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Re: [IPk] 4 vs 2 injections

Abigail is right, but there is another side to the 4 vs 2 injection

One of the big disadvantages of 4 injections a day, particularly if the
short-acting is an analogue, and the long-acting at night is a medium
insulin like insulatard, is that daytime gaps between meals are short of
insulin, and bg's can climb throughout the afternoon each day, even though
everything else is right. This is less likely with twice daily, as there is
some longer-acting given twice a day.

Secondly, children from the start of primary school to early secondary have
reasonably ordered lives, with mealtimes inevitably decided by a
parent/guardian. So the twice a day regime isn't too restrictive.

Third, twice daily regimens give quite good control, certainly good enough
for modern kids with diabetes who, and I don't mind repeating this, are NOT
facing a lifetime of diabetes. Studies show 2 injections to give better
control than 4 in this age group.

Fourth, analogue insulins, and better mixes with subtle variations in
proportion have improved twice daily treatment too, so it isn't the dreary
conservative approach it once was.

But regardless of all this, what really worries me is the 'performance
anxiety' which seems to be fed to many parents to make the diabetes
disappear  by keeping blood glucose within the normal range at all
times....but at what cost?

Professionals have a lot to answer for in raising the anxieties of parents
about major complications age 12 if the child doesn't keep a bg below 7 at
all times. This is not how it is. Of course we should all try to keep good
control etc, but this should be at an acceptable cost to quality of life,
and to me that includes the quality of life of the parents! HbA1c's above 7
give experienced expert patients such as Elizabeth the heeby jeebies, but
for most of us, and that includes kids with diabetes, they shouldn't.

Most of us have been weaned onto a pump after a period of multi-dose
injections, 4 or more times a day. It isn't written in stone that this
should be the way. Many US clinics use the pump as the default treatment
from day 1, and for someone who is enthusiastic, and wants to combine better
control with the freedom (eg to eat when and what you want), it can make
perfect sense to go straight from twice a day to the pump.

Am I a cynic? When I hear someone say 'I'll be happy when I have really good
control', I sometimes wonder if they are saying 'I can't really accept that
I have diabetes'. I've experienced denial, but dealt with it in a differnet
way, by ignoring the diabetes. I suppose I'm basically offering a little
caution to the idea that more tech is the answer, or shaving 0.2% off my
HbA1c will improve my life. We should stop once in a while to ask a more
basic question. Can I accept this common, manageable condition for a few
more years until a cure is available, and in the meantime, which of us will
be in control of my life?

Sorry, I should've saved it till Sunday!

Tony O'Sullivan
26 yr T1, pumping 6 months
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