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[IP] Re: Nurse needs help

>From: "Leslie Wall" <email @ redacted>

I will post your message to the Insulin_Pumpers mail list.
You should join.

> I am a nurse educator in Newfoundland a small province in Canada. Our
> clinic offers multi dosing therapy to anyone who will try it using Humalog.
> We have never used a pump however I would like to start some of our
> patients on same and a few of our Mds are keen. 

I will try to assist, I am a pumper DAD.  My daughter Lily has been 
pumping since she was 11 (now 14) and does use Humalog. She does not 
use a CDE and sees her doc only quarterly. Her hbA1c's are in the mid 
to high 6's.  I have provided all her support until this last year 
when she has taken it over herself. She plays competition soccer and 
swims competitively in the spring. (some lows here)
> I have one child aged 15 who is on multi therapy with Humalog and has
> delayed hypo reactions with exercise. we have tried the decrease of insulin
> and the extra food but he still has rapid drops in sugars post exercise
> sometimes hours later. 

This appears to be a common reaction with athletes, Lily experiences 
same occasionaly, however she modifies her basal rate when exercising 
(playing soccer or swimming) to compensate.  This phenomenen is 
easily quantifiable.  I think the problem is with the use of Lispro 
insulin and it's rapid onset rather than the exercise regimen perse. 
The doseage needs to be adjusted to match the exercise.  This occurs 
with regular insulin also.  Any fixed insulin regimen will exhibit a 
problem when the individual's energy useage goes up (or down for 
that matter).  Call me (below) and I will describe how to fix it.

Does this kid carbo count?? this can greatly improve control.

If not, buy a copy of 'Pumping Insulin' You don't have to use an 
insulin pump to use this book.
Contact Torrey Pines Press in San Diego California, they will ship 
and then bill you (at least in the US)

 >Do you know of anyone who has had this problem and a
> pump was used to fix same.

Pump will fix -- but it is a control and data taking exercise. The 
pump just makes it easy to do.  It is really hard with 
multi-injections to achieve the same degree of control.

> Or can you link me to someone who can? I would
> like to give as much information to this child and his family so they can
> decide? Please provide  me with names of clinics who have lots of
> experience with kids and pumps.

To my knowledge there are no clinics that fit this description, just 
individual docs.  There about a dozen kids in the Insulin-Pumpers 
membership. Ages 7 (I think) to 16.  The 16 year old started pumping 
at age 3  (that right!!)

Lily's doc has 500 pumpers but only a couple of kids.  They typically 
get more information from us than the other way around.  Lily is 
still (I think) the youngest person in the practice that is a pump 

 Please call me during the day at 650 494 3351 and we can chat 
about your questions and concerns.  I strongly recommend that you 
have any diabetic with type I go on the pump.  Everything gets 
easier.  This child, in particular, can certainly benefit from an 
insulin pump.  There are many bg control issues that become simpler 
including the problem you describe above.  Lily varies her basal rate 
almost every night to compensate for the day's activity and regularly 
makes adjustments for physical activity or lack thereof.  It works 
pretty well!

Also, you should join the mail list.


and click on the mail icon  --  then click join and fill out the 

> I hope you can help
I think you can find the answers you seek from the general mail list 
membership.  There are only a few medical professionals (who usually 
do not comment much) but many very knowledgeable pumpers willing to 
share their insight.
email @ redacted