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[IP] a Response from Joslin to my letter

   If you recall a post about a month ago in which a frustrated mom wanted
letters written to Joslin in support of her desire to put her 7 yr old on a
pump, then you should be interested to hear that I just received a 2 page
response from the doctor I wrote to!!!...Sorry to say, it doesn't "back down"
one bit from their earlier stance...I'm going to type it in, so this may be l-

    [ Thank you very much for your letter of March 21,1998. I certainly
appreciate your taking the time to write to me.  I think that the information
you have gotten about our attitude toward pumps in teens at Joslin in not
quite complete.
     We certainly do support the use of pumps in teens if they, and their
family, are willing to do the intensive blood sugar checking, make insulin
basal & bolus adjustments and have regular contact with their diabetes team.
In fact, I have patients on the pump and Joslin Center is planning to put
together a more formal pump program this year.  I certainly think that the
type of program you describe for your daughter, including seeing a CDE
regularly on a monthly basis & being involved in a support group, is very
appropriate & helpful.
    Certainly, individual patients can markedly improve their control on the
pump, although most studies show that groups as a whole can do as well on 3 or
4 shots a day as on pump therapy.  This probably has a lot to do with the
individual commitment of people toward carbohydrate counting & bolus
adjustment.  Pumps certainly require a close & supportive interaction between
parents & teenagers, as well as between the family and the health care team.
     As yet, we have not had children under the age of 12 on pumps at Joslin
and, although we would consider this on an individual basis, I have referred
patients to centers with more experience in pumps with young children.  I
suspect that the family you have spoken to may be the parents of a young child
with diabetes who is not old enough to make decisions about boluses by
themselves.  This is obviously a more difficult problem although, as you say.
individual families have done a very good job with this.
     All of us who work in diabetes are open to new approaches and any ways
that we can safely and effectively improve blood glucose control we want to
explore.  The Internet has proven a tremendous support for parents and
patients on the pump, and I think the communication between parents through
the Internet has been helpful for many families.
    I certainly support families on the pump being involved with our
multidisciplinary team here at Joslin, which would include a psychologist.  We
do ask of families that they meet our psychologist for a review of
developmental issues involved in pump therapy at different ages.  This is a
multidisciplinary approach to intensive therapy as was done in the DCCT and
not a criticism of an individual family.
     Emotional and behavioral support was a very important part of the
diabetes care and complications trial because of the intense demands that
daily diabetes tasks require in an intensive diabetes management program.
Most of the families that meet with our psychologist in advance of beginning
pump therapy have found this as a part of our overall support for them rather
than an invasion into their privacy.  We certainly see it this way.
     Thanks again for your attention and for your input.  A dialogue is
certainly always very helpful.  We continue to offer pump therapy as an option
for diabetes management for many families in the future......Sincerely, Dr.

HMMMMMMMM...to quote Shakespeare, "methinks this lady doth protest too

Regards, Renee
Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
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