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[IPk] Lantus v. pump

Dear Jackie,

Unless Sasha has the problem Bev experiences--bg rising during exercise--she 
could well do better taking off a pump for strenuous exercise anyway. As 
glucose is usually 'burned off' during exercise, exercise-induced hypos are 
common when there is too much background insulin in the system...the big 
reason why I couldn't exercise safely until I got a pump and could reduce or 
even completely eliminate my basal insulin whilst at the gym. Whether one 
should take a off a pump totally during exercise depends on individual 
insulin sensitivity, duration of activity, and whether there's a safe place 
to put the pump when it's disconnected. Trial and error!

I noticed your comment that Lantus does not produce a 'flat line' for Sasha, 
by which I gather you meant 'in-range blood sugars'. Lantus does not produce 
a 'flat line' of in-range blood sugars for anyone whose insulin requirements 
vary at different times of day (er, most people). The problem is most likely 
not that Lantus doesn't *deliver* a 'flat line' of insulin action--it 
probably does--it's that Sasha needs different quantities of basal insulin 
at different times of day. A pump can offer upteen different basal rates but 
once Lantus is injected, it's IN and ON until it's gone.

If there are patterns to Sasha's highs and lows in the 3 days that she wears 
a CGMS, you will have a fantastic argument not only for getting Sasha a 
pump, but maybe even for getting the consultant who has stood in your way 
discredited, possibly suspended from practicing medicine. Have you sought 
advice on taking legal action against him, or not yet?

Contact Hannah Dickinson at Medtronic if your hospital does not possess a 
CGMS Gold (Sasha's DSN will know if they do) and she'll explain how Sasha 
might get use of one.

Type 1 10+ years; MiniMed pumper 7+ years
Co-ordinator, Oxford University Student Union Diabetes Network
Oxford area contact, INPUT

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