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[IPk] Re: ip-uk-digest V2 #563

Hi Nanette

Yes advice always needed.  You are lucky to have advice from medics 
available.  I thought diabetes was a DIY condition.  I don't even think of 
asking a medic.  Who would I ask?  If it goes wrong it is wrong.  Up to 20 
this morning after breakfast Why?  Heaven alone knows.  I think I'm past 


>From: email @ redacted (ip-uk-digest)
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: ip-uk-digest V2 #563
>Date: Tue, 25 Nov 2003 04:14:22 -0800
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>ip-uk-digest        Tuesday, November 25 2003        Volume 02 : Number 563
>PLEASE edit the subject line of your reply messages.
>This issue of the digest contains:
>[IPk] Re: Pump Holiday, and an idea
>Re: [IPk] Re: Pump Holiday, and an idea
>[IPk] D'oh
>Profile of Michelle Richards <email @ redacted>
>[IPk] Re: Profile of Michelle Richards <email @ redacted>
>Profile of paul hawkins <email @ redacted>
>[IPk] RE: Profile of Michelle Richards <email @ redacted>
>Re: [IPk] Re: Profile of Michelle Richards <email @ redacted>
>[IPk] Re: Profile of paul hawkins <email @ redacted>
>[IPk] Ryan's Pump
>Re: [IPk] Ryan's Pump
>[IPk] RE: Profile of paul hawkins <email @ redacted>
>[IPk] RE: Ryan's Pump
>[IPk] RE: Profile of paul hawkins <email @ redacted>
>[IPk] RE: Profile of paul hawkins <email @ redacted>
>[IPk] (Long) Pump funding (lack thereof) in/around Oxford
>RE: [IPk] RE: Profile of paul hawkins <email @ redacted o.uk>
>Date: Mon, 24 Nov 2003 10:37:21 +0000 (GMT)
>From: =?iso-8859-1?q?Nanette=20Chana=20Freedman?= <email @ redacted>
>Subject: [IPk] Re: Pump Holiday, and an idea
>Apologies for replying late - I have been busy and plagued with a
>feverish cold (now feel like a human being again thankfully) and got
>behind with emails.
>I agree totally with everyone else who said that if blood glucose
>control is not going well, the last thing you need may be a pump
>holiday, though for sure you really do need is not only a lot of
>sympathy, but also some sort practical ways to deal with the
>difficulties you are experiencing.
>Your email reminded me that control has not been very good for me over
>the last weeks, and that I really should do something about it. So I
>did what I am lucky enough to be able to do, and what I understand to
>be sadly quite out of reach within any reasonable time framework for
>most people in the UK. I picked up the phone to my friendly
>endocrinologist and told him I needed help - we arranged that I would
>go and see him with all my bg records and graphs in a couple of days.
>Every time this happens, he looks at the records and graphs and almost
>always has insight into where I should experiment with changing basal
>rates or boluses. This always helps me back on the right track, and he
>is happy for me to phone him or come in briefly for follow-up help if
>the initial changes do not work out as planned.
>This is possible partly because he is essentially a colleague since I
>also work in the same hospital and we have collaborated on some
>projects, but also because relations between doctors and patients here
>tend to be less formal, and though not many people can, like me, just
>walk up one flight of stairs and drop in for for some quick advice from
>their doctor, it is not unusual for patients to have (and to make use
>of) phone access to doctors. And all this despite a very bad financial
>situation in the health service here, and cutbacks etc.
>I thought how much it helps me to have someone who understands look at
>my BG data. Almost always, he points out things that I could have seen
>myself had I thought carefully, or had I looked in a more impartial way
>- - so very often it is not some special professional expertise or the
>fact that he is a remarkably intelligent person, but simply that he is
>experienced, and looks at the data from a sane distance, and without
>the prior assumptions and lonely despair that I sometimes develop.
>I know that occasionally people on this list present BG records, and
>ask for help problem solving how to change basal or bolus rates for the
>better, and I wonder whether it is possible, without treading on
>professional territory, or generally on dangerous ground - after all
>our lives depend on basal rates and boluses being correct - to take
>advantage of all our combined expertise gathered slowly and painfully
>over the years, and to expand this function of the list.
>On a slightly different tack, Melissa wrote suggesting the need for
>more checking of basal rates by fasting. I have come to despair
>somewhat of this method of testing. My basal requirements are almost
>never the same when fasting. A prime example is when I eat a late
>breakfast (for example if fasting for an early morning blood test), my
>blood glucose always, without fail, rises during that fasting time,
>unless I agressively up the basal rate by at least 30% - it continues
>to rise at least until 11 or 12 o'clock (after that if I continue
>fasting, basal requirements decrease until I have to decrease the basal
>rate by 30%). If I do eat breakfast as usual at 7.15, and bolus
>appropriately, I have to watch carefully that I do not go hypo around
>10 or 11 - i.e. after the effect of a 7 am pre-breakfast bolus should
>have worn off - so it seems like a difference in basal requirement in
>the fasting vs the non-fasting state. This is not a problem for me - I
>can make the necessary adjustments, but it has made me very sceptical
>indeed about the 'traditional' recommendation for fixing basal rates
>according to fasting requirements. Has anyone else found this sort of

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