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Re: [IPk] 4 vs 2 injections

Hi Tony

I did find that when Sasha was having only 2 injections a day life was very
difficult, restrictive and caused five severe nocturnal hypos with seizures.
The trouble with the Mixtard 30 you cannot give more of one type of insulin
without the other.   Either Sasha didn't have enough of the longer lasting
insulin to  cover during the day and to cover for lunch and if I gave a
bigger dose she would hypo with a couple of hours.  We never got it right
despite learning carb counting so at least this wasn't another variable to
b***er things up.  In the evening it was even worse as Sasha needed more short
acting to cover what was the largest meal of the day but needed much less
longer acting as she has no dawn rise.  This of course may change at puberty
she is only 7 at present and has been D for over 3 years. Mixtard 40 wasn't
the answer either.

We couldn't use direct acting insulin like Novorapid or Humalog for quite a
while as Sasha and her twin sister had undiagnosed coeliac disease which also
cause havoc with her blood sugars.  This was resolved when after contact by
email with others whose child had the same two conditions, I asked the clinic
to do blood tests.

I do see your point about using 4 injections a day and the blood sugars rising
in between the meal gaps.  I think some have used Humalog 25 mix to combat
this. There may be other combinations as well.

At one point she was on Mixtard 30 in the morning and separate injections of
Actrapid and Insulatard in the evening.  We used to give the injection of
Insulatard at 7.30 so that the peak would be over by 11.30pm when we test
before bed.

Recently we asked to change to Novorapid for the evening meal and this has
been very, very good.  Much better than I thought it would be.  Now we have
more steady blood sugars in the 2 hours after the injection.  We used to  get
sudden drops when Sasha would think she was going hypo when she wasn't.  The
recently we have split the morning dose to separate injections of Novorapid at
7.45 with  breakfast and then give the Insulatard just before we leave the
house at 8.20 to 8.30.  We have always had a problem with the longer acting
insulin peaking at 11.30.  They dont eat until 12.30 this was still a major
problem at the infant dept when they ate at 12.00.

Sasha has never minded more injections as this seemed to help iron out the
poor control we had before where she   would be high after breakfast and then
suddenly drop at 11am and then go too low just before lunch.

I would never go back to giving Mixed injections unless we had to.

However twice daily injections must suit a fair proportion of people or they
wouldn't use them.

My older daughter is at college with a girl in her 2Os who has been diabetic
since she was 10.  She told me that the clinic had offered her Humalog but she
was worried about changing and wanted to stay on the twice daily regimen
because it suited her.  We were only changed because I asked to make the

We still dont have prefect control, just good enough control.  I am still
always struggling with the problem that the insulatard never covers her lunch
well and she could really do with a shot at this time.  Without me going in
every day to do this it is not an option to us until she is older.

As   for the comment that kids today are not facing a lifetime of diabetes,
well I do hope this is true but my best friend at school was diagnosed with
diabetes decades ago and was promised a cure was on the horizon but it never
So meanwhile we do the best we can with what is available to us at present and
hope that this means it will delay or prevent complications for as long as

We have never has any pressure from the clinic to change anything they are
happy to jog along with anything, the D nurse we see also sees all the type 2s
referred to the clinic so we dont have a paediatric specialist D nurse.  There
are no pumpers at our clinic.

Mum of Sasha age 7 identical twin sister of Rebecca both coeliac.

----- Original Message -----
From: "Tony O'Sullivan" <email @ redacted>
To: <email @ redacted>
Sent: 18 April 2002 00:11
Subject: Re: [IPk] 4 vs 2 injections

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