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



Heather you have access to doctors too, there are at least 3 pump-using
doctors in the list. The funny thing is, they (we) gain as much from pumpers
who aren't doctors as you might from doctors. My conclusion from reading this
list for over a year as a mature doc is that being a pump user or someone with
diabetes for a few years, is as important as a medical degree. This list is a
tremendous resource, and everyone contributing to it should be proud of the
excellent balance it provides between good advice, reassurance and open
discussion.

I like Nanette's suggestion about providing information about setting your own
basals etc. This is not treading on doctors toes; most doctors don't know, and
those that do don't have the time, and in any case, the last time I looked, it
was me and not my doctor who was at risk of complications!

I liked the Minimed workbook, and I've seen charts from a number of (UK)
hospitals aimed at setting basals. The ideal has to involve missing meals, but
of course if this is a big trauma, it will set off a release of the wrong
hormones and glucose will rise (faster than usual). An alternative is to eat a
carb-free meal, and limit basal rate adjustment to three hours before and an
hour after.

John and Pat, why not collaborate on a section about basal setting on the
site? I can muster additional professional help at any level if you wish.

Tony O'S


  ----- Original Message -----
  From: Heather Gibbs
  To: email @ redacted
  Sent: Monday, December 01, 2003 1:54 PM
  Subject: [IPk] Re: ip-uk-digest V2 #563


  Insulin Pumpers is made possible by your tax deductible contributions.
  Your donation of $10, $25, or more... just $1 or $2 per month is
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  Your annual contribution will eliminate this header from your IP mail

  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
  caring.

  Heather


  >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
  >
  >Insulin Pumpers is made possible by your tax deductible contributions.
  >Your donation of $10, $25, or more... just $1 or $2 per month is
  >needed so that Insulin Pumpers can continue to serve you and the rest
  >of the diabetes community. Please visit:
  >
  >     http://www.insulin-pumpers.org/donate.shtml
  >
  >Your annual contribution will eliminate this header from your IP mail
  >
  >
  >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
  >thing?
  >
  >Thanks
  >Nanette
  >

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