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Re: [IPp] Re: switching a child from Humalog to Novolog/Now "the pump"

In a message dated 3/16/2002 6:57:25 AM Pacific Standard Time, email @ redacted 

> My daughter had been on shots for 16 years and her a1c were in the 7's 
> sometimes 6.  I decided to switch for more flexibility but find that all 
> the 
> extra testing and counting carbs, etc. is more time consuming and 
> frustrating 
> since her sugars still fluctuate like before.  I wonder if I did the right 
> thing by changing to the pump.  Everyone's feedback is very helpful and 
> enlightening.  Thanks.  Lee

My son had great control on injections.  HBA1C were 6, 6.2, 5.9 and most 
recently 5.8.  He pretty much ate what he wanted (but at meal times; few or 
no snacks).  He didn't mind the injections and was testing before each meal 
and bedtime and we checked him at 3 a.m.  I was not even considering the 
pump, until his new doctor suggested it.  

We had a terrible pump start; I really could  not find a reason to justify 
using it and was ready to "throw it out".  Finally, I made up my mind that we 
were going to try it for 2 months no matter what so that Gabe could have a 
fair chance to make a decision based on the reality of the situation.  I 
think it is a psychological issue.  If you are satisfied with injections and 
don't really want the pump, or don't want to commit for a period of time, it 
is difficult to get started and continue pumping.

I can only tell you, it would have been a MISTAKE to quit the pump.  I have 
spent hundreds and hundreds and hundreds of hours learning how to use 
injections.  There is no comparison of the control you can get with the pump 
and the injections.  I would think that you could get similar meal results 
(although the injections only measure in .5 units and the pump in .1 units).  
But the long-acting insulins simply cannot give the control that the pump 
basals give.  No way.....we measured and measured.  The Ultralente dose we 
gave to keep b.g. overnight stable ended up as way too much later in the day. 
  It simply stopped working well as he grew and needed more and his dawn 
effect grew. 

Also, with the pump, you can dose high protein/high fat meals.  For pizza, 
steak, chicken and so on, my son would need a split dinner dose (two shots) 
and a correction dose at 3 a.m.  That was not acceptable in the long run, so 
he simply stopped eating protein in larger quantities.  With the pump, you 
can give extended boluses to cover any type of food.

I was absolutely sure we would stick with MDI (multiple daily injections), 
but now we would never turn back.

If you are not going to count carbs, measure doses, and check frequently, you 
are not going to get control with MDI or the pump.  The pump delivers insulin 
more efficiently and more physiologically (like a real pancreas), but a HUMAN 
still has to program it how and when to give the insulin.

If you want good control and are willing to do the work, then I suggest the 
pump.  If you are satisfied with average control and/or minimal control, than 
injections are the way to go because they are safer (no chance of being 
without long acting insulin unless you forget to inject) in terms of possible 

These are only my opinions and thoughts after three years of struggling with 
diabetes and doing pretty darn well on injections.  The pump is the closest 
thing to a cure that I can think of at this time.  Short of pump malfunction 
(site being occulded, pulling out and etc), Gabe's b.g.s have been better 
than I could imagine; in fact, they are almost in the non-diabetic range with 
the pump.

I guess maybe you could look at where the "instability" of b.g. is and focus 
on that; whether or not you use the pump or injections, you can probably 
figure out what is causing some of the unstable blood sugars.

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