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Subject: [IP] A VENT ....

Let's all agree to be tolerant of each other's opinions. If
someone has an issue with someone's attitude or position on
a subject, then please send it directly to the person  and
not to the entire list.

We are here to educate and support, not bicker, argue, and
flame people we haven't met personally.
I usually try to stay out of these 'wars", but I could not
do so, this time.

Much of what Roxanne had to say was correct in that type 1
DM does not go away. Also, type 1s on pump usually take less
insulin after going on the pump because the insulin can
match food and activity more physiologically.  Some people
develop insulin resistance to long acting injected insulin
(pre-pump)and require higher doses to control BG, but also
developing unpredictable low BG when diet and activity
levels change, potentially adding to the "roller-coaster"
problem and increased food intake to "feed" lows, and then
more insulin to correct rebounds from undetected lows or
from unabsorbed insulin. While the "rollercoaster" is more
frequent in type 1, it can occur in someone with type 2.

Type 2 in the elderly can be problem with aging and
decreased appetite. There are several elderly still alive
who only took insulin because that is all there was to
control BG and some MDs did not add oral medications. If
these people eat less, then their own insulin may be enough
for them to control BG, but I would personally want to see a
BG profile over at least a week, that includes pre- and
post-meal, and 3 am BGs.

Another situation that can occur with anyone taking insulin
is the problem of decreased renal function (very common in
the elderly and any person with diabetes who develops renal
complications). Renal insufficiency, plus residual insulin
remaining in the body because of renal complications, will
require the individual to take less insulin to avoid low BG.

We have come a long way in diabetes management from 50 years

It is all quite complicated, and each person has different

Barbara A. Bradley, MS, RN, CDE
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