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Re: [IP] Sliding Scale Insulin Dose



There _are_ two schools of thought in this regard, particularly with youngsters.
You could refer to these as the 'active' and 'passive' schools.  I prescribe
to the 'active' school, as I think pretty much any pump user would.

The goal is to decrease the area under the overall BG curve, and I feel that
the 'active' approach holds much more promise for doing this than the
'passive' one.
You get to be the 'chaser', rather than the 'chasee'.

The way I see it, it's sorta like learning how to control a car that's gone
into a skid (due to snow, rain, or racing).  The first few times you try to
steer out of it, you're likely to fishtail back the other way and end up in
the ditch (or knocking down cones or whatever).  But after lots of practice,
you _can_ learn to control it and get the vehicle back under control without
oversteering.

I once had an endo who prescribed to the 'passive' school.  I switched to a
new one, and eventually ended up with a pump.  The area under my BG curve is
now substantially smaller than it was before.

To each his/her own, but to me, it's better to try and fail than to never
have tried at all (sheesh, get me off this soapbox).

HTH,
DanO
--------
At 00:06 2/21/98 EST, Sherri Lynn wrote:
>
>Once again I am writing for advice.  My daughters Endo and our Pediatrician
>both say they do not believe in doing "sliding scale" for insulin dosages.
>They say we are just trading highs for lows and it is NEVER recommended for
>pediatric treatment of Type 1 Diabetes.   They say what is below the peaks is
>what counts and not the occasional peaks.   Whatever her readings are they
>want me to give the same amount of insulin each day.  (this makes no sense to
>me - why would you give the same amount of insulin for a 300 reading as you
>would for a 90?)
>
>Also, as a mother I struggle with not giving her Humalog to bring down an
>occasional high.  This doesn't happen frequently but on occasion it does.  I
>realize if this are happens frequently and we see a trend it is time to change
>the insulin dosage.   To not treat the high bothers me greatly.  When I give
>the extra Humalog I am careful to not do it in conjunction with the NPH peak
>(so far I have never sent her crashing).   Currently she is on a 2 shot/day
>regimin - before breakfast and dinner.  
>
>If we have the technology available to bring quickly bring down highs then why
>not?  I don't want to be going against our doctors but I am sense there may be
>two schools of thought on this.   Any input will be greatly welcome.  Also if
>I am completely off base please set me straight!  
>
>Sherri Lynn (Laura's mom)   

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