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Re: [IP] zero to DKA in nothin' flat?

On  5 May 98 at 13:15, Kim Huffman wrote:

> Yesterday I was on the phone with our CDE making insulin adjustments and
> wanted to remind her that at our next visit I wanted to discuss the pump
> for Stephanie (she's 9 yrs. old).  Even though they have some kids on
> pumps, they are all over age 12, and I could tell she was trying to
> discourage us from considering it right now.  She talked about how fast
> you can go into DKA on the pump, and said that it does happen, even with
> those who are meticulous (I think that statement was for our benefit, as
> she knows how meticulous I am).  I would like to know just how fast this
> can actually happen.  For instance, let's say she goes to bed and
> somehow the infusion set comes out.  Between night and morning, how high
> could her blood sugar rise w/out insulin for that period of time? 

There are many variables here - one is how much residual function 
remains in her beta cells.  Some people have no insulin production 
left while others retain a significant amount for several years.   
Physiology has a lot to do with it too, along with what was eaten in 
the time period preceeding the triggering event (infusion set falling 
out) and activity levels.  I'm not sure I believe the stuff about 
going into DKA in a matter of hours - you may be headed for trouble 
but my doctor has said several times that the key is to take 
appropriate action when you discover the problem and that you should 
have eight to ten hours before you get into really serious problems.

The key to the pump is to check before bedtime and immediately on 
waking up.  My wife knows how to check my bg and can take appropriate 
action if I am unresponsive.  One of the unfortunate impacts of 
diabetes is that we do depend on those around us - the people at my 
office know what to do if I start acting strange (although one of the 
accountants ventured that they would have a hard time noticing the 
difference!) or if I am unconcious.  As long as you know how to 
handle DKA appropriately by giving a shot then I wonder what the big 
deal is - it's not any different than someone forgetting to take a 
shot.  Ask the CDE about that problem - isn't she afraid that a young 
child may decide not to take a shot (simply being assertive) or may 
forget to take the shot?  The results of missing a shot, eating an 
extra snack without compensation, or loosing an infusion line are all 
the same...

I think that some of the resistance by some CDE's and other medical 
professionals is that they don't want to take the time to learn about 
their patients and work with them.  How many young children have we 
heard about recently that are doing well on the pump?  It just takes 
effort on the part of caregivers, medical professionals and others - 
but unfortunately some "professionals" don't want to invest in their 
clients.  Be careful that your CDE isn't using "scare tactics" to 
attempt to control you and your daughter...  
Randall Winchester

* The views expressed here are mine and do not necessarily *
* reflect the official position of my employer.            *
* There's no guarantee on anything said here...
* If I say I understand something completely the only thing
* we can both be assured of is that I must have completely
* misunderstood something. 
Insulin-Pumpers website http://www.bizsystems.com/Diabetes/
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