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Re: [IP] Brittle Diabetics

Kathy Bruckmeyer wrote:
>... I was wondering if there are any brittle diabetics out there who are 
>pumping and has being on the pump helped give you better control?

Hi, Kathy.

I've had IDDM (Type 1) for almost 30 years. I certainly consider myself to 
be brittle. My basal doses and boluses can vary considerably from day to 
day. At constant activity and diet, the basal can vary from 0.5-1.3 
units/hr. At constant exchange values, my dinnertime bolus can vary from 
8-14 units. Insulin requirements generally persist for a few days and then 
change again. I can recognize changes to the basal requirement much faster 
than those to the bolus. If I'm taking too much basal, I'll have repeated 
low blood sugar episodes at unexpected times. If the basal dose is too low, 
I'll have a very particular sluggish feeling and blood sugars that climb 
slowly and steadily when I'm not eating.

The pump has certainly helped. When any basal change occurs, I can react 
instantly. When I was on MDI, I had to wait for the long-acting insulin to 
complete its activity first. (This eliminates over 12 hours of needless 
wait with Ultralente, my last long-acting insulin.)

My control is no better statistically now than it was prior to the pump, 
considering the distribution of blood glucose values, the generated 
statistics, and my A1C values (which, surprisingly, have continued to be in 
the middle of the normal range). I feel better about the treatment I'm 
providing myself with the pump, though, since I know that I'm reacting as 
fast as modern technology allows to the whims of my body concerning its 
insulin requirement. Only closed loop control could be better.

Slowly, I learn to recognize new influences. It took me years to conclude 
that low-level sinus infections were at work. It then took several more 
years to find an effective treatment. After the sinusitis subsided, the 
amplitude of the changes decreased dramatically, but there were still other 
changes that persisted. Years later, I discovered that I'm sensitive to 
certain milk products, especially ice cream and whipped cream. Eating a 
couple of scoops of ice cream will elevate my basal for about two days. 
Whipped cream in any quantity has an even more pronounced effect.

Lately, I've noticed that I'm seeing either accelerated insulin absorption 
or delayed release of my meal from my gut -- I'll eat and administer my 
bolus, start a reaction as I finish dessert, treat the reaction, and 
observe elevated blood sugar about 5 hours later. The bolus I'll need to 
administer is *exactly* what's needed to compensate for the sugar used to 
treat the reaction. I'm using square wave boluses to contend with this.

Over the years, I've had short periods of up to several months when my 
insulin requirement stays stable. Diabetes is truly simple to manage at 
such times and, for me, such periods are like a vacation from diabetes. 
Those periods end as quickly as they begin and for no discernible reason.

None of my endocrinologists has been able to do more than skeptically shrug 
their shoulders at all this. After all, my A1C tests are good, as is my 
overall health -- I have no overt diabetic complications. So any discovery 
I make is due to my own persistence. It's slow, since I'm my only subject 
-- few diabetics ever complain about changes to insulin requirements, 
except when talking about their kids and the effects of "growth hormone". 
It appears, then, that the incidence of brittle diabetes is very low.

To summarize, the pump helps me respond more quickly when my insulin 
requirement changes,  but it hasn't diminished the frequency or intensity 
of those changes.

Hope that helps.

regards, Andy
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