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Re: [IPk] 4 vs 2 injections

Well Jackie, nobody could accuse you (or Sasha) of not trying different
approaches in the 3 years with diabetes! Good luck with whatever works out
best for you both.

One last point re the cure. In 1987 I worked with the Biostator, which I
proclaimed as 'Ireland's first artificial pancreas', even though there was
another one in the North at the time. It was a huge machine on a trolley,
with a very basic computer and wires and tubing coming out in all

Now we have implanatable pumps, several long-term in-dwelling glucose
sensors under trial, and the question is no longer if, but how soon. Even if
a suitably small sensor to drive an external or implantable pump can't be
found, we will have islet cell therapy as many people around the world
already enjoy. I'm going to the ADA meeting in June, so I'll have a lot more
information then. Meanwhile, stay positive.

----- Original Message -----
From: "Jackie Jacombs" <email @ redacted>
To: <email @ redacted>
Sent: Sunday, April 21, 2002 2:08 PM
Subject: Re: [IPk] 4 vs 2 injections

> Hi Tony
> I did find that when Sasha was having only 2 injections a day life was
> difficult, restrictive and caused five severe nocturnal hypos with
> The trouble with the Mixtard 30 you cannot give more of one type of
> 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
> 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
> she is only 7 at present and has been D for over 3 years. Mixtard 40
> the answer either.
> We couldn't use direct acting insulin like Novorapid or Humalog for quite
> while as Sasha and her twin sister had undiagnosed coeliac disease which
> cause havoc with her blood sugars.  This was resolved when after contact
> email with others whose child had the same two conditions, I asked the
> to do blood tests.
> I do see your point about using 4 injections a day and the blood sugars
> 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
> 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
> more steady blood sugars in the 2 hours after the injection.  We used to
> sudden drops when Sasha would think she was going hypo when she wasn't.
> 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
> insulin peaking at 11.30.  They dont eat until 12.30 this was still a
> 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
> 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
> wouldn't use them.
> My older daughter is at college with a girl in her 2Os who has been
> since she was 10.  She told me that the clinic had offered her Humalog but
> 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
> change.
> We still dont have prefect control, just good enough control.  I am still
> always struggling with the problem that the insulatard never covers her
> well and she could really do with a shot at this time.  Without me going
> 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
> well I do hope this is true but my best friend at school was diagnosed
> diabetes decades ago and was promised a cure was on the horizon but it
> came.
> So meanwhile we do the best we can with what is available to us at present
> hope that this means it will delay or prevent complications for as long as
> possible.
> 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.
> are no pumpers at our clinic.
> Jackie
> 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
> > everything else is right. This is less likely with twice daily, as there
> > some longer-acting given twice a day.
> >
> > Secondly, children from the start of primary school to early secondary
> > 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
> > for modern kids with diabetes who, and I don't mind repeating this, are
> > 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
> > 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
> > about major complications age 12 if the child doesn't keep a bg below 7
> > all times. This is not how it is. Of course we should all try to keep
> > control etc, but this should be at an acceptable cost to quality of
> > 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,
> > 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
> > 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
> > control', I sometimes wonder if they are saying 'I can't really accept
> > I have diabetes'. I've experienced denial, but dealt with it in a
> > 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
> > 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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