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Re: [IP] Docs for no pumps

> In a message dated 7/25/99 2:31:22 PM Eastern Daylight Time, 
> email @ redacted writes:
> <<  So, I think this is a ni-ni blanket for the 
>  docs rather than a real necessity to achieve good control.  >>
> I think you missed the point.  If a patient does not have good
> control, and is not willing to keep records so that the doctors
> could make suggestions for improvement, they feel giving that
> patient a pump is not going to magically give them good control,
> which is what some patients think.  

No, I did not miss the point. There is another point which the doctor 
has missed entirely. Specifically, the reason for the poor control in 
the first place. Consider this.....

Taking into account all the difficulties a child has with control in 
addition to those brought about by growth spurts, raging hormones, 
etc... what incentive does he or she have for good control. There is 
absolutely no positive feedback. They are committed to their day when 
the NPH or UL is administered in the morning and if the slightest 
little thing goes wrong they end up high or low for apparently no 
reason and there is little or nothing they can do about it. A blood 
sugar test simply confirms that they have yet again failed to achieve 
the EXPECTED results, even though it is really not their fault at 
all. This is difficult enough for an adult to deal with much less a 
child. What feedback do they get??? Well if they don't test, no on 
knows they didn't make "their numbers". The archives are full of 
stories told by adults of how they faked their logs when they were 
kids to get the approval of their parents and doctors. Good record 
keeping for kids is a CONTROL FREAK issue with the doctors and 
parents more than it is useful or even desirable from the perspective 
of the child.

On the other hand, consider the same situation for a child with a 
pump. The situation is reversed in the sense that BECAUSE they can 
exert control on the situation by actively managing their own blood 
sugars, there is truly a desire to test more frequently. Many parents 
on this list will verify this and I can state absolutely that for my 
daughter, testing went from 3 or maybe a maximum of 4 times a day to 
6-7 times daily almost overnight when she started pump therapy. I 
didn't tell her to do it, she figured it out by herself real quick. 
If she wants to eat/not eat, sleep in, stay up late whatever.... 
where she was previously restricted by highs or lows, now she can 
fix those problems herself quickly by pushing a couple of buttons. I 
suggest you read her own comments about the "control" issues in her 
essay which is available on the web at:


Small children are not nearly so expressive, but they certainly share 
all the same problems with respect to motivation and desires that 
older kids and adults with diabetes experience. The difference is 
that an adult can be many times be motivated to do something simply 
by intellectually understanding that it is necessary. With a kids, it 
is difficult to hold their attention on something like record keeping 
for very long when all they get is negative feedback and another 
"chore" to do.

I have not addressed the necessity of the record keeping itself. I 
like to see the records for my daughter, and the doc used to want to 
see them, but now simply downloads her meter. I see no justification 
for the "requirement" that records be kept. In reality the serve 
little useful purpose that can't be handled another way with much 
less burden to the patient, in this case a youngster who justifiably 
would rather not be bothered.

email @ redacted
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