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Re: [IP] NYC endo


>         I purchased a copy of Pumping Insulin several months ago and read
> it before I obtained a loaner pump from my Minimed rep to try!  In fact
> when I met him, he recommended that I read it and was surprised that I
> already had. I spoke to lots of people about pumps and as many parents of
> pumpers as I could find before deciding that a pump would be suitable for
> my son.  Then I had to spend considerable time convincing the endo that he
> wanted to try it.

Has your endo read Pumping Insulin yet? 

>         We had a long talk today about the ultralente and it was quite
> clear that she feels it would be dangerous to start him without it.

I feel so strongly about this that I'm going to echo Michael, Randall, Ted,
and Jim. It would be dangerous to *use* ultralente in addition to the
pump. The ultralente will cause unpredictable highs and lows, and you won't
be able to determine when you've set the pump basal and bolus ratios
correctly. In addition, you should be prepared for it to take 3-4 *days*
after you/Tim stops taking Ultralente for its effects to completely wear
off. It took me 3 days with NPH. 

>  She said that if that was what we wanted to do we would have to find another
> endo. 

That makes it difficult, since you like her. But it's probably a blessing
in disguise. Coupled with your statement that you had to expend a lot of
effort to convince her that the pump would be good, it sounds like she
really is still against the pump. As others mentioned, using ultralente
just sets you and Tim up for failure. 

>  She claimed that it is common practice to give NPH or ultralente to
> pregnant woman on the pump since the risk of pump failure would result in
> fetal death.  

I've *never* heard of that. I was pregnant last year and on the pump, with
an endo who's had lots of type I pump patients. I also saw a CDE in a Sweet
Success program, which is all about managing pregnancy and diabetes.  And I
read everything I could find on type I and pregnancy.  The major precaution
against DKA was simply to test my blood sugar 10-12 times a day. And to
change the set for any unexplained high. Also to change the infusion set
every 2 days.  I had maybe 3 infusion set problems the entire pregnancy,
caught them all when I was in the 200s or low 300s (300 was during the
night), took an injection to bring the low down fast, and changed the
set. The fetus was fine. Extremely healthy at birth, born at full term.

Perhaps this recommendation dates from 10 or more years ago? Ask for some

> She also said many pump patients are given compazine to keep
> on hand in case they wake up in DKA.  

Huh? What's compazine? And what's it supposed to do? DKA is caused by lack
of insulin, and insulin is what's needed.  I can only speak for myself, but
I *know* when my pump isn't working. And it's not that the pump failed,
only the infusion set. I feel nauseous and generally sick. A shot of
insulin is the most effective treatment, and works within an hour. (You
might want to keep Humalog on hand for such instances, should they ever
occur, and if your endo recommends it.) 

> She said that it would be easier for my son to disconnect or "take a
> break" from the pump with the ultralente on board.

No way. To disconnect, just bolus first for the basal insulin you'll miss
while disconnected. Or use a shot of insulin for missed basal and
bolus. Pumping Insulin explains how to do this in detail. 

> She also said she has lots of collegues to turn to for help if need
> be but is totally confident on being able to do this for my son. She is
> even wearing the pump exactly the way she wants to use it on my son.

She's wearing the pump? That might help her figure out how to change sets,
but (unless she's also type I) won't help her calculate basal rates or
bolus ratios or learn carb counting... 

> I did finally find two doctors with some pump experience, one at
> MT. Sinai hospital in Manhattan and one in Valhalla in Westchester
> county. MT. Sinai wants 4oo dollars for the initial visit and the other
> wants 285 dollars!  Neither accepts our insurance.....and unfortunately
> money is tight for us.

There are more pump familiar doctors than that in the NYC area. Call your
local Minimed rep and ask for recommendations. There should be at least one
that accepts your insurance. :-) 

I recognize that this is a very difficult decision. Firing someone you like
always is. :-) But, it's your son's *life*. I'd switch doctors 20 times if
I thought it would help my (fortunately very healthy) daughter...

Good luck. Let us know if you have more questions or want more
"support. :-) And feel free to write privately.

email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/