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Re: [IP] Convincing a CDE

For eveyone who asked...no we don't really want to use a different endo...my 
daughter adores her to no end and so do I...she takes very good care of us 
and she is trying to come up with a reasonable explanation as to why to put 
katie on the pump so young, when none of her colleagues here do...she's a 
wonderful person and actually becoming more like a friend...she and i do a 
ton of jdrf work together and she gives katie extra personal care...we don't 
have to see one of her colleagues...we have her personal number and i can 
get in touch with her on a moments notice...so as a doctor, she is 
wonderful..can't sing her praises enough...it's not her fault really...just 
the politics of her office...a pump needs to be approved by a CDE and endo 
team psychologist...we've passed all the requirements and we are doing a 
pump trial in JUly...the CDE says she hesitates though because with katie's 
little insulin doses, she just doesn't trust pumps...yes they are made to 
give smaller doses, but she said that air can get in the tubing with smaller 
doses, etc...she says that there is no need to rush to put katie on a 
pump....but i don't feel we're rushing...i know katie has only had this 
"illness" for 7 months....but I am very actively involved in her care as 
well as the fight for a cure and i feel a pump is the best decsion in our 
case and we are committed to that...I think I need "proof" for the CDE as to 
why it is okay to put a 6 year old on the pump with only 12-14 units of 
insulin a day...that is the ONLY thing holding us back....and personally i 
don't feel like sitting around praying for katie's insulin needs to go up to 
get her on a pump:(
Thank you all for your thoughts nad suggestions...i greatly appreciate the 
response i have received!

>From: email @ redacted
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: Re: [IP] Convincing a CDE
>Date: Thu, 28 Jun 2001 14:07:18 EDT
>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 
>for your daughter and your family -- In case you haven't communicated all 
>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 
>honeymooning and in those cases I can see why it's hard to justify the 
>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 
>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 
>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 
>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 
>earlier in life (and more quickly after dx) there will be clear evidence 
>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 
>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 
>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 . . .
>for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
>send a DONATION http://www.Insulin-Pumpers.org/donate.shtml

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