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Re: [IPk] 4 vs 2 injections

I quite agree - I won't be ruled by my HbA1c, there's more to life - however
long it is!
It is possible to give an extra dose of insulatard in the morning as well as
nightime to stop bgs rising before meals - something my GP suggested to me
but I never got round to trying.
Does anyone do this?

----- Original Message -----
From: "Tony O'Sullivan" <email @ redacted>
To: <email @ redacted>
Sent: Thursday, April 18, 2002 12:11 AM
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
> 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 enough
> 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 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
> 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
> 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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