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RE: [IPk] Re: MDI


Thanks for the post.  I think I might put Sasha on to MDI by still using the
NPH and Novorapid in the day but adding a lunchtime injection as at the
moment she hardly eat any lunch without her BG shooting up.  We would
probably have to go in everyday to do this though.    If I increase the NPH
which peaks very early in Sasha then she goes far too low.


> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of Melissa Ford
> Sent: 11 December 2002 12:41
> To: email @ redacted
> Subject: RE: [IPk] Re: MDI
> Your annual contribution will eliminate this header from your IP mail
> Hi Jackie,
> I honestly don't know what 'most' people do, as doctors and
> patients should
> work out what seems best on a case-by-case basis (though, as we all know,
> these are not always or even often the truly optimal soultions!).
> Perhaps a
> DSN or GP could comment on the consensus among professionals re
> the 'best'
> schedules for MDI?
> When I was last on MDI in 1996, before the advent of Humalog, my regimen
> was:
> Before breakfast (c.7:30 a.m.)
> Regular + NPH (isophane; intermediate acting)
> Before lunch (c.12 p.m.)
> Regular (because the NPH was not peaking sufficiently to 'cover' my lunch)
> Before dinner (c.6 p.m.)
> Regular + NPH
> Before bed (c. 10 p.m.)
> Some regular if necessary to correct post-dinner BG.
> I was never prescribed a longer-acting insulin than NPH (isophane), only
> Regular and NPH. My diabetes educator (i.e., DSN) was rather
> suspicious of
> the supposedly 24-hour insulins. In some people they actually work for
> closer to 18 hours (or even less time) and in others they might
> have effects
> for up to 40 hours. She thought the potential margin of error too
> great: at
> least with NPH one could sort of assume 8-12 hours duration (i.e., +/- 4
> hours), rather than something like 18-40 hours (i.e., +/- 22 hours!).
> One could take an extra shot of regular to close a 4-hour gap or
> reduce the
> amount of a pre-meal regular shot according to the apparent
> duration of NPH,
> but the chances of something going funny with something like Lente or
> Ultralente seemed too great to my diabetes management team (great
> euphemism
> for 'doctor, nurse, and dietician' eh?) for them to recommend
> either to me.
> Also, I was not allowed to mention 70/30 split-mix insulins in my
> diabetes
> educator's presence--like Pat, she thought them the 'work of the
> devil'. I
> was taught to combine NPH and regular in the same syringe to spare myself
> the extra tissue damage of a second injection while getting closer to
> getting the right amount of insulin.
> As for other insulins I _have_ tried: I used Buffered Regular in
> my pump for
> the first couple of years I had one (1996-1998) as Humalog was
> still being
> invented and tested.
> Melissa
> ------------------------------------
> Melissa
> Do most people take an intermediate in the morning AND at night,
> or do they
> have three shots of short acting (Humalog or Novorapid) and then use an
> intermediate or long acting at night.
> Jackie
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