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RE: [IPk] Lantus v. pump


 At the moment we always have to stay with Sasha at gym (sitting in the changing
rooms, so we don't
 distract the kids) we did try leaving the twins with our mobile phone to ring
with readings when the stop
 for a break, but each week the readings are entirely different. The coach has a
mobile as well. One week
 Sasha could be in range when we check before, during and after, at other times
she is really high or low.
 After she had a really bad hypo just after gym and lunch where I gave glucagon
and still had to call an
 ambulance we decided that one of us would have to stay in case something went
wrong again. We reduce the
 Insulatard that morning and Sasha has a snack before doing gym and sips non
diet coke through the lesson.
 I guess if we had a pump that we could stay and look after the pump or for part
of the lesson she may
 well be able to wear it. Or just reconnect to bolus. We will have to see if we
even get a pump!! I am
 working on a document/report to show why we think that Sasha should have a pump
at the moment.

 Lantus for Sasha had a big drop in BG two hours after the injection which she
took in the morning at 8.30
 pm. It was very pronounced, much sharper drop than Insulatard has. Sasha had to
have a snack just
 before this time everyday on Lantus and it had to be about 15 to 20 carbs. The
other problem was that
 during the afternoon and early evening the BG would steadily rise. During the
time from the evening meal
 until bedtime the blood sugars climbed steadily. When we gave more Novorapid to
try to cover this we
 had hypos due to too much NR. The worse thing was that we had some hypos during
the night if Sasha has
 been active during the day which was obviously often and you just couldn't
predict when it would happen
 by the readings taken before we went to bed. We couldn't increase the Lantus
because Sasha would have
 had hypos during the morning and there wasn't enough around to control the
basal needs after the evening
 meal. Lantus did not last 24 hours for Sasha either. On two days two weeks
apart we did readings every
 two or so hours from 10.00 pm until 7.00am to see what was happening as Sasha
was waking up with high
 morning levels. You could see that at about 5.30am the BGs would begin to rise
as the Lantus action came
 to an end. Sasha has no apparent dawn rise when she uses Insulatard and usually
has reasonable morning
 levels. It is a known problem that the small doses of Lantus frequently do not
last 24 hours.

  I am sure that our consultant does not deliberately set out to make things
more difficult and he can
 always claim that the clinic could not possibly support a pumper because they
have no experience. I just
don't think he can be made to accept that we need a pump.

 I am still trying to find a hospital that will take us on that isn't too far
away. There is a
 possibility that the hospital in the next town will look into pumps for
children but havent made up their
minds yet.


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