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RE: [IP] Re: Question

> I've been off - line for a while, so I apologize for my delay in responding.
> Of the three endocrinologists I have dealt with on a regular basis in the
> Atlanta area, all of them tend to follow the thought process that I outlined
> below.  What has been your experience with the results achieved when putting
> a child who refuses to take control of his care on a pump?
> Hunter
> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On Behalf
> Sent: Monday, October 19, 1998 9:36 AM
> To: email @ redacted
> Subject: RE: [IP] Re: Question
> >>> "Hunter Hughes" <email @ redacted> 10/18 10:06 PM >>>
> Typically - a pump is not recommended until an A1c is within a reasonable
> range in children.  Of course, this is only the case when high A1c levels
> are due to poor effort on behalf of the patient.  If a younger person cannot
> adequately control their bg levels, they probably don't have the
> responsibility needed to handle the pump.  "Doc shopping" will more than
> likely NOT solve this problem. Hunter Hughes, NREMT-P<<<
> My experience and belief is entirely opposite your statement.  Glad we are
> all entitled to our opinions....

If you think about this a little bit, the Doc's attitude is a self 
fulfilling promise. A child on a typical 2 or 3 shot a day regimen 
has absolutely no incentive to try and improve. The are stuck with a 
big glob of NPH in the morning and a big glob at night. No matter 
what they do, if the doses chosen by the doc don't happen to exactly 
match the kid's basal requirements, the poor kid goes high, then low. 
This results only in pure frustration and rebellion on the part of 
the child. The kid gets hassled for being non- compliant when, in 
fact, it is poor response by the medical team with a one-size fits 
all mentality that is causing the problem. The child, rebels against 
the nonsensical request for 'compliance' since it doesn't do any good 
anyway and the promise is fulfilled.

Contrast that with pump therapy in a simple minded example. The kids 
knows if he/she tests and does a small bolus if high or glucose/small 
snack if low that perfect control and 'privilege' is literally at 
their fingertips. That ice cream cone or hamburger is just a test and 
adjustment away AND they feel a lot better as well. Talk about 
positive incentive!!!

So..... who's off base here? You figure it out.

email @ redacted
Insulin-Pumpers website http://www.insulin-pumpers.org/