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[IPk] RE: ip-uk-digest V1 #651



Insulin strength
I have some type 2 patients using lots of insulin and interested in actrapid
500. The manufacturers say it is not recommended in pumps. Are any pumpers
using this?

-----Original Message-----
From: email @ redacted [mailto:email @ redacted]
Sent: Friday, December 14, 2001 08:59
To: email @ redacted
Subject: ip-uk-digest V1 #651



ip-uk-digest         Friday, December 14 2001         Volume 01 : Number 651



PLEASE edit the subject line of your reply messages.
####################################################
This issue of the digest contains:
RE: [IPk] RE: was  urgent info request re: children - now cure
[IPk] Insulin strength
[IPk] Check-up report back + tit-bits
Re: [IPk] RE: was  urgent info request re: children - now cure
[IPk] overnight basal rate

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Date: Thu, 13 Dec 2001 09:42:24 -0000
From: Julian Doncaster <email @ redacted>
Subject: RE: [IPk] RE: was  urgent info request re: children - now cure

Hi Tony

What's 400 strength insulin please? Just checking.

Is that 4x normal concentration - 400iu/ml?

Thanks

Julian
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------------------------------

Date: Thu, 13 Dec 2001 12:42:39 +0100
From: John Neale <email @ redacted>
Subject: [IPk] Insulin strength

>What's 400 strength insulin please? Just checking.
>
>Is that 4x normal concentration - 400iu/ml?

Yes. If you regard "normal" as 100iu/ml... In the good old days (creak!) it
was U20, U40 or U80. I seem to remember I used U40. It meant you had to use
a syringe marked with the right scale for your insulin strength. Plenty of
scope for hard-pressed hospital staff to grab the wrong syringe in a hurry,
and give someone an overdose.

About 1985 I think they converted UK to U100. In France and Germany U40 is
still widely used. Aparently it is absorbed more consistently than the U100
stuff. But noone knew that when Britain made the big change.

My pump (MiniMed 507) can also be programmed to speak in U40, U50 or U100.
Diluter insulins are preferable if you are on a low basal rate for example
- - you get greater accuracy.

I remember reading about these implantable pumps a couple of years ago.
MiniMed and Disetronic both have working pumps, but one major problem was
finding an insulin that had a long enough shelf life at body temperature,
and didn't crystalise and block the system. I seem to remember Hoechst (now
Aventis) developed a special implantable pump insulin.

John

- --
mailto:email @ redacted
http://www.webshowcase.net/johnneale
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------------------------------

Date: Thu, 13 Dec 2001 12:09:51 -0000
From: Julian Doncaster <email @ redacted>
Subject: [IPk] Check-up report back + tit-bits

Well, I went for my "GP" checkup last night (review with GP on double appt
because my hospital appt has been delayed until late Feb 2002). A number of
interesting tit-bits, which may be useful to some for different reasons:

* Generally all happy with treatment etc., apart from post-meal highs still
too high, and occasional precipitous drop in bg (10 points or more in half
an hour sometimes) in late afternoon, perhaps due to combined
characteristics of Insulatard taken am and Novorapid taken for a late lunch
or afternoon snack. He filled in a data point - my HBA1c's have been: data
not available from hospital at diagnosis (Feb/Mar), June 9.5, late August
8.6, late Nov 7.9 (a nice straight-ish line).

* A number of detailed questions (e.g., splitting Insulatard doses half and
half at midday/midnight rather than on 26u:6u evening/morning bias) he
referred to the db nurse at the clinic ("they know more about the fine
tuning than us"). Sensible reply.

* In my area (South Camden Primary Care Trust in Camden and Islington Health
authority) they are looking to appoint a community-based diabetic specialist
nurse in the future, working for the Primary Care Trust rather than the
clinic.

* As a practice they will follow prescribing recommendations of the db
consultant at the clinic, and the recommendations of Diabetes UK. This was
in relation to low-dose aspirin. Stupidly, I didn't have a copy of the Db UK
policy to hand - it would marginally recommend me for the treatment (over 30
+ slightly overweight - bmi 26). My bmi has gone up because the GP's
computer thought I was 6'1" not 5'11" :-( )

* He indicated that the Primary Care Trust would probably follow the
recommendations of the clinic for pump funding (presumably consumables
only). This was a probability, so would need to be explored in practice. I
would expect to have to self-fund the capital cost, because I don't think I
come into the categories for NHS funding, and I don't have any incriminating
information about the key decision-makers!

* He does not know whether DAFNE courses (Dose Adjustment for Normal Eating
- - basically advanced carb-counting and bg control taught in a 1 week
residential course) are planned in London (again referred to the db nurse),
but if a case can be made out it may be possible to get one funded by the
Primary Care Trust. In my case I reckon I would have to pitch this to them
as a "pilot" for the area and be willing to report back to the Trust in
detail. Though I see that there is a part of the DbUK DAFNE research project
based in London, so I will talk to them.

* And they are about to go hi-tech: there is going to be an email link to
the hospital clinic from my GP!

Julian
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Date: Thu, 13 Dec 2001 18:59:40 -0000
From: "Tony O'Sullivan" <email @ redacted>
Subject: Re: [IPk] RE: was  urgent info request re: children - now cure

> Hi Tony
>
> What's 400 strength insulin please? Just checking.
>
> Is that 4x normal concentration - 400iu/ml?
>

Yes that's it.

Tony
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------------------------------

Date: Fri, 14 Dec 2001 12:58:05 -0800
From: email @ redacted
Subject: [IPk] overnight basal rate

Hi all,

I am sorry if I bore you with a question that has probably been asked many
times before by new pump users but I was wondering if anyone had any
thoughts on the following please. I am just new to the pump and am trying to
sort out my night time basal rate. When waking up every 2 hours things seem
to be going very well with a variation of only 1 or 2 mmol/l but when I
sleep through the night I am waking up at 16 - 18! Does the waking up to
test disturb the normal sleep patterns/circadian rhythm/hormonal output that
lead to the dawn phenomenon (which I experienced strongly on injections)?
Any thoughts are most welcome.

Thanks
Richard Walsh (23 yrs, DMx7 yrs, 508x4 days)
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End of ip-uk-digest V1 #651
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