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Subject: [IP] Boy, I wish she had a pump! Kinda long

Hi Carrie,
Don't you just hate diabetes?  Sometimes, I tell my daughter Jenna that I
wish we could just ask her body what it's up to today, so we knew how to
adjust the insulin accordingly.  Sounds like to me, that her NPH insulin
peaked early yesterday.  NPH is so variable day to day, somedays, it will
peak by lunch, some days not till much later.  If it peaked early, that
would explain the low at lunchtime, and by supper time, it was probably
mostly gone, so you got the high after supper.  Alternately, she also may
have had a strong adrenaline response to the low sugar that made her rebound
to high, but it seems like the high was too far after the low for that
really to be the problem.  My daughter is older than yours, but if she eats
19 grams of carbs, it will raise her blood sugar by at least 200 points.
So, for a  young one, 19 grams of coke, once the insulin has worn off, may
have caused the high also.  But, you just never know.

Endos are really divided about pumps for very young kids.  Many of them are
very "traditional", and pumps are seen as new-fangled things.  There is also
a debate about the philosophy of care for young kids.  In "conventional"
though, you try to keep them from being hypoglycemic, and from being in DKA,
and you don't worry about the swings as long as you don't swing to either
extreme.  The other philosophy is intensive control, which means keeping
blood sugars as close to normal all the time as possible.  Since very young
kids seem to be more immune to the diabetic complications to their eyes and
kidneys, most doctors haven't thought there was much long-term reason for
pushing intensive control (which is definitely shown to reduce those

HOWEVER......These philosophies don't take into account that it requires a
warped lifestyle to manage diabetes in kids (clock watching, food
regulating, regimented warped-ness),  and that most kids are inattentive,
crabby and out of sorts when their sugar is either high or low, so it feels
like a losing battle.

The pump lets kids have more of a normal lifestyle.  It lets them have fewer
(notice I didn't say "no") highs and lows, therefore less mood swings.  The
biggest disadvantage is that someone has to pay attention to the pump, and
troubleshoot it - and since your kid is young, that would be you.  But, if
you're already checking sugars, giving shots, and in general troubleshooting
diabetes, why not do it with a pump, and feel like you see some success?

UCSF has a reputation as a pump-friendly place for kids.  Hope it works out
for you.

Nancy Morgan, Jenna's mom

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