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RE: [IP] Re: Question

Why does this have to be black and white?
The "real life" examples I have seen have various outcomes, but the majority
of the outcomes that I have observed have been less than ideal.
Shouldn't the prescribing practitioner be assured of some responsibility
before taking such a step?


-----Original Message-----
From: email @ redacted [mailto:email @ redacted]On Behalf
Of Michael
Sent: Tuesday, November 03, 1998 4:09 AM
To: email @ redacted
Subject: RE: [IP] Re: Question

> I've been off - line for a while, so I apologize for my delay in
> 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
> below.  What has been your experience with the results achieved when
> 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
> 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/

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