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[IPk] 2 vs 4 injections

Hello Tony
I certainly see some of your argument here
However, many children with DM do have woefully inadequate control- whether
this is always due to suboptimal regime or whether there are other factors
is another question
I certainly don' t blame people for taking a zealous approach, although I
hope that your prediction about the future for type 1 is true. I think ther
is slightly suboptimal control due to BG sometimes being on the high side
which may not be disastrous, or there is abysmal control due to BG being
high much of the time, or recurrent severe hypos or a combination of the two
which can not be ressolved by reducing the insulin dose without a
deleterious effect on HBA1c. The latter 2 would certainly be miserable to
live with from day to day, even without the worry of long term
Can we honestly say that there will be widespread transplant or other "
curative " treatment in the next 10 years or so?. If there is no definite
"yes" then surely tight control is still worth striving for as complications
have been known to occur in people in the late teens or 20s

Perhaps an A1c in the mid 7s to low 8s in this group is an acceptable, even
" good " target ( actually it's what I achieve, even being on the pump), but
surely 9s and 10s and 11s are no good and I have come across plenty of young
people with this level of control

Some youngsters are stable and do manage to achieve good control on 2
injections, others don't, because they are either persistantly high or have
severe hypos with seizure.
Yes excellent control comes with a price and may have disastrous side
effects of it's own(ie hypos or just general guilt and too many
restrictions), but surely if things are less than perfect and parents and
particularly child are motivated to try a more intensive regime then this
should be the way to go

Regarding the issue with short acting analogues, if 2 injections of long
acting are too much to cope with then the answer would surely be either to
wait for glargine to be licensed/ available/ licensed for use in children or
just use plain old actrapid or velosulin

By early secondary school age some families do start to eat later, and
children may have slightly more irregular lifestyles due to participation in
after school activities. If this can't be accomodated on a 2 injection
regime then it would either result in deterioration of control or disruption
to the childs life making then feel singled out from their family and
friends. Obviously 4 injections wouldn't be a panacea and they would need to
test, be responsible,eat snacks etc but I think there is a place for MDI in
responsible motivated children in this age group

I think the key issue here is how much the child and family want to take on,
in terms of testing and general responsibility, and whether the child is
genuinely happy to take more injections and understands the rationale behind
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