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Re: [IPk] Pump or New Insulin

In message <email @ redacted>,
email @ redacted writes
 >I would be very grateful for all your comments about this. I'd also like
>regarding how long I should trial the new insulins before deciding whether to
 >stay on them or move on to a pump (if a trial on these insulins is the best

I think the nurse is right.  As to 'how long': if control is worse, and
they have to switch you back to your current regime, I'd say a matter of
weeks - the problem with glargine, the new, predictable basal, is that
it has a very flat (as well as very predictable) profile.  Which is
great if your pump would be set to a constant 0.3 units p/h through the
day (or 0.8 u, or 3.5 u, or whatever).  But disastrous if your pump
would be set, like mine, to between 0.8 and 0.1, depending on the hour
of the day!  I'd end up high or low all the time on glargine - and maybe
you will too: that's your counterindication which will get you the pump.

You may also find that while it suits you 4 days out of 5, for 2o hrs
after exercise you need 0.3 u p/h, not 0.5, or for 36 hrs after taking a
medication which you occasionally need, you need 1.2 u p/h, not 0.9 ...
and both of these will get you the pump.

I would think that 3 months was a reasonable trial, which should show a
marked improvement in hba1c.  Agree beforehand where you think you
should be in 3 months.  There should be a long phone/fax consultation,
if not a personal consultation, after 6 weeks, to move you back to the
old regime or give you more education, too.

What you will probably get is 'come back in 6 months', and if you've
deteriorated, you'll be told to try harder, and 'come back in six
months'.  So you might get a pump in 18 months or so.

Best wishes,

(dm 30+, 508 2+)
Pat Reynolds
email @ redacted 

     "I have now got a pesitilent doctorate thesis to explore, 
      when I would rather be doing something less useful ..."

                (JRR Tolkien Letter 176)
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