Being Heard In Diabetes

A curious title? Perhaps. Hang in there and allow me to explain. This is going to be a positive-in-tone blog post about our voices as diabetics and how today, in 2023, things are far different and far better than they were only a few years ago.

Living with a long term condition, such as diabetes, is a huge burden for many to shoulder. The nuances make the burden different from person to person and in some cases individuals report no burden at all. It's a long, varied, spectrum - the burden of diabetes. What many have spoken about and in some cases shared experiences of historical events is that as a patient they rarely felt listened to by their HCPs. It's something I can relate to and also something that I've noticed a change with.

When I was a lad, it was all trees and fields as far as the eye could see. And a hospital or two. At one of those hospitals, I attended my diabetes outpatients appointments every 3 or 4 months. They were terrible. From threats of visits to the "amputation ward" to a single focus on the numbers in my blood glucose diary (most of which were lies anyway) I never felt heard, never supported and was once described as "an angry young man". Little wonder, you might think, that I decided to put my head into the sand and as an older teenager and young adult I would avoid attending clinic. 

Let's jump back to today; less fields and trees but still a hospital or two - a different hospital or two in a different area. What's different? Well, the general attitude of my HCPs is outstanding. Despite what you may have read, I'm a 46 year old adult and my treatment in the last few years has been excellent, respectful and kind. Compared to my treatment in the 1980s and 1990s it is a different world. I feel delighted to have this much improved care but also a little sad for younger me who went through years of very poor care. 

It isn't just in the clinic environment where things have improved. As diabetics, even those recently diagnosed, we are seen as experts of the condition. It's probably right to suggest that some know an awful lot more than others but eventually nobody will know more about your diabetes than you do. It's very respectful to view the person living with the chronic illness as an expert and it sets a great tone for communication from then on. As experts, our views and experiences must matter. You may have noticed many conferences which focus on our lived experiences and our views on diabetes and long may they continue. As we share, as we listen, we help others and we help ourselves. 

You may have also heard of the draft guidance for Hybrid Closed Loop, recently. Our views matter there! NICE are welcoming comments until 5pm UK time on January 31st - soon after this blog is published, so head over there and let NICE know where the guidance for HCL should be focused. 

Social media has become an incredibly powerful way to be heard in recent years, too. Diabetics from around the world share experiences, knowledge and their struggles. Many have cited the #GBDoc community on Twitter as transforming their diabetes for the better. I include myself in that as you probably know if you've read much of my blog before. Because of being heard by my peers, by HCPs and by some diabetes businesses I am able to live a far less burdensome life than that of just a few years ago. I'm also able to dedicate some of my time to helping others to achieve their diabetes goals. 

Although I live with various conditions, Type 1 Diabetes has dominated my time and energy for almost four decades, but never to such a small degree as today. Things seem set to continue to improve in most areas of managing the condition, too. Technology is advancing and even the cumbersome NHS are embracing it. Peer support has been given the recognition it deserves. The diabetic voice is a loud one and heard in almost all circles. Of course, there is much more which needs to be done to provide fantastic care to everybody living with diabetes in every country and not just in certain areas of the United Kingdom. 

There is never a great time to be a diabetic but 2023 is certainly a better time to be living in the UK with a wonky pancreas than most years gone by. Let's keep talking and keep pushing for the very best care for everybody, regardless of type.

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The Six Principles of Good Peer Support - My Thoughts

World Diabetes Day saw an eagerly awaited NHS document on peer support published. 'The Six Principles of Good Peer Support for People Living With Type 1 Diabetes' hit the NHS website and various socials. Many congratulatory responses were passed around, including my own.

I've written and spoken about peer support, both formally and informally, many times and I make no apologies for that. It might just be the key element in my own T1D care - the reasons for that? I've detailed so many times that I won't bother to do so again in this blog post, you likely already know them very well and I don't want to lose your attention in paragraph two. 

Let's take a quick look at the six principles which the NHS and helpers believe to be part of good peer support if you have T1D. I'll throw in my comments in Italics and bold. 

1. Driven by the shared experiences of people living with Type 1 Diabetes

Why is this important?

The value of good peer support comes from people sharing their experiences, frustrations and successes with others who have been through similar things themselves.

Straight in there with shared experiences. Great stuff. Many of us love to share but also to learn from the experiences of others. I think it's important to remember that, despite T1D, we are all very different in many ways. A review of a CGM or a pump can be completely different from person to person, a visit to a certain clinic, reactions to certain meds, diets, exercise. It's very obvious that there is little in the way of black and white when it comes to T1D. Taking on board the words of others and their experiences can absolutely prepare a person, give them a heads up, etc but don't always take a shared experience as gospel.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People can share real-world examples of how living with Type 1 diabetes affects them. They can find reassurance and support from other people in the group who know what it’s like to live with the condition.

Absolutely. How often do you read "Hard relate" when somebody shares an experience? Very often, for me. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

Facilitators being able to share their own experiences with confidence will help and encourage others to do the same, whilst being mindful that each person’s own experience is unique.

Mindful indeed. I'm pleased that this was added in Principle 1. Peer support cannot be "Do it this way because it works for me". Well done to whoever pushed that in.

Clinicians and service providers?

Referring people to a group of ‘experts by experience’ will provide a vital avenue for people to feel confident and supported in living with Type 1 diabetes.

I'm not comfortable with 'experts'. We might be! about our own T1D but about living with T1D in general? By all means, refer to yourself as an expert if you're happy with that. I think the word might also set high expectations from the newly diagnosed or those looking for a specific type of support. Peer support is largely voluntary and it might be very respectful to refer to us volunteers as experts but, I worry about expectations and disappointment. Clinicians could refer people to 'Experienced people living with T1D' and if specific support is needed? '...T1D and a related issue'. I run a T1D group for men, that might look like '...T1D and men's health'

2. Reciprocal, with opportunities for people to ‘give and get’, as well as to learn from one another

Why is this important?

Reciprocal support recognises the mutual benefit of giving and receiving support

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

All experiences of living with Type 1 diabetes are valid and no one person is more ‘expert’ than another. It would be helpful for group members to understand the difference between information and advice.

Fabulous. Nobody is more important than another in peer support circles. Ugh "expert". No one person's experiences are more valid than another? Great, RE: info and advice. Do the signposting thing and the "My experience of that is..." thing. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

The reciprocity of peer support emphasises the importance of creating a flexible space for people to share their experiences and from people to ‘give and get’ from one another. It is recommended that Facilitators have confidence in leading groups, including the ability to manage group dynamics and potentially difficult discussions.

Absolutely right. The GBDoc Twitter accounts often throw up issues and decision making which sometimes needs much discussion. To lead or facilitate requires a skill set that some don't possess. A track record is vital to good (and safe) peer support groups. 

Clinicians and service providers?

Confidence that people are being referred to an evidence-based, overarching experience that gives meaning and purpose.

A good track record? Cool. 

3. Safe and encouraging, enabling people to share their experiences free from any judgement

Why is this important?

Peer support should provide people with a safe, non-judgmental environment to be able to talk about their experiences of Type 1 diabetes.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

In listening to others’ experiences and building trust and confidence in the peer support group, people should feel safe to share their own experience of living with Type 1 diabetes. All group members may contribute to and agree common ground rules and boundaries (for example confidentiality) that will enable this trust to be built.

Essential and well done to whoever pushed this through. 

People giving Type 1 diabetes peer support as a group leader/facilitator?

Peer supporters should create the right conditions for a safe, nurturing, and welcoming environment, enabling and encouraging people living with Type 1 diabetes to share their own experiences and to learn from others. Group leaders might want to be aware of the benefit of establishing ground rules and/or a group agreement.

Absolutely right. In my own groups, we vet private group members before acceptance. In the open groups such as the GBDoc Twitter accounts, volunteers will discuss decisions to keep people safe and share information about anything which might put someone or a group of people at risk. 

Clinicians and service providers?

Confidence in referring people with Type 1 diabetes to a safe and supportive peer support group.

A good track record of protecting peers? Cool! 

4. Accessible and inclusive, available to everyone with Type 1 diabetes

Why is this important?

Everyone with Type 1 diabetes should have equal access to peer support.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People can feel confident that they can access their choice of peer support group.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Clear thought should be given to what would make groups accessible and inclusive e.g. the appropriate language for health literature, physical accessibility and/or cultural or religious considerations.

Barriers that might prevent people from accessing support should be mitigated wherever possible.

It is unlikely that any one group or avenue of support will be able to meet the needs of large groups of people, so knowing about and being able to signpost alternative avenues of support is useful.

I agree about unlikely but it is massively important to TRY. GBDoc has an Accessibility Pledge to cover very basic things in terms of accessibility such as ALT text (image descriptions) and disability friendly venues for get togethers. It is incredible to still see that many accounts of communities and their leaders/facilitators do not consider this. It has taken a lot of work from me to get the major diabetes charities on board with ALT text. I don't have high hopes for some volunteer led communities which offer peer support, sadly. That said, again, well done to whoever pushed through this very important aspect.

Clinicians and service providers?

Confidence in referring people to an accessible and inclusive peer support group.

Please check this before referring. Imagine referring somebody living with visual impairments to an account which does not ALT text their images? 

4. Person-centred, taking account of each person’s own strengths, values, needs and feelings

Why is this important?

Peer support should be focused on each person, their own unique characteristics, and what matters to them.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

People with Type 1 diabetes are seen as a whole person in the context of their own lives and experiences. Good peer support can help people to understand where their existing strengths and assets lie and how they can draw on these to help them manage their day to day lives.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Good listening skills are implicit in supporting someone to identify their own skills and resources, as well as what is available to them in the community. Good peer support looks outside the peer support group itself to signpost effectively to other services, which meet the needs of each person in the group.

Perfect. Listen to your peers and the language they use, I guess? Send them to the right resources or another group if need be.

Clinicians and service providers?

Confidence that people are being supported to develop their knowledge, skills and confidence to support their Type 1 Diabetes.

5. Complementary, working hand in hand with health and social care providers

Why is this important?

Good peer support should run alongside existing health and social care provision, enabling holistic provision of services to suit each individual person’s needs.

What does this mean for:

People with Type 1 diabetes accessing and giving group support as a group member?

Good peer support is one component in a complete toolkit of care. It provides options, opportunities, and choice for people to live well with Type 1 diabetes.

People giving Type 1 diabetes peer support as a group leader/facilitator?

Working in a complementary way means that people will be encouraged to access a range of services that best meet their needs. It recognises that peer support is only one aspect of Type 1 diabetes management.

Absolutely perfect.

Clinicians and service providers?

Confidence in referring to a peer support group to complement the service that they are providing.

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To read the full document then tap/click here

I'm very happy with this document, despite there being two point 4s and zero point 6 (eck!). I think it covers all the good basics and my concerns are few and very minor. I write that as a Type 1 Diabetic and as a facilitator of many peer support groups. The task now? I think to put together a well vetted database of groups and individuals which NHSE can call upon or offer to people when needed. How to vet? The usual record checks but consult those who have been neck-deep in peer support for years (good track record) within the United Kingdom. There is a safety disclaimer on the document and I think that's very wise Without any vetting of referred groups and individuals there needs to be a "you do this at your own risk" agreement in place.

 

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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Diabetes HCP Anonymous 1 - DSN Guest Blog

Post-Covid, the demands on HCPs in the UK have grown to unprecedented levels and Diabetes care has not escaped the turmoil. As an active member of many Diabetes circles, I have been fortunate to learn about the current situation faced by many of our hardworking HCPs within the NHS. Some of their stories have horrified me and given me a new perspective on life "on the other side of the appointment". I have offered my blog space to my HCP friends as a safe space for them to air their views anonymously. 

Welcome to the first of these Guest Blogs, written by a Diabetes Specialist Nurse.

Dad.

I love my job - I just need to get that out there before I open up to you about the current climate for people like me, working for the NHS. I work with some incredible people and the PwDs who I've met have been the most amazing, strong and stoic individuals. 

It's hard. Being a DSN right now is becoming really tough and some of us are at breaking point. The issues are complicated and come from many directions but the main one is Covid. You've probably felt the delays or a shift in your care due to the pandemic, as a patient. We understand your frustrations and we are trying our best to get through the backlogs. Many of us have been faced with very distressing issues, as really poorly people with Type 2 Diabetes are coming through to us following two years of seeing nobody. As you might imagine they need urgent care and referrals to other areas, all of which take up lots of time and resources. We're getting through things but it's going to take a while to until we see some sort of normality again.

I know that Paul has a large following of PwDs with Type 1 Diabetes and that you're all excited about the new availability of technology and the new NICE guidelines. I also know Paul to be a great champion of technology and an advocate for better access but I must offer some hard truths. Despite what you may have read, simply asking for a CGM will not result in you getting one immediately. 

Some of you are asking for Libre 3 which hasn't been released on to prescription yet, to transfer a patient to that requires the filling of a 10 page document - a very time consuming process when the demands come from hundreds of people. There is also no iPhone option for Libre 3 and no reader so it's only suitable for Android users. 

Elsewhere, I've seen requests for Dexcom 1 which has no sharing function, no predictive alerts and isn't yet available to prescribe. The Dexcom G6? That's still not happening unless the patient is hypo unaware. If you want a Dexcom and you have hypo awareness then you'll be directed to Dex 1 which is much inferior to a G6. Other options have been brought forward but there are huge question marks over quality and a lack of sharing with HCP options means the patient is left to manage their own data without our support.

Despite what you may have read on Twitter, the new guidance is a mess for us. It would've been helpful if these stumbling blocks were addressed and fixed long before the changes were announced to allow us to make changes easier. There is a push to bring these changes forward quickly, an undertone of "it's easy, NICE guidance, etc" but each device which isn't on prescription requires us to fill out 10 pages of information in a form called an IFR. There simply isn't the staff to cope with the current levels of demand much as we want to help everybody right away.

 Some of you, like Paul, have been fighting for access to pumps. The same issues are true in that area. Demand has increased because of the Looping trials and increased positive exposure through social media. Of course, to Loop you'll need a CGM and a Pump and the training. That's a lot of time and staff resources for us when we're already at breaking point. It feels like we're moved too quickly, tried to run before we can walk, and the result is going to be huge delays for patients. I'm working my socks off, I promise, because almost without exception I believe you guys deserve the very best care and technology that we can offer.

I'm sorry to have disappointed any of Paul's readers. What you read on social media, highly praised "Gods of technology" don't live up to the hype very often despite the roles they hold in regards to tech access at various orgs. If the senior HCPs won't or can't bend the rules to allow easy access then how are we mere mortals supposed to?

Thank you for reading my Guest Blog. Please leave your thoughts in the comments below.

DSN.

As you might have seen, a conflict has broken out in Ukraine as Russia has invaded that country. The scenes on TV and on social media are horrifying. What can we do? Well, I don't think there is a wrong way to help if you donate to charities who are active in helping the people of Ukraine. I support many charities but one which has always had my heart is MSF. Medecins Sans Frontieres translates as Doctors Without Borders. When it comes to the health of others in disaster areas, war zones and the like then I think we all have a duty to do what we can to help and help those who directly help! such as MSF. With that in mind, all donations to me via Buy Me a Coffee and all the pennies generated through the ads dotted around my pages will be donated to MSF. I will make up the difference for the fees taken by PayPal and Buy Me a Coffee. That will run until further notice, no time frames and possibly until Ukraine is a free country again. Thank you for reading my blog. 

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90 Days on an Insulin Pump

The 90s were definitely "my era". At the beginning of that decade, I was a schoolboy. Ten years later, I was engaged to be married. Everything in between was magnificent; the friendships (some of which still exist today), the nights out, the loves, the football, the TV, the Internet became a big thing and the music... Wow! the music. Of course, many reminisce about their teens and early adulthood and remember things through rose-tinted spectacles. Why not? Holding on to good memories can't be a bad thing. So, the 90s were important to me but you didn't come here to read my autobiography. 

90 days on an insulin pump has become incredibly important to me, too. I'm not sure I would swap the entire 1990s for this experience but it's up there with life changing events. 90 days is often the window used to monitor T1D management. Your HbA1c, TIR, hypo events and all the usual MOT bits and pieces get the once over by your HCPs for that period. I have some data because of using a CGM, some of that looks like this:

- Time in range: 82%

- Estimated HbA1c: 6.8%

- Hypo events: 7

 How does that compare to Multiple Daily Injections? I have some data!

- Time in range: 63%

- Estimated HbA1c: 7.5%

- Hypo events: 9

I am delighted by the improvement in the numbers, of course but they are a second, a distant second, to something more important. Something which, once we've accepted that Type 1 Diabetes is here to stay, becomes something we might strive for; a good quality of life.

QoL will differ from person to person because we all lead different lives. For me, it means reasonable levels of sleep, to not feel overwhelmed at the prospect of another injection, to wake up without Dawn Phenomenon ruining my morning, to be able to bolus for meals in comfort in public, to have more confidence in so many ways... to feel, dare I say, a step closer to being a person who does not have Diabetes. A baby step, perhaps given that I look like Robocop. Your move, NICE.

Ah, yes, NICE. Guidelines, criteria, a tax funded system. I know, I get it. Tax payer funded healthcare must have a criteria for various things which could impact upon the purse. So, unless you meet the current insulin pump criteria, you're going to find NHS funding hard to come by. Your health and wellbeing is secondary to the bottom line, sorry. That's the harsh reality of where we are with insulin pump access in England. All the noise and enthusiasm about Looping trials is super but you can forget Looping unless you're on an insulin pump and for that you need to meet the NICE criteria. A1c under 8.5% and on MDI? suddenly all the exciting Looping headlines don't look so... exciting.

"Keep asking"

"Keep making noise"

Oh, I will. Earlier this month, I reached out to my practice nurse and GP in regards to my switch to pumping and the barriers I am facing in getting full NHS support for it's long term use. We did have a nice exchange and I feel very supported by primary care but, of course, there is little they can do to change the decision of secondary care. Secondary care are understanding to a degree but their hands are tied by NICE criteria and a limited budget. Frustrating, eh!? This isn't a Path To Pumping blog, it's a little overview of the last 90 days, so I'm going to stop this particular subject in this paragraph. Needless to say, we are not done.

A few things have cropped up in other discussions, lately. Some questions which I can actually answer!

How does long acting insulin work in the pump?

It doesn't. The pump continually "drips" fast acting insulin. That becomes your basal. You don't notice it happening as you might not if you've ever had a drip in hospital. Your pump is programmed to give you the insulin you need, hour by hour. For a bolus, you ask it for more!

How are you rotating sites with your pump and CGM?

Legs! Although I have plenty of abdomen to work with. The CGM is a "set and forget" thing for 2 weeks, the pump cannula can then be moved around that. The pump works perfectly well on a thigh, by the way.

Are you going to Loop?

Once I have obtained NHS pump funding and Looping is embraced across the board, maybe! I know some are Looping and have more lows than me but similar numbers in other ways. I will, undoubtedly, try it. It seems inevitable and I expect numbers to be the same or better but the more important QoL will be ramped up another notch.

One of my patients mentioned your switch to Fiasp and Pumping in their appointment!

Good! Apparently, I'm an "Influencer" but I don't try to be. 

It seems that my switch to pumping has gained a lot of interest from my peers and various HCPs. As always, what works for one does not necessarily work for all. However, if you think that pump therapy might work for you then please do start the discussion. Noise will change things for the better for us all. The squeakiest hinge gets the most oil.

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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Peer Judgement

I've been a vocal advocate of peer support within Diabetes for a long time. It would be strange, in my position, to not be. The list of support, help and friendships offered to me has been incredible and I'll be forever grateful.

Alongside my peer support gushing, I have been deliberate in my attempts at trying to warn others about the potential pitfalls of engaging with peers within Diabetes circles. The ugly side of peer engagement rarely sticks its head above the parapet fortunately but it is there and as more official avenues of care begin to recognise the positives of peer support, I think it is very important to have a firm safeguarding and vetting procedure in place to at least minimise, if not eliminate, the possibility of damaging engagements between people living with Diabetes.

The Internet is a wild place. Anybody can create accounts and spout all kinds of hate, extreme views or health damaging advice.

"He's clearly not using the technology correctly..."

"Perhaps his grocery bill would be lower if..."

"The truth hurts" - A personal favourite of the peer judges.

Those three came from one person, a person who lives very locally to me and who (at the time) was claiming to be an active volunteer for Diabetes UK. He wasn't a volunteer, of course and it became apparent that he had aired his views about others' Diabetes management across social media resulting in various bans and outrage from other peers.

I think the great thing about Diabetes Twitter is the unquestioning welcoming and support of new people. I hope that remains because we were all newly diagnosed and frightened, once. I hope that remains despite the recent welcoming of an individual who claimed to be a student nurse, recently diagnosed with T1D. Tonnes of love and support from various quarters arrived in his life. At the same time his true colours became apparent. The colours of a racist, ableist, liar. The Twitter community noticed and large numbers were quick to express their displeasure before turning their back on that person.

This week, I passed the two month mark in my pumping journey. It's been great and I felt very encouraged by the real life changes as well as the improved numbers. I tweeted my numbers for a comparison to my life as a Diabetic on MDI. Much positivity followed until this reply:

"So clearly not worth having such an unsightly pump?! What gets to me is how damn ugly & unsexy all related to diabetes is!"

I did reply, later on but when I read that response I was angry. I was angry for others more than myself because I'm a man in my mid 40s and, after living a life with disability, I am almost numb to hurtful comments. I was angry for the newly diagnosed, the children, the impressionable, the low on confidence... I can't imagine how the teenager felt, after starting pump therapy recently, once they had read that response. How would you have felt? So, I didn't reply immediately. I retweeted the comment and invited others to share their views. It's a few days later, now and their tweet is still attracting replies. I think that underlines the strength of feeling and the general dismay.

What does pop up occasionally, if I've highlighted something which is horribly offensive, discrimination or possibly damaging to the health of others is the old "They're allowed an opinion" response. Sometimes dressed as freedom of speech and sometimes with a heavy hint of accusation with a #ThoughtPolice hashtag. Here's the deal; If a person responds to something you've done or said with words that express offense, that they feel discriminated against, that they're worried your words or actions could be damaging, then it's probably not for fun. It takes bravery for a person to call out these things. Then it's down to you to take a breath and consider if they have a point, was it a misunderstanding you can clear up or do you need to re-evaluate things? Perhaps even apologise!? I think everybody should be free to express themselves if that expression is not going to cause distress or damage to another person or persons. That would seem to be a reasonable, kind way to live and engage with others.

Words which struck a chord with me came from Dan Newman (@T1D_Dan) when the subject of harassment came up during an online conference. Dan said that if you read something which you don't like then simply block that account. He's right. You're not obliged to respond to anybody and your only duty on social media is to that of your own well being. You may be questioned, I certainly have been, about why you've blocked X, Y or Z. You don't owe any explanations to anybody. Do all your social media in a way which is comfortable for you and not others.

It seems that peer support could be a part of your Diabetes care through the NHS in the future. To the decision makers, the leaders, I encourage you to tread carefully by vetting each person you enlist, reading their social media and asking others for thoughts. If you offer somebody a job then you ask for references, don't you? and to everybody else online or otherwise; Stranger danger. 

Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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Size Matters

 

It's not what you're thinking, let's get that clear right away. Although! I am referring to little things in this blog, at least in regards to Diabetes. Those little things which we might be guilty of neglecting, ignoring or putting on the back-burner for another day. I've certainly done those things for various aspects of my Type 1 Diabetes.

Recently, it occurred to me that the little things can get neglected by others. Specifically, our healthcare professionals. I'm a firm believer that the majority of HCPs go into the profession with the very best of intentions and that they carry those intentions throughout their professional lives. Perhaps, with experience, shortcuts are used and without any problems arising from doing something to save time, to allow for a break, deal with a clinic which is overflowing and full of patients, etc. An HCP might repeat the practice because it's a small thing, nothing bad happened. Those of us who have been employed may have done similar things. Perhaps the job was stressful, you needed a break or you just really hated your boss! So, you cut some corners, reduced your load.

Yesterday, I tweeted the image below:

And I asked "Can anybody see the problem?"

The Tweet is here if you'd like to read through the replies.

It's probably obvious to you, if not - That's my prescription for 100 needles to be used on my Insulin pens. The NHS app indicates they cannot be reordered for 3 months. That's 100 needles for around 90 days. A needle should be new for each injection and I average around 8 injections per day.

It's probably an app issue. Probably! It's still a reasonably new way of ordering your repeat prescriptions. I know a way around this by calling my GP's prescription line and re-ordering needles through that method. It's never been challenged so, what's the problem?

Let's assume you're newly diagnosed. You're given a mountain of information to take home alongside the emotional pain of dealing with your new chronic condition. You're going to forget something or make mistakes. Maybe, after seeing your 100 needle allowance, you forgot that your DSN told you to use a new needle for each injection. You assume you can only use one needle per day and you're unscrewing it and moving it around between your basal and bolus pens, each time it's getting blunter, damaging your skin, perhaps not delivering the dose you require, damaging your BG and health in other ways.

Perhaps your maths isn't great and the numbers don't even hit home to you, until it's Saturday morning and you notice one needle left in the box.

It's just a little problem. Perhaps nothing terrible will happen but the chance is there and even things with huge odds have to happen sometimes, otherwise nobody would win the Lotto.

Needles and other Diabetes "paraphernalia" are the basics of life with the condition. Although I can work around my particular problem by ordering meds on the telephone, this isn't the first hurdle I've faced with access to the things I need to stay well, to stay alive. In 2017, I had my test strips reduced from 200 to 100 per month by my GP because my HbA1c was too high. Because, in her wisdom, giving me less test strips would seemingly improve my blood glucose. We spoke, at length, and after I questioned how long she'd been living with T1D and all it's difficulties & quoted NICE guidelines to her (thank you, Martin) my original prescription was re-instated but not without more gatekeeping. "If your A1c is over 7% in 3 months then I'm referring your care to the hospital". It was 6.8%. 

Little problems, little annoyances, a little more burden, Sir? Why, don't mind if I do! Just pop that on to my already burden-laden plate of Diabetes. 

"Oh, you think tech will help your Diabetes because it's proven to help hundreds of thousands of others? Well! We need you to jump through some hoops, go on some courses, give thanks at the DAFNE altar and if things are looking better in 90 days then maybe we'll let you continue to use that"

I've used some artistic licence, there but this one is accurate:

"You're too good at this to need a pump".

Flattery goes a long way! But deflecting through positivity is something I've known for many years. 

There are more but you get the gist. Gatekeeping some things might seem like a small matter, something of little concern, keeping things well within budget. The bigger picture for a growing condition within our population? I don't think I need to spell that out.

I know the NHS isn't perfect and that mistakes will happen. I also know it's 2021 and we're about to trial the use of artificial pancreas technology with 1000 individuals. Amazing stuff! Yet, some are denied enough BG test strips, some can't get an appointment to see a DSN or Diabetes Consultant, some have been promised a pump... in 2019! (they don't have it). Little things are still happening which do not lend themselves to good Diabetes care. Perhaps we need to start spending pennies on very basic care, uniformed care no matter where you live, before we get giddy with the pounds. 

 Thank you so much for reading this blog. I do appreciate your visit and your support. As you might know, I LOVE COFFEE! So I've teamed up with a thing called Buy Me A Coffee. If you enjoy my content and appreciate the time it takes to create such things then you can buy me a coffee! If you leave your Twitter @ name when you buy me a coffee, I will personally thank you. If you'd rather be anonymous then that's totally cool. Thanks for the caffeine!

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