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Re: [IP] Convincing a CDE
In a message dated 6/28/2001 10:26:24 AM Mountain Daylight Time,
email @ redacted writes:
> .but the CDE said she would not recommend us for the pump
> until Katie is on 15 units of insulin a day(she is currently on 11.5-14
> depending on her carb intake in a day)....what can I say to change her
Vicki -- It sounds like you've really thought through why pumping makes sense
for your daughter and your family -- In case you haven't communicated all of
that to your doc & your CDE, be sure that you do. I would definitely
emphasize the problem with lows that occur because you can not stay on a
strict eating time schedule.
One thing I might you might ask your CDE is to explain exactly why 15 units
is the magic number . . . Some docs don't llike to put kids on pumps while
they're still honeymooning -- especially when some kids insulin needs drop
down to really tiny amounts (a couple units a day or even less) while they're
honeymooning and in those cases I can see why it's hard to justify the costs
and the learning curve required for going on a pump. However, it looks
pretty clear that this doesn't apply to your daughter -- so you might have an
easier time convincing her to recommend you if you understand what the
reasoning is behind the "15 units a day Rule" . . .
One other thing: If they talk about your daughter still being somewhat in
the honeymoon phase as a reason for NOT putting her on a pump -- you could
share with them the concept that the constant flow of basal insulin from a
pump ( and the more stable BGs that come with it) seems to give more relief
to a pancreas than injections do and that there is a fair amount of anecdotal
evidence that this can result in a substantial extension of the time period
where your daughter would retain the ability to produce at least some of her
own insulin (a very good thing).
I wish I had a study to cite regarding this, I haven't yet come across
anything documenting it. I can say that I have heard this from three
different endos and a nurse practitioner. One doctor (of national
prominence) told us directly that he thinks that as more children go on pumps
earlier in life (and more quickly after dx) there will be clear evidence that
pumps will extend residual islet function for years, if not decades . . .
WHile we don't know now if this will prove to be true, we won't ever know if
more docs don't start looking at pumping well before adolescence.
The other point that you could add is that with a child this age, the doctor
is effectively putting YOU on a pump since you will be the one fully
responsible for managing her diabetes care for the next several years (just
as you do now on injections) -- and if a pump could potentially help YOU
manage her diabetes more effectively (and safely!) there really is not good
reason not to try it . . . you can always go back to shots . . .
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