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Re: [IPk] Re: Very low carb diet

-----Message d'origine-----
De : John Neale <email @ redacted>
À : email @ redacted <email @ redacted>
Date : lundi 17 avril 2000 13:21
Objet : [IPk] Re: Very low carb diet

>Sue - I'll go a step further than Julette, and suggest that your dietician
>may not know what she is doing!!! If she thinks that a continuous (and
>correctly set) basal rate requires you to "feed" the insulin with
>carbohydrate, she has completely misunderstood the whole concept of pump
>therapy. The correctly set basal rate simply holds the bg level steady. >


Yes, but.

I have been scathing about dieticians in the past, but let me put in a word
in their defence.

 First, dieticians cannot be expected to lead the charge in medical
awareness of the ins and outs of pump therapy - that is not their rôle
(after all, the UK medical establishment seems to expend its efforts
disproportionately in looking for the drawbacks rather than the advantages,
on the basis that pumping is a new development which will require "new

 Second, the majority of diabetics are type two and isn't the kind of good
sense dietary advice that dieticians provide much more their essential,
daily need?

Apart from this, I would only like to take issue slightly with your comment
that the correctly set basal rate simply holds the bg level steady. I take
this as a theoretical statement. It is true in practice, in an individual
case, if one can draw a simple distinction between basal rate and bolus, but
I don't think one should let it limit the way one exploits the advantages of
the pump.

 To be clear: we have seen numerous correspondents talk about the timing of
boluses and splitting boluses (square waving - is that it?) which seems to
be quite a problematical issue. The whole point is getting the right levels
of insulin in the blood at the right time.  I, with my "unstable" version of
the condition, can get closest to this by having a basal régime which tries
to anticipate the sharply varying requirements at different times of the
day, by building up and building down the insulin levels, sometimes in
anticipation of mealtimes. I also find I need to take the morning bolus
after breakfast (far too much and too variable to be happy simply putting it
in the basal rate) and split the lunch and evening doses. At a guess, but I
tend only to vary the time of my meals rather than miss them altogether, my
current basal régime, with normal physical activity and no food intake,
would leave me hypo mid morning, mid afternoon and mid evening.

My point is that the basal régime and boluses should be viewed as
complementary and, to some extent, interchangeable. I know this compromises
the "total flexibility" goal which many hope for with the pump but, even in
a case such as mine, the pump goes much closer to this flexibility ideal
than a multiple injection régime.

Regards,    Simon

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