there is definitely down to education.  Like many people, I was always a bit wary of DAFNE because it meant taking a full week off work to talk about my diabetes – not something I was particularly looking forward to.  Having attended the course, I’d urge everyone to try and do it if you can.  The long term benefits of understanding your diabetes in real detail are huge, and getting the opportunity to interact with other people and share experiences is incredibly invaluable.

I’ve already enquired about switching to a pump for my ongoing treatment and the early indications look promising.  There are certain criteria that have to be met (under the Sheffield CCG at least) and anyone with a pump has to attend an additional pump clinic to ensure they’re using it correctly and continuing to meet the criteria.  There’s definitely no guarantee but I’m hopeful I can demonstrate why it makes sense for me to continue with a pump from 2015.

Christmas will be interesting as I’ll have transitioned back to MDI for at least a few weeks until I get a follow up clinic appointment.  I’m curious to see how the change in regime will affect my BG in the short term, and whether I can use DAFNE to minimise the impact.

I think using the pump has given me an extra level of freedom that I wasn’t really expecting and that’s been incredibly refreshing.  Whether or not the pump has contributed more to an improved HbA1c is a different question, but I know that DAFNE has been very valuable for me.  I know the results of the study will start to be available next year so I look forward to seeing whether there’s a significant difference across the country.

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